This Week’s Focus: NDEWS Early Warning in Action — Insights from the NDEWS Early Warning Network including Sentinel Sites Report and Rapid Street Reporting  data (Minneapolis, MN)

This week, the NDEWS Weekly Briefing focuses on our Sentinel Site Director (SSD) reports and our newest Rapid Street Reporting (RSR) findings from our weekend visit to Minnesota. Additionally, we highlight two special achievements within our NDEWS community, provide a special report from the Florida Attorney General's Office, and publications associated with our NDEWS Early Warning Network.

NDEWS RSR is a monthly, venue-intercept study conducted across our national Sentinel Sites. RSR interviewers travel to sites on weekends to interview people about their use of substances in the past 12 months, including the recency of use. The seven-minute interview covers common drugs as well as new psychoactive substances (NPS). With over 7,000 participants surveyed to date, RSR complements traditional surveillance by capturing emerging trends in naturalistic, public settings. Optional saliva testing will be starting in the near future to understand the concordance between self-report and drug testing.

As always, we welcome your input.

NIDA T32 Predoctoral trainee Vijaya L. Seegulam graduated Friday, August 8, with her PhD in Epidemiology from the University of Florida. Dr. Seegulam's dissertation focused on cannabis use using All of Us Research Program data. She spent the three years as a NIDA T32 predoctoral fellow working on all aspects within NDEWS such as the weekly briefings, Rapid Street Reporting and Virtual HealthStreet primary data collection. We wish her well as she continues to contribute to psychiatric epidemiology in the addiction field. We will also continue to seek her advice on the Briefing as a consultant.

Additionally, NDEWS MPI Dr. Joseph Palamar has been promoted to Professor of Population Health at NYU Langone Health. Dr. Palamar specializes in drug use in the US and the New York City nightclub scene, with much of his work focusing on the use of party drugs such as MDMA, ketamine, GHB, methamphetamine, and cocaine.

Congratulations to Drs. Seegulam and Palamar.

Are you committed to advancing the science of substance use and public health? The University of Florida’s NIDA-funded T32 Training Program offers predoctoral and postdoctoral scholars an exceptional opportunity to launch impactful research careers focused on NDEWS!

What We Offer:
- Interdisciplinary training at the intersection of addiction science, epidemiology, and surveillance
- Mentorship from leading UF faculty in epidemiology, public health, psychology, medicine, and more
- Hands-on research with landmark and important NIH-funded projects and access to rich data
- Career development support, including grant writing, publishing, and professional networking
- A collaborative, inclusive research community committed to reducing the burden of substance use

Eligibility:
- US citizens or permanent residents
- Interested in a PhD in Epidemiology, or early-stage postdoctoral fellows
- Demonstrated interest in substance use, addiction, or public health research

Location: Gainesville, Florida — a dynamic hub for scientific innovation with high quality of life and low cost of living.

Florida Attorney General James Uthmeier announced Wednesday, August 13, that an emergency rule was filed to classify isolated and/or concentrated 7-hydroxymitragynine (7-OH) as a Schedule I controlled substance in Florida. Read the full release here.

More Information:
- Statement from FDA Commissioner Marty Makary, M.D., M.P.H., on Florida Restriction of 7-OH Opioid Products | FDA

The Rapid Street Reporting (RSR) team visited Minneapolis, MN on July 25th
and 26th, 2025 and surveyed 248 individuals. After alcohol and marijuana for
recreational use, the next most commonly reported substances used in the
past 12 months were delta-8 (11.3%), psilocybin (7.7%), marijuana for medical use (7.3%), methamphetamine (6.5%) and delta-10 (6.5%).

Click here to read the full report.

Click here to read more about NDEWS Rapid Street Reporting.

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 June 2025, our Sentinel Site Directors reported on heroin-related trends and other recent trends of note in their respective areas. Below we have highlighted their insights on heroin-related trends. To read the full detailed report along with regional breakdowns for each click here.

Click here to read more about NDEWS Sentinel Site Reports

A recently published research letter in JAMA Network Open by Kerester et al., co-authored by NDEWS Co-Director Dr. Joseph Palamar, analyzed poison center reports concerning alkyl nitrite “poppers” exposures over 11 years (2013 to 2023). Data collected by America’s Poison Centers’ National Poison Data System were retrospectively reviewed for eligible cases with reported exposure to amyl or butyl nitrite, identifying 2,431 cases (1,110 involving inhalation and 1,367 involving ingestion). The results show an increase in exposures involving inhalation and ingestion, with a significant increase in severe clinical outcomes from ingestion exposure. The NYC Department of Health and Mental Hygiene has also issued a public health alert that people should not drink poppers. Read the full letter here.

A recently published study in Drug and Alcohol Dependence led by NDEWS Co-Director Dr. Joseph Palamar and co-authored by NDEWS SAG member Dr. Alex Krotulski, investigates both intentional and unintentional use of synthetic cathinones, fentanyl, and xylazine among nightclub attendees in New York City. Saliva samples were collected from 1,024 participants and analyzed using liquid chromatography quadrupole time-of-flight mass spectrometry. The results were that 1.1% tested positive for synthetic cathinones, 1.5% for fentanyl, and 0.4% for xylazine. Most exposures were associated with unreported use, suggesting unintentional exposure. Read the full study here.

A recently published study in Academic Emergency Medicine by Hughes et al., co-authored by NDEWS SAG member Dr. Alex Krotulski, examined benzodiazepine co-exposure among emergency department (ED) patients with confirmed opioid overdoses. Data from the Toxicology Investigators Consortium (ToxIC) Fentalog Study analyzed waste serum from 10 ED sites between September 2020 and December 2023. Among 1,427 patients with opioid exposure, 29.0% had detectable benzodiazepines. Of these, 20.5% involved had tested positive for prescription benzodiazepines and 8.5% had novel benzodiazepines. Read the full report here.

A recently published study in Drug and Alcohol Dependence, co-authored by NDEWS Sentinel Site Director Dr. Phillip Coffin, focused on the acute effects of methamphetamine use during mirtazapine treatment. A placebo-controlled, crossover, double-blind trial was conducted with 15 healthy adults who had moderate to severe methamphetamine use disorder. The study analyzed the prototypical methamphetamine stimulant-like effects when treated with a placebo and with mirtazapine. It was noted that mirtazapine decreased hypothetical methamphetamine demand. Read the full study here.

A recently published study in the Journal of Addiction Medicine by London et al., co-authored by NDEWS Sentinel Site Director Dr. Jeanmarie Perrone, focused on the ability to describe the severe withdrawal syndrome that is associated with medetomidine-adulterated fentanyl exposure. The study was conducted across three hospital systems in Philadelphia between September 2024 and April 2025 and included 209 patients. The symptoms of withdrawal were difficult to manage with traditional opioid treatment. 77.5% of cases resulted in Intensive Care Unit admissions, and patients encountered severe complications that included encephalopathy, myocardial injury, and seizures. Read the full study here.

Additional Resources:
- CDC medetomidine webinar for clinicians

📅 Date: Tuesday, August 19, 2025

🕑 Time: 2:30 pm - 3:00 pm ET

📍 Location: Online 

📅 Date: Thursday, August 21, 2025

🕑 Time: 1:00 pm - 2:00 pm ET

📍 Location: Online 

📅 Date: Wednesday, September 3, 2025

🕑 Time: 2:00 pm - 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

You can share the NDEWS Weekly Briefing with friends, colleagues, and others who would benefit from information on recent and relevant news, articles, and data related to novel drug trends in the US and globally by clicking 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.