Last week, we received a request from one of our readers for a Michigan State Report. If you would like us to create a report for your region or state please reach out to us at ndews-cc@ufl.edu.

In this week’s State Report, NDEWS highlights opioid and non-opioid overdose alerts for Michigan during 2023. These alerts indicate days in which the number of overdoses exceeded the expected number for that county. This expected count, or threshold, is calculated through biospatial, and accounts for population, seasonality, and other factors. Between January 1st and December 31st, 2023, there were a total of 14,840 opioid-involved nonfatal overdoses and 14,428 non-opioid-involved nonfatal overdoses identified in biospatial. The maps above indicate the frequency of alerts for non-opioid- or opioid-involved nonfatal overdose dispatches. Counties with three or more alerts during the reporting period are labeled. Read the report here.

This week’s MMWR details the cluster of severe illnesses in New Jersey from Neptune’s Fix Tianeptine. Twenty cases of tianeptine ingestion associated with severe clinical symptoms were reported in New Jersey from June to November 2023. Clinical effects included altered mental status, tachycardia, hypotension, seizure, cardiac arrest, and increased risk for ventricular arrhythmia. Among the 20 encounters, 13 of the 17 patients were admitted to an intensive care unit, and seven of the 17 underwent endotracheal intubation. All bottles were labeled as containing kavain and tianeptine; analysis identified variable compositions, including the presence of two synthetic cannabinoid receptor agonists. Read the report here.

Last week, the US Food and Drug Administration (FDA) published a drug alert warning consumers not to purchase or use Neptune’s Fix or any tianeptine products. Neptune Resources, LLC agreed to voluntarily recall all lots of Neptune's Fix Elixir, Neptune’s Fix Extra Strength Elixir, and Neptune’s Fix Tablets. Consumers, distributors, and retailers that have these products should either dispose of them or return them to the place of purchase immediately. Read the statement here.

We surveyed our Sentinel Site Directors and the community about tianeptine, or "gas station heroin," in January 2023. Of the 17 sites who responded to the survey, four sites reported no cases of tianeptine use in their areas, while Atlanta reported the availability and use of tianeptine, Chicago reported one tianeptine-involved overdose death in 2022, and Denver reported two tianeptine-involved overdose deaths (one in 2021, one in 2022).

In response to the recent MMWR report and FDA advisory, we are again asking the community if you have any information regarding the use of tianeptine or "gas station heroin" in your area. Please submit using the form here or email us at ndews-cc@ufl.edu.

A study recently published in JAMA Network Open characterized proximal motivators, effects, and patterns of kratom use and assessed whether use frequency is associated with motivations, effects, past-year criteria for substance use disorders for kratom, or other substance use. Results showed that, among kratom consumers surveyed, most reported using kratom daily to relieve pain, improve mood, or increase productivity. More frequent use was associated with tolerance, withdrawal, and craving, but not with social or functional impairment. The authors note the need for longitudinal studies that examine changes in kratom use patterns and effects over time. Read the study here.

A recently published study assessed delta-8 THC retail, by calling locations with alcohol, tobacco, and/or consumable hemp retail licenses in Fort Worth, Texas, before and after Texas announced ongoing litigation surrounding delta-8 THC legality. Data were collected before a statement was made regarding delta-8 THC legality and after a state injunction ‘temporarily’ defined delta-8 THC as legal, with no specified end date. The results showed that despite the changing legal landscape in Texas, interest in delta-8 THC did not appear to decline. Read the study here.

For the first time, Toronto’s Drug Checking Service identified medetomidine/dexmedetomidine in Toronto’s unregulated drug supply. Medetomidine/dexmedetomidine was first identified by Toronto’s Drug Checking Service on December 29, 2023. Between December 29, 2023, and January 23, 2024, it was found in 11% of the expected fentanyl samples. It was found in samples expected to be fentanyl, alongside high-potency opioids, and other central nervous system depressants. The presence of medetomidine/dexmedetomidine was not reported as being expected by those who submitted these samples to be checked. Read the report here.

A national expert panel of persons with histories of drug use are invited to join Virtual HealthStreet to participate in periodic anonymous, special topic surveys specifically aimed at garnering a better understanding of emerging drug trends across the US. Join here.

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