Please submit any information concerning shifts in the fentanyl market supply dynamics in your area here.

This week, NDEWS highlights the frequency of counties — among 28 states/districts with statewide coverage that were included — ranking among
the top five counties for nonfatal overdoses from any drug per 10,000
population over a 12-week period ending on September 30, 2024. A total of 11 counties appeared in the top five two or more times, with the District of Columbia ranking in the top five in each of the 12 weeks.

Click here to read the full report.

Click here to read more about NDEWS Hotspot Alerts.

The American Journal of Emergency Medicine published a study co-authored by NDEWS Director Dr. Linda Cottler and NIDA T32 alumni Drs. Andrew McCabe and Nae Won, titled “The preponderance of opioid overdoses among middle-aged individuals in the US: Analysis of 911 dispatch data — Q1 2018 to Q3 2023.”

The study team used emergency medical service data collected by biospatial.io to identify 1,420,298 opioid-related 911 dispatches, of which middle-aged individuals accounted for 48.9%. Significant increases among this age group were identified between Q1 2018 and Q2 2021, while a significant decrease in dispatches among younger-aged individuals occurred between Q2 2021 and Q3 2023.

Click here to read the full report.

What was found? The web monitoring team most recently reported on rilmazafone on May 17, where rilmazafone discussion was at a peak. Discussion has continued to increase since then.

What is rilmazafone? Rilmazafone is a prescription drug used in Japan that acts as a prodrug to rilmazolam. It is primarily used medically for its fast-acting sedative, anxiolytic, and soporific effects. Although not a benzodiazepine itself, it has several benzodiazepine metabolites. 

How is it being discussed? Reddit users note diverse reasons for ingesting rilmazafone. Some of the primary ones are as "landing gear" to end trips early, to enhance the effects of alcohol or opioids, to mitigate social anxiety, or as a sleep aid. Many Reddit users also note that they prefer it to other benzodiazepines, such as etizolam, due to its lesser sedative effects. Addictiveness, memory loss, and sleepiness are mentioned as negative side effects. Since the last report, there has been increased discussion on claims of rilmazafone not being detected on drug tests.

Drug Terms: Rilmazafone, rilmazolam, rhythmy, リスミー, and 450191-S.

Click here to read more about NDEWS Web Surveillance.

The New York Times recently interviewed both NDEWS Director Dr. Linda Cottler and Deputy Director Dr. Joseph Palamar about the increasing popularity of the polysubstance tusi, or pink cocaine.

Cottler said that she considers pink cocaine among the most dangerous club drugs because users rarely know what is mixed into any given batch. Palamar also spoke about the potential dangers. “All you need is one drug dealer to mix fentanyl into their tusi batch,” he said. “They have the ability to poison a bunch of people.”

Read the article here. 

Photo credit: Getty Images via The New York Times

NDEWS Deputy Director Dr. Joseph Palamar was recently interviewed by The Washington Post about the polysubstance known as tusi, or pink cocaine, which he described as a mix of uppers and downers that are dyed so the powder appears pink in color. “I view it as a marketing scheme by drug dealers,” he said.

In reference to fentanyl reportedly being discovered in a toxicology report, Palamar said: “I’ve been warning about this possibility for some time. Fentanyl entering the tusi supply could be disastrous.”

Read the Washington Post article here.

In addition to The Washington Post article, Dr. Palamar was featured in articles from a number of other news organizations this week:

      • The Associated Press: What is the recreational drug ‘pink cocaine’?
      • Los Angeles Times: ‘Pink cocaine,’ the designer drug tied to Liam
        Payne’s death, isn’t what it sounds like
      • CBC News: 'Pink cocaine': What is it and how is it linked to Liam Payne          and Sean (Diddy) Combs? 

Photo credit: David Ovalle/The Washington Post

The NDEWS Director and Deputy Director were quoted in a recently published Psychology Today article comparing recreational and clinical psilocybin use. 

“Most national surveys and studies don’t capture self-reported data on psilocybin use specifically,” said Dr. Linda Cottler. “So such findings help shed important light on an area where we’ve been largely left in the dark." Dr. Joseph Palamar was also quoted, saying, “People who use psilocybin outside medical supervision need to be educated about risks associated with use.”

Read the article here. 

A study recently published in Drug and Alcohol Dependence by Georgia State University and the DrugsData Project, titled “Misrepresentation of MDMA in the United States, 1999–2023,” analyzed 4,500 samples collected from a drug-checking service. The study team discovered nearly 200 unique adulterants in the MDMA supply over a 25-year period, though it also found that MDMA quality has stabilized at relatively high levels in recent years.

Adulterants included designer drugs, such as piperazines and synthetic cathinones (found in 5% of samples), that are associated with serious health risks. Other stimulants, meanwhile, were discovered in a quarter of the samples, with caffeine (18%) and methamphetamine (9%) being the most prevalent.

Read the study here.

Photo courtesy of the Drug Enforcement Agency

A review was published this month in The Lancet by researchers affiliated with the Campbell Family Mental Health Research Institute in Toronto and the University of Toronto’s Department of Family and Community Medicine, titled “Facilitators of and barriers to buprenorphine initiation in the emergency department: a scoping review.”

The review provided insight regarding patient introduction to buprenorphine in emergency rooms across North America, highlighting efforts across academia, public health policy, funding, and hospital administration to advance integration of buprenorphine as a life-saving treatment for opioid use disorder. However, it also identified issues preventing its implementation, such as structural stigma, client complexity, and an increasingly toxic drug supply.

Read the article here.

Photo credit: Pixabay/pexels.com

NPR recently reported that fentanyl overdose deaths have decreased for the sixth consecutive month, according to Centers for Disease Control and Prevention data. Such deaths have decreased by 12.7% over a 12-month period ending in May 2024, a significant improvement over last month’s report showing a 10.6% decrease.

If this downward trend continues, overdose deaths could drop below 100,000 for the first time in 25 years, according to the article.

Read the article here.

Image courtesy of the Centers for Disease Control and Prevention

Date: October 30, 2024, noon ET

Location: Virtual

Learn more and register here. 

Martha Whitfield, PhD, APRN, FNP-BC, Assistant Professor in the College of Nursing and Health Sciences at the University of Massachusetts Dartmouth, and a board-certified Family Nurse Practitioner will present the results of a qualitative study exploring the experiences of nurse practitioners in primary care settings across New England and Ontario regarding capability development for prescribing medication and safe supply for opioid use disorder.

Date: Thursday, October 31, 2024, 4:30 – 6 p.m. EDT

Location: Virtual

Learn more and register here. 

Ashley Jordan, PhD, Director of Research and Program Evaluation at the New York State Office of Addiction Services and Supports will discuss a study that examined overdose death risk among people who were terminated from addiction treatment in New York City. 

Date: Monday, November 11 – Wednesday, November 13, 2024

Location: Philadelphia, Pennsylvania, USA

Learn more here. 

Date: Thursday, November 14, 2024, 2 – 3 p.m. ET

Location: Virtual

Learn more and register here. 

Date: November 19, 2024, 4:30 – 6 p.m. EST

Location: Virtual

Learn more and register here. 

Organized by AIDS United, Black Harm Reduction Network, Drug Policy Alliance, Human Impact Partners, and the National Alliance of State & Territorial AIDS Directors (NASTAD), this webinar will feature experts who will share recent racial and ethnic trends in overdose mortality, including drug type, age, and gender variations.

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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 911 EMS dispatch 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 (PI: Cottler, Co-Is: Goldberger, Nixon, Striley), New York University (Deputy Director: Palamar), and Florida Atlantic University (Co-I: Barenholtz). Any item may be reproduced provided the source is acknowledged.