This Week’s Focus: NDEWS Early Warning in Action — Insights from the NDEWS Early Warning Network including Sentinel Site Directors Report

The NDEWS Weekly Briefing focuses on our Sentinel Site Directors (SSD) report, which highlights distinct trends in substance use, adulterants, and overdoses observed in 2025. 

Additionally, we feature our NDEWS Community Overdose Responder (COR) Network Quarterly Report from the fall of 2025. For this report, we collected information on observed shifts in the local drug supply, including adulterants, over the past 3 months, in addition to other local trends of note.

Last week, we published our NDEWS Special Report: Predicting future trends involving nonfatal fentanyl overdoses in the US: A first look through December 2026. The link to the full report was invalid when the briefing was published, so it has been added here. It has also been updated on the website's archive. We sincerely apologize for any inconvenience or confusion this may have caused our readers.

As always, we welcome your input.

Our Sentinel Site Directors were recently asked about notable local trends observed in 2025 compared to the previous year(s). Many site directors reported on changes in the rates of overdoses and shifts in the local drug supply, including 3 directors mentioning the emergency of medetomidine. Click here to read the full report.

Click here to read more about NDEWS Sentinel Site Reports.

Of the 57 responding organizations, 25 (44%) provide services locally within their county or city. Another 23 (40%) operate at a regional level or across multiple counties/cities within the same state, followed by 8 (14%) organizations provides services at a state-wide level, and 1 (2%) operates nationally. The tables directly below provide information about the type of area organizations operate in, with most being in a mix of urban and rural areas, and how many clients their organization has served in the past 3-months.

Among responding organizations, 23 (44%) offer drug checking services. In‑person sample testing using test strips was reported as the most commonly available option, followed by in‑person Fourier-transform infrared (FTIR) spectroscopy testing and mail‑in testing services.

In this quarterly survey, we collected information on observed shifts in the local drug supply including adulterants over the past 3 months, in addition to other local trends of note. Responses are anonymous and aggregated by reporting location. For the Fall 2025 report, we received a total of 57 responses from 29 states, of those a subset of respondents completed extended responses, see below. To read the full report, click here.

Click here to read more about NDEWS Community Overdose Response Network.

A recently published multicenter study in Addiction led by Jennifer Love, co-authored by NDEWS SAG members Alex Krotuslki and Barry K. Logan, examined patients presenting to 10 U.S. emergency departments with suspected opioid overdose as part of the American College of Medical Toxicology’s (ACMT) Toxicology Investigators Consortium (ToxIC) Fentalog Study. Investigators conducted extensive chart reviews, and waste blood specimens were sent to the Center for Forensic Science Research and Education (CFSRE) for confirmatory toxicologic testing. Approximately 23% of patients had confirmed xylazine exposure. Xylazine detection was associated with more than double the odds of presenting with bradycardia in the ED (AOR: 2.11; 95% CI: 1.06–4.06) compared with patients without xylazine exposure. Read the full article here.

The Center for Forensic Science Research and Education NPS Discovery program continues to document rapid shifts in the US novel psychoactive substance (NPS) landscape, with near‑real‑time alerts on synthetic opioids, stimulants, benzodiazepines, and emerging drug classes. Recent reports highlight increasing detections of nitazene‑class opioids, often found in counterfeit pills or mixed with fentanyl, as well as the expansion of synthetic cathinones in forensic casework. Xylazine remains prevalent in polysubstance samples, but newer sedatives such as medetomidine are appearing with growing frequency. Read the full report here.

The latest Signals Alert, published by Millennium Health and NDEWS Community Based Health Expert Dr. Levi Bolin, highlights continued increases in stimulant positivity in urine drug tests across the US, with particularly sharp rises in methamphetamine detection. Nationally, methamphetamine positivity remains more than double pre-pandemic levels, while cocaine positivity has stabilized but continues to appear frequently in polysubstance combinations. Read the full report here.

The latest CCENDU bulletin highlights substantial increases in stimulant‑related harms across Canada. Methamphetamine availability and use continue to rise nationally, particularly in Western provinces, where hospitalizations and overdose deaths involving methamphetamine have increased. Read the full study here.