This Week’s Focus: Overdoses Across the United States

This week’s briefing focuses on overdoses across the United States. Data-driven insight from our latest NDEWS Special Report looks at EMS encounters for nonfatal overdoses at the county level across the US and breaks down the trends of the top-10 counties.

Additionally, our NDEWS Web Monitoring Report highlights an emerging trend concerning the substance PipTapentadol. Over the past two months, discussions of first experience reports have surfaced in online forums.

We close out the briefing with recent studies and reports published in International Journal of Drug Policy, Harm Reduction Journal, Neuroscience and Behavioral Reviews, and The Guardian.

As always, we welcome your input.

Out of 28,569 EMS encounters for nonfatal drug-related overdoses from January 1, 2025 to September 30, 2025; Los Angeles County, CA ranked highest in EMS encounters for nonfatal overdoses followed by Cook County, IL. Los Angeles County, CA had higher EMS encounters for fentanyl compared to Cook County, IL. But Cook County, IL had higher EMS encounters for heroin compared to Los Angeles County, CA.

To view the entire Special Report from the weekly briefing, click here.

Click here to learn more about NDEWS Hotspot Alerts

Why are we reporting on this?
The first experience reports for PipTapentadol have emerged in online communities within the past two months. Despite being advertised by vendors as an "O-DSMT (O-desmethyltramado) alternative," early reports suggest the compound does not produce typical opioid effects and may cause unexpected adverse reactions.

What is PipTapentadol?
PipTapentadol (3-(2-methyl-1-(piperidin-1-yl)pentan-3-yl)phenol) is a novel research chemical opioid being marketed as a structural analog of the prescription medication tapentadol. Reddit discussants report that vendors are positioning this compound as an alternative to O-DSMT, though some commenters suggest it may not function as a typical mu-opioid receptor agonist. The compound has begun appearing on supplier websites originating in China, with discussants reporting no available information about its effects, dosing, or safety profile.

Public Health Impacts:
Reddit discussants express significant concern about the complete lack of human safety data for PipTapentadol. Early experience reports describe atypical effects that do not match expected opioid profiles, with Reddit commentors reporting uncomfortable physical sensations including abnormal temperature regulation, chest discomfort, and unusual cardiovascular sensations. Commenters who self-identify as individuals maintained on methadone and those seeking to transition from intravenous to alternative routes of administration are expressing interest in the compound.

How is it Being Discussed?
Many of the current Reddit posts center around seeking information about PipTapentadol as vendors have recently listed it as a new opioid research chemical. Discussants actively search for user experiences, dosing information, and comparisons to other substances, but acknowledge the near-complete absence of available data. Reddit commentors compare PipTapentadol to O-DSMT, tapentadol, and other opioid research chemicals, with some expressing interest due to O-DSMT supply shortages. Some discussants report that the compound does not produce typical opioid effects, with one detailed report describing effects more similar to dissociatives or stimulants than opioids. Commenters mention planning to use PipTapentadol alongside other substances including etodezitramide and spirobrorphine. Reddit users on methadone maintenance therapy are inquiring about the compound's potential for producing euphoria or managing withdrawal symptoms. The compound is being discussed in the context potential alternatives to both prescription opioids and more potent research chemicals like nitazenes.

Drug Terms:
PipTapentadol, piptap3, 3-(2-methyl-1-(piperidin-1-yl)pentan-3-yl)phenol

Click here to read more about NDEWS Online Monitoring

A recently published paper in the International Journal of Drug Policy by German et al. conducted a mixed-methods study in Baltimore, Maryland. The study found that 87% of people who inject drugs expressed interest in participating in prescribed safer supply programs if they were legal and available. Key motivations included reducing overdose risk, avoiding street drug market violence, and achieving greater life stability through managed use and access to healthcare. Read the article here.

A recently published study in Harm Reduction Journal by Saavedra, featuring NDEWS SSD Director Annick Borquez, outlined a community-informed, consensus-driven effort by the NIDA HEAL RISE Network to standardize harm reduction research through the development of Common Data Elements (CDEs) and Common Outcome Measures (COMs). The study harmonized data collection across 10 diverse research projects. The results were that 94% of Tier 1 CDEs were adopted without major modification, and 100% of COMs were implemented across studies. Read the full article here.

A recently published systematic review in Neuroscience and Behavioral Reviews by Mosca et al. explored the link between novel psychoactive substances and psychosis. The review highlighted synthetic cannabinoids (SCRAs) as the more frequently implicated class. Among 4,829 individuals who were exposed to SCRAs, 44 cases of acute psychosis with remission were reported, alongside nine persistent psychotic episodes and 10 relapses. Poly-substance use also emerged as a significant risk factor. The authors underscore the importance of screening NPS use in individuals with first-episode psychosis. Read the full study here.

A recently published article in The Guardian reported a significant decline in drug overdose deaths in Cook County, Illinois, which was marked by a 37% drop from the previous year. The article stated that the drop is attributed to the distribution of naloxone, the establishment of overdose prevention sites, and expanded overdose surveillance. The author’s findings suggest that localized, tailored interventions can yield measurable public health benefits and may serve as a model for other urban centers grappling with overdose crises.  Read the full article here.

A recently published article in The Guardian reported that despite a national decline of overdose deaths in the United States in 2024 by the Centers for Disease Control, a reversal of the trend has begun in several states. According to state-level data, deaths began to rise again in January 2025 and reached near peak levels in Arizona, while they climbed in other states such as Delaware, Hawaii, Minnesota, New Mexico, and Washington. These findings underscore the need for expanded harm reduction strategies, real-time surveillance, and targeted outreach to communities that are affected. Read the full article here.

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.

📅 Dates: Thursday, November 20, 2025

🕑 Time: 2 pm - 3 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.

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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.