This Week’s Focus: Early Warning in Action — Insights from the NDEWS Early Warning Network

The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.

This week’s NDEWS Briefing highlights the growing impact of the NDEWS network. Our goal is to present the most current information on emerging drug trends. We appreciate the efforts of our Network for continuously contributing to the field and protecting public health. 

In a new Current Opinion in Psychiatry perspective led by NDEWS co-investigator Dr. Sabo-Attwood, details barriers to scaling wastewater-based epidemiology for drug surveillance in the US, including inconsistent data ownership policies, limited biostatistical benchmarks, and risks of public backlash. Based on the NDEWS supplement that collaborated with Tempe’s BioIntel dashboard investigators, the authors call for integrating health and wastewater data, establishing consumption thresholds, and prioritizing community engagement to support local public health action. 
Read the study here.

In a new Current Opinion in Psychiatry perspective, NDEWS Affiliates Drs. Varela-Lema, Correia, Perez-Rios, and NDEWS Co-Director Dr. Cottler examine the feasibility of launching a sentinel surveillance network for illicit substance use in Spain. Using focus groups with 40 experts across health, education, law enforcement, and community sectors, the authors identify structural needs, including multidisciplinary membership, digital reporting tools, and coordinated alert systems, and key barriers such as professional fatigue, lack of toxicology training, and uneven data practices. Findings draw on international models like NDEWS, CCENDU, and Euro-DEN Plus, and offer targeted guidance for countries seeking to expand early warning capabilities for monitoring drug trends.
Read the study here.

In a recent Current Opinion in Psychiatry, Gipson et al., including NDEWS Co-Director Dr. Linda Cottler and NDEWS Affiliates Drs. Knackstedt and Stoops, call for preclinical models that reflect high-risk polysubstance use (PSU) patterns tracked by NDEWS, such as fentanyl with methamphetamine or alcohol. They cite the importance of pre-clinical and clinical investigators working together to tackle the monitoring of PSU. The authors advocate for early inclusion of people with lived experience to guide model design, endpoint selection, and interpretation. 
Read the study here.

In a JAMA Psychiatry viewpoint, Dr. Palamar (NDEWS Co-Director), Dr. Krotulski member of the NDEWS Scientific Advisory Group (SAG), and Dr. Goldberger (NDEWS Co-I and Sentinel Site Director [SSD]) report a sharp rise in the adulteration of illicitly manufactured fentanyl (IMF) with local anesthetics such as lidocaine and procaine. Drawing on alerts from NDEWS and data from the Center for Forensic Science Research & Education’s (CFSRE) NPS Discovery program, they document a 705% increase in IMF–lidocaine codetections from 2022 to 2024. Nearly 30% of IMF samples in December 2024 contained multiple anesthetics.
Read the viewpoint here.

A recently published study in Open Forum Infectious Diseases by Fanucchi et al., co-authored by NDEWS SAG member Dr. Havens, examined injection-related infections and self-treatment practices among 463 people who inject drugs in rural Appalachian Kentucky. Over 70% reported a lifetime abscess, and 44.4% of those with a recent abscess used nonprescribed antibiotics. Syringe reuse, sharing, and fentanyl injection were significantly associated with higher abscess counts. Only 26% had received education on safer injection practices.
Read the study here.

A recently published study in the International Journal of Drug Policy by Mixson et al., including NDEWS SAG member Dr. Bobashev, examined multiple injections per injection episode (MIPIE) among 2,441 rural people who inject drugs. Over 70% reported MIPIE, which was significantly associated with syringe and supply sharing, hepatitis C virus infection, and both recent and lifetime overdose. The study highlights the dual risks and benefits of MIPIE as a harm reduction strategy.
Read the study here.

A recently published short communication in Drug and Alcohol Dependence by Black et al., including NDEWS SSD Dr. Coffin, applied thematic analysis to 101 stimulant-related death investigations in San Francisco. The study found that 85% of deaths were unwitnessed and 68% occurred in private settings, often with no evidence of recent drug use. Cardiovascular events were common in stimulant-only deaths, while fentanyl-stimulant deaths more frequently showed signs of recent use.
Read the short communication here.

A case series in Clinical Toxicology by Cembellin-Kao et al., including NDEWS SAG members Drs. Krotulski and Logan along with SSD Dr. Perrone, studied seven patients from a single emergency department that were treated for an acute overdose and found to have bromazolam in their blood despite no self-reported exposure. Six of the seven patients presented acute signs of excessive sedation, while one presented signs of agitation, and the median bromazolam concentration was 29 µg/L (range <5–84 µg/L). In all cases of sedation, patients responded to naloxone (in all cases the patients admitted to taking opioids, which was confirmed analytically), and there was no ongoing sedation attributed to the detected bromazolam.
Read the case series here.

An article in the Journal of Substance Use and Addiction Treatment by Frank, et al., including NDEWS Community-Based Health Expert Caty Simon, interviewed 29 people who used illicit opioids and reported a recent withdrawal experience. The study team then coded data thematically from the transcription of the semi-structured interviews using Atlas.ti. The patients described withdrawal as a significant issue that negatively impacted their treatment experience. It was specifically cited that restricted access to take-home doses, limited hours of operation and a punitive focus on complete abstinence were factors that made withdrawal difficult to avoid.
Read the case series here.

Three recent reports from the Center for Forensic Science Research & Education’s (CFSRE) NPS Discovery Program that included NDEWS SAG members Drs. Krotulski and Logan. First, an update on BTMPS in the drug supply and the discovery of tetramethylfentanyl-related substances, followed by a quarterly NPS report from 2024 focusing on the ToxIC fentalog study group. The third report is on the updated scope recommendations for NPS testing in the US from the second quarter of 2025.

- An Update on the Presence of BTMPS in the Drug Supply and the Discovery of Tetramethylfentanyl-Related Substances - May 20, 2025
- ToxIC Fentalog Study Group - Quarterly NPS Report: 2024 - May 22, 2025
- Updated Scope Recommendations for NPS Testing in the US — Q2 2025 - June 3, 2025

You are invited to attend the NDEWS Summit at the College on Problems of Drug Dependence (CPDD) 87th Annual Scientific Meeting on Saturday, June 14th (06/14/2025) from 4:00 pm - 6:00 pm CT in Bayside Ballroom AB, 4th floor. The Summit will be open to all CPDD meeting attendees. 

We hope to see you there!

NDEWS Posters and Presentations at CPDD

In June, the NDEWS team will be traveling to attend the 87th College on Problems of Drug Dependence (CPDD) Annual Meeting in New Orleans, Louisiana. Along with posters, the NDEWS team will be presenting a late-breaking abstract, an oral presentation and two invited symposia. We invite you to join us for these presentations. Please find the presentation information below:

Sunday, June 15
3:30 pm - 4:45 pm CT Late-Breaking Abstract
Anesthetics (“-Caines”) Adulterate the Illicit Fentanyl Supply: A National Drug Early Warning System (NDEWS) Alert
Joseph Palamar, Joshua DeBord, Alex Krotulski, Bruce Goldberger

5:00 pm - 6:30 pm CT Poster Session 1 (Napoleon Ballroom CD, 3rd Floor)
Trends in Nonfatal Fentanyl Poisonings Involving Stimulants in the United States, 2015–2023
Nicole Fitzgerald, Joshua Black, Linda Cottler, Silvia Martins, Joseph Palamar

Monday, June 16
10:45 am - 12:15 pm CT Invited Symposium
Found in Translation: Coordinated Preclinical, Human Laboratory and Epidemiological Approaches to Understanding Polydrug Use
William Stoops, Lori Knackstedt, Linda Cottler, Christa Corley

3:30 pm - 4:30 pm CT Oral Session: Sex Matters: Translational Evaluations of Sex-Specific Factors in Substance Use
Sex Differences in Problematic Substance Use, Mental Health, and Social Determinants of Health among Middle-Aged and Older Adults in the All of Us Research Program
Vijaya Seegulam, Bia Whipp, Liva LaMontagne, Linda Cottler

5:45 pm - 7:15 pm Poster Session 2 (Napoleon Ballroom CD, 3rd Floor)
Natural Language Processing Analysis of 7-Hydroxymitragynine Reddit Discussion
Daniel Van Zant, Kirsten Smith, Oliver Grundmann, Catherine Striley, Elan Barenholtz, Christopher McCurdy, Linda Cottler

Tuesday, June 17
3:45 pm- 4:45 pm CT Oral Presentation at Mini Symposium: Prevalence and Characteristics of Recreational Ketamine Use among Nightclub Attendees and College Students in the New York Tristate Area.
The Current Landscape of Medical and Recreational Ketamine Use
Shahar Almog, Meredith Berry, Joseph Palamar 

5:30 pm - 7:00 pm CT Poster Session 3 (Napoleon Ballroom CD, 3rd Floor)
Reported Use of Recreational and Medical Cannabis, Delta-8, and Delta-10: Findings from NDEWS Sentinel Sites and Hotspots (2022–2023)
Tamara Millay, Vijaya Seegulam, Monica Bhargavi Kodali, Linda Cottler

Wednesday, June 18
2:00 pm - 3:30 pm CT Poster Session 4 (Napoleon Ballroom CD, 3rd Floor)
Alcohol Polysubstance Use among past 30-Day Opioid Users in Northern Florida: A Model for Back Translational Research
Christian Conger, Linda Cottler

Friday, June 20
3:00 pm - 5:00 pm CT Polysubstance Use: From Bench to Communities Session 2 Keynote (LSU Health Sciences Center, 411 S Prieur Street, New Orleans, LA 70112)
The National Drug Early Warning System Networks, Initiatives and Data: How can we help?
Linda Cottler

📅 Date: June 10, 2025

🕑 Time: 12:00 pm - 1:00 pm ET

📍Location: This session will be held in a hybrid virtual and in-person format.

Learn more here.

📅 Date: Thursday, June 12, 2025

🕑 Time: 9:00 am - 3:30 pm PT

📍 Location: Online

Learn more here.

📅 Date: Friday, June 20, 2025

🕑 Time: 3:00 pm - 5:00 pm CT

📍 Location: New Orleans

Learn more here.

📅 Date: Thursday, June 26, 2025

🕑 Time: 1:30 pm ET

📍Location: Online

Learn more here.

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If you miss or want to learn more about NDEWS Original Content, you can find our archived content on the NDEWS website:

     • NDEWS Hotspot Alerts using substance-related EMS data
     • NDEWS Rapid Street Reporting (RSR) survey data reports
     • NDEWS Web Monitoring Team Reddit Alerts
     • NDEWS Sentinel Site Reports
     • Previous issues of the NDEWS Weekly Briefings

The Weekly Briefing is a newsletter published each week by the National Drug Early Warning System (NDEWS) Coordinating Center, which is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), New York University (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.