National Drug Early Warning System (NDEWS) Weekly Briefing


Central Florida drug overdose deaths up 70% during COVID, report shows 

An analysis from Project Opioid found a 70% increase in overdose deaths in Central Florida between March and June 2020. It also found a 43% spike in drug overdose deaths statewide in the first eight months of 2020 compared with the same period in the previous year. Compounding factors such as limited social interactionisolation, and access to rehabilitation and healthcare are believed to have contributed to this increase in overdose deaths.

According to NDEWS Co-Investigator Dr. Bruce Goldberger, this is what he will be reviewing when his team at FROST begins their supplemental study with Medical Examiners and coroners on drug-related mortality during COVID-19. Read more about this story in the article in the Orlando Sentinel here, and the Project Opioid study here.

NDEWS COVID-19 study progress as of 12/04/2020

NDEWS is conducting ongoing interviews with three key informant groups––funeral directors, emergency responders, and syringe exchange programs––across all 18 sentinel sites to understand the national and regional impact of COVID-19 on drug use, drug-related mortality, and health services. To date, NDEWS has completed 65 baseline interviews and 17 follow-up interviews with key informants across 12 sentinel sites.

In their baseline interviews, among other questions, key informants reported on their experiences regarding the number of decedents who died of a drug overdose (funeral directors), the number of fatal and non-fatal overdose calls (EMS personnel), and clients served (syringe exchange programs) in the past 30 days. For fatal and non-fatal overdoses, respondents also quantified which drug(s) were involved. All respondents were asked additional qualitative questions on what they would like others to know about their experiences with drug use and drug-related mortality during the COVID-19 pandemic. Below are preliminary data collected from baseline interviews to date.

Stay tuned: Additional findings will be rapidly disseminated to the scientific community and public, in addition to peer-reviewed publications. Read more about the supplement here.


Emerging characteristics of isotonitazene-involved overdose deaths: A case-control study 

A new study investigated case reports of fatal overdoses involving the novel synthetic opioid isotonitazeneUsing publicly available mortality records from January 1, 2020 to July 31, 2020 in Cook County, IL and Milwaukee County, WI, 40 fatal overdoses were found involving isotonitazene and 981 fatal overdoses involving other synthetic opioids. This emergence of highly potent novel synthetic opioids such as isotonitazene underscores the need for future studies. Read the full article here 

NPS Discovery publishes two new alerts this week 

NPS Discovery released two alerts this week: an alert regarding the identification of 4-fluoro-3-methyl-alpha-PVP in the U.S., and a public alert regarding increasing identification of fluorofentanyl.

4-fluoro-3-methyl-alpha-PVP is classified as a novel synthetic stimulant and substituted cathinone. While other structurally similar novel stimulants alpha-PVP and alpha-PHP are Schedule I substances in the U.S., 4-fluoro-3-methyl-alpha-PVP is not explicitly scheduled. Read the full alert regarding identification of this substance here 

Fluorofentanyl is a potent synthetic opioid with reported potency similar to fentanyl. It was identified in the U.S. as early as 2016, but overall detection remained low until Q3 of 2020; within a few months, NPS Discovery had identified para-fluorofentanyl in 16 forensic cases. While it is commonly found in combination with fentanyl, para-fluorofentanyl is the primary synthetic opioid in multiple cases. Read the full public alert here, including recommendations for public health, medical examiners and coroners, clinicians, and laboratories.  

U-4770 and its analogs: Non-fentanyl synthetic opioids impacting the recreational drug market

A nestudy published in Brain Sciences analyzed the synthetic opioid U-47700 and its analogs. U-47700 and its analogs are classic examples of chemical entities that were diverted from the patent and medicinal chemistry literature for recreational purposes. Although a number of U-compounds have reached illicit drug markets worldwide, U-47700 is the only one of this group to achieve a level of prevalence sufficient for risk assessment by the World Health Organization. The full study can be found here.


Launch of UNODC 2020 Global Synthetic Drugs Assessment

The recently released UNODC Global Synthetic Drugs Assessment 2020 provides a global thematic analysis of the key trends and emerging developments of the synthetic drugs market, as well as the recent trends in the manufacture of synthetic drugs. Over 1,000 new psychoactive substances (NPS) have emerged in the illicit drug market. One of the recommended options for response include early warning systems like NDEWS for identifying and tracking NPS. The full report can be found here 

Polysubstance involvement in opioid overdose deaths in adolescents and young adults, 1999-2018 

study recently published in JAMA Pediatrics examined national trends in polysubstance-involved opioid overdose deaths among youth in the U.S. Using cross-sectional data from the CDC Wide-Ranging Online Data for Epidemiologic Research (WONDER) Multiple Cause of Death file from January 1999 to December 2018, investigators found that in 2018, polysubstance-involved opioid overdose deaths became more prevalent than deaths involving opioids alone. These findings are consistent with adult usage. Read the full study here.

Association of neighborhood characteristics and travel patterns with fatal drug overdoses 

Another recently published study examined travel patterns between locations where fatal drug overdoses occurred, the home residences of the people who died, and the neighborhood-level characteristics that may have differed across these locations. The study further compared travel patterns where overdoses involved fentanyl and heroin. Investigators found that 30% of decedents traveled far from their home to the location of the fatal overdose. Decedents tended to travel to more resource-deprived and segregated neighborhoods compared with their home neighborhood. Those who traveled were more likely to have fentanyl in their system at the time of death. Read the full study here 


U.N. reclassifies cannabis as a "less dangerous drug" 

The United Nations Commission for Narcotic Drugs voted to remove cannabis for medical use from Schedule IV of the 1961 Single Convention on Narcotic Drugs, where it was listed alongside opioids like heroin. The reclassification passed 27 to 25, with an abstention from Ukraine. The U.S. and European nations were among those who voted in favor, while the likes of China, Egypt, Nigeria, Pakistan and Russia were opposed. Read the report by the New York Times here.


NDEWS is currently recruiting for the following positions: 

•   NIDA T32 Postdoctoral Fellow (available immediately)

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