This Week’s Focus: Alcohol Intoxication 

In this week’s briefing, we examine alcohol intoxication in the context of EMS encounters. Following the College on Problems of Drug Dependence (CPDD) and Research Society on Alcohol (RSA) meetings in June, many of us have been reflecting on the growing harms that can be associated with alcohol and polysubstance use.

Data from the 2023 National Survey on Drug Use and Health (NSDUH) suggests that 78.5% of people aged 12 and older have had a drink of alcohol at some point in their lives, 62.8% have had a drink of alcohol in the past year, and 48.7% have had a drink of alcohol in the past month. Particularly concerning is the sharp rise in drinking among adults aged 65 and older. According to the NIH National Institute on Alcohol Abuse and Alcoholism, from 2002 to 2019, monthly drinking in this group increased by 16%, representing an 80% rise in the number of older individuals who consume alcohol.

Researchers are now examining the relationship between alcohol use and rising rates of colon cancer, liver disease, and other alcohol-related conditions. Co-use of alcohol with other drugs—especially opioids—was another major theme at CPDD and RSA, prompting us to take a closer look at EMS data.

For a first look, we reviewed the past six months of biospatial.io EMS data—75% of which is available within 24 hours of the encounter—focusing on three types of events: (1) nonfatal opioid-related overdoses involving alcohol intoxication, (2) nonfatal opioid overdoses without alcohol intoxication, and (3) standalone alcohol intoxication encounters.

Although data on the effects of alcohol and other substances in older adults remain limited, we hope this first glimpse of EMS encounters related to opioids and alcohol—by men and women during different periods of their lives—will help us think further about how to prevent the harmful consequences of these substances. We welcome your feedback as we explore this topic further in future briefings.

NDEWS Special Report: EMS encounters for nonfatal alcohol intoxication, and opioid-related overdoses with and without alcohol intoxication, among adults in the US January 1, 2025 - June 30, 2025

From January 2025 to June 2025, there were 13,750 EMS encounters for nonfatal opioid-related overdoses with alcohol intoxication; 110,160 EMS encounters for nonfatal opioid-related overdoses without alcohol intoxication and 1,123,267 EMS encounters for alcohol intoxication by itself. The data shows a statistically significant increase in EMS encounters for nonfatal opioid-related overdoses with and without alcohol intoxication as well as alcohol intoxication by itself across all ages and sexes in the past 6 months.

EMS encounters increased for all ages; however, they were highest for 18- to 44-year-olds, regardless of sex. EMS encounters related to alcohol intoxication alone were higher for women 60+ compared to women 45-59 years of age; the same trend was seen for men.

The opposite was true for nonfatal opioid-related encounters with alcohol intoxication. While encounters increased over these six months, they were higher for men and women 45-59 years old compared to the 60+ year old group.

Encounters related to nonfatal opioid-related overdoses without alcohol intoxication were higher for the 60+ age group for women vs the 45–59-year-olds; for men, the opposite was seen. Men 45-59 had higher increases over time than their 60+ year old counterparts.

To view the entire Special Report from our Weekly Briefing, click here.

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A recently published article in the New York Times highlights how even light or moderate alcohol consumption poses increasing health risks for older adults. Experts cited, including NDEWS Co-I Dr. Sara Jo Nixon, emphasize that aging reduces muscle mass and total body water, amplifying alcohol’s cognitive and physical effects. Alcohol use in later life elevates risk for falls, drug interactions, and worsened outcomes in chronic disease. Notably, alcohol is involved in 1 in 7 opioid-related deaths, highlighting the urgency of age-tailored screening and intervention as both alcohol and opioid co-use rise among older adults. Read the full article here.

A recently published article in Psychology Today's Addiction Outlook by NDEWS SAG member Dr. Mark Gold discusses how alcohol affects women differently than men. The article references pioneering research by the Yale Program on Sex Differences in Alcohol Use Disorder (AUD) and a press release issued in May that highlights significant differences between women and men regarding AUD, binge drinking, metabolism, the risk of overdose/poisoning, and treatment. Read the full article here.

A recent analysis in JAMA by Shuey et al. used 2017–2019 and 2021–2023 National Survey on Drug Use and Health (NSDUH) data to examine sex-based differences in alcohol use. Among adults aged 18–25, past-month binge drinking was higher among females than males in 2021–2023 (31.6 vs 29.9 per 100%), reversing the prior pattern from 2017–2019. Heavy drinking remained more prevalent among males across all age groups, but the gap narrowed. The authors call for increased screening among young adult women, given rising alcohol-related liver disease and mortality. Read the full study here.

A recently published study in Alcohol and Alcoholism by Farkas et al. examined 251,300 emergency department visits at Veterans Administration hospitals from 2010 to 2019 with clinical or laboratory-confirmed alcohol intoxication. Among visits with a completed AUDIT-C screen within six months (n=222,839), 79% screened positive for alcohol use disorder (AUD). Even among patients with lower-range serum ethanol concentrations (50–100 mg/dl), 64% screened positive. Read the full study here.

A recently published multi-method study in the Journal of Substance Use and Addiction Treatment by Broussard et al. examined the feasibility of implementing screening and brief intervention for alcohol and opioid co-use in community pharmacies. The study focused on the elevated overdose risk associated with concurrent use of these substances and co-use that is involved in approximately 1 in 7 opioid-related deaths. Pharmacy staff in Utah and Tennessee reported strong awareness of the clinical importance of addressing alcohol use at the point of opioid dispensing. While 75% expressed support for implementing co-use screening, key barriers included stigma, limited training, and time constraints. Despite these challenges, participants viewed pharmacists as uniquely positioned to identify and intervene on alcohol–opioid co-use during routine medication dispensing. Read the full study here.

A recently published study in Drug and Alcohol Dependence Lorvick et al. used ecological momentary assessment to assess polysubstance use in a community-based sample of 177 people who use drugs in Oakland, California. Polysubstance use was defined as opioids combined with stimulants, alcohol, benzodiazepines, or another opioid within the same hour. Opioid–alcohol co-use occurred on 18% of study days, making it the second most common high-risk combination after opioids with stimulants. Read the full study here.

A recently published study in Journal of American Pharmacists Association by Lu et al. analyzed data from 27,029 adults in New York State who initially sought treatment for alcohol use and were later diagnosed with opioid use disorder (OUD). From 2005 to 2018, new buprenorphine prescriptions increased overall but remained low in this dual-diagnosis population—averaging just 64 per 1,000 clients. Significant disparities were observed in buprenorphine prescribing among people with co-occurring alcohol use and opioid use disorder: clients aged 18–35, white non-Hispanic individuals, and those who were employed had the highest prescribing rates, while older adults, Black and Hispanic clients, and those with disabilities had substantially lower rates. Read the full study here.

A recently published article in The Independent reports that alcohol-related liver disease in the US has more than doubled over the last 20 years. This increase is linked to four groups: women, adults aged 45 and older, people living in poverty, and those with metabolic syndrome. The study analyzed data from 1999 to 2020 and found that the average drinking rate remained unchanged, except during the pandemic. Over 51,600 adults died from liver disease in 2020. Read the full article here.

A recent update from NDEWS colleague Dr. Christopher McCurdy from the FDA press conference highlights the announcement that the FDA has requested scheduling of 7-OH in semi-synthetic and concentrated products. This follows an FDA assessment showing that 7-OH—which normally makes up less than 2% of kratom alkaloids—is now found at higher concentrations in enhanced formulations. Poison center data, using new 7-OH–specific codes since February 2025, indicate nonfatal exposures and withdrawal symptoms consistent with opioid effects, and a Tampa Bay Times report described over-the-counter pills containing up to 15 mg per dose, levels not present in natural kratom. Read the full report here.

📅 Date: Thursday, August 7, 2025

🕑 Time: 11:00 am ET

📍 Location: Online 

Archive available here.

📅 Date: Wednesday, August 13, 2025

🕑 Time: 3:00 pm ET

📍 Location: Online 

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

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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.