This Week’s Focus: Sentinel Site Report

Each month we send our Sentinel Site Directors (SSD) questions of interest to the field that are suggested by SSDs, our NDEWS team, or individuals reading this Briefing. SSDs inform us of signals of drug use in their local areas and in their state.

In this briefing, we are sharing the responses from our SSDs concerning what they know about carfentanil-related trends. This followed a recent submission by an NDEWS Weekly Briefing reader that informed us about the Arizona's Pima County Health Department alert in response to the Tucson Police Department’s seizure of multiple counterfeit blue M-30 pills. The counterfeit M-30s appeared to be fentanyl, but tested positive more specifically for carfentanil.

We also present SSD feedback on newly updated Centers for Disease Control and Prevention provisional data, which show a continued decline in fatal overdoses over the past twelve months in the United States overall. Of note, the NDEWS network has received reports suggesting fatal overdose rates may have begun rebounding in some areas and that emergency medical service encounters and emergency department visits for nonfatal overdoses may also be rising.

The SSDs additionally reported on other local trends related to substance use or overdoses—both fatal and nonfatal.

We also welcome YOUR input: submit questions for future briefings. If you know of anyone who is interested in being a Sentinel Site Director please have them reach out to us.

As a final note, following our recent NDEWS Weekly Briefing on kratom and 7-hydroxymitragynine (7-OH), we are sharing an important regulatory update from the US Food and Drug Administration (FDA), flagged by NDEWS colleague and kratom expert Dr. Christopher McCurdy.

On July 15, 2025, the FDA issued warning letters to seven companies illegally marketing products containing concentrated 7-OH. These unapproved products—often sold as tablets, gummies, drink mixes, or shots—were cited for violating federal law by marketing 7-OH as a dietary supplement, food additive, or drug. The FDA reiterated that 7-OH is not approved for any use and poses safety concerns.

In addition, NDEWS is currently monitoring the mass overdose event involving 27 people that took place Thursday, July 10, in Baltimore, MD. The event occurred in the Penn North area of the city and it currently remains under investigation. However, recent lab test findings by the National Institute of Standards and Technology (NIST) have identified a combination of substances that are believed to be responsible for the event.

A recent US Food and Drug Administration (FDA) alert was brought to our attention by NDEWS collaborators Drs. Chris McCurdy, Kirsten Smith and Oliver Grundman. The FDA issued seven warning letters to companies for illegally marketing products containing 7-hydroxymitragynine, also known as 7-OH. While 7-OH occurs naturally in trace amounts in kratom, the FDA's letters focus on concentrated 7-OH products such as tablets, gummies, drink mixes, and shots. The full release can be found here.

Previous NDEWS Weekly Briefing Featuring 7-OH & Kratom:
- Issue 233 | May 30, 2025
- Issue 217 | February 7, 2025
- Issue 211 | December 13, 2024

A recent article in The Baltimore Banner reported that the NIST, in collaboration with a rapid‐testing program partnering with 80 community sites across 15 states, applied chromatographic and mass spectrometric analyses to trace drug samples from this overdose event. Edward Sisco, a research chemist at NIST, indicated that these tests detected fentanyl combined with N-methylclonazepam, a potent benzodiazepine derivative not previously observed in their network, alongside the cutting agents acetaminophen, caffeine, mannitol and quinine. The intense sedative properties of N-methylclonazepam align with reports of many patients remaining unconscious despite receiving naloxone, an opioid overdose reversal medication.

More Information:
- Mass overdose in Baltimore may be tied to new illicit drug mixed with fentanyl
- City of Baltimore Update on Penn North Overdose Event - BaltimoreCity.gov
- 27 people in Baltimore rushed to hospital last week for possible overdoses - NPR

The NDEWS Early Warning Network is comprised of Sentinel Site Directors spanning urban, suburban, and rural areas in the US. They regularly collect community-level indicators of drug use, morbidity, and mortality.

In May 2025, our Sentinel Site Directors reported on carfentanil-related trends and fatal and nonfatal overdose-related trends in their respective areas. Below we have highlighted their responses, to read the full report covering both questions and regional breakdowns for each click here.

Click here to read more about NDEWS Sentinel Site Reports

A recently published commentary in Addiction by Dr. Phillip Coffin, NDEWS San Francisco SSD, critiques the proliferation of high-dose and long-acting naloxone products, highlighting limited evidence and risks such as precipitated withdrawal and cardiovascular stress. He proposes that overdose reversal depends on administering low-dose naloxone before cardiac arrest, paired with respiratory and cardiovascular support, expanded primary care, and real-world dosing data to refine strategies. Read the full commentary here.

A recently published study in Drug and Alcohol Dependence by Hochstatter et al. reviewed 260 street opioid samples collected March 2024–March 2025 in Philadelphia’s Kensington neighborhood using direct analysis in real-time mass spectrometry and liquid chromatography tandem mass spectrometry at the National Institute of Standards and Technology. They reported a decline in median fentanyl concentration from 9.6% to 5.3%, xylazine prevalence falling from 100% to 58%, lidocaine and tetracaine rising to 63%, and emerging adulterants medetomidine and bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS) reaching 83% and 25% prevalence. Read the full study here.

A recently published analysis featured in the Spokesman-Review detailed SSD Dr. Caleb Banta-Green’s examination of Washington State Department of Health mortality data from 2002 to 2024. The analysis found a 1,660% increase in methamphetamine-related deaths in Spokane County, more than five times the 288% rise in opioid fatalities over the same period. These trends reflect cumulative cardiovascular and organ damage among individuals who have used methamphetamine for a decade or more rather than increased initiation. Read the full article here.

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.

More about The NDEWS Early Warning Network
- Issue 230: Early Warning in Action — Insights from the NDEWS Early Warning Network
- Issue 234: Early Warning in Action — Insights from the NDEWS Early Warning Network

📅 Date: Tuesday, July 22, 2025

🕑 Time: 12:00 pm - 1:00 pm ET

📍 Location: Online

Learn more here.

📅 Date: Tuesday, July 29, 2025

🕑 Time: 3:00 pm - 4:00 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), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.