This week’s NDEWS Hotspot Alerts report includes 29 counties with a higher-than-expected number of nonfatal drug-related 911 dispatch overdoses from October 30 to November 5, 2024.

Click here to read the full report.

Click here to read more about NDEWS Hotspot Alerts.

What is MD-PiHP? MD-PiHP is a synthetic cathinone. It is a pyrrolidine derivative structurally similar to α-PiHP, MD-PHP, and 3f-PiHP.

What was found? Analysis of online discussions indicated that MD-PiHP has had sparse mentions since at least 2018. It first started being mentioned consistently in December 2023, and our team reported on it on August 2, 2024. Since then, it has seen an increase in discussion and is currently at an all-time peak.

How is it being discussed? Reddit users report obtaining MD-PiHP in crystal form and using various routes of administration, including vaping, snorting, and injection. Discussions mention sedating effects, strong dopamine activity, and anticholinergic properties. Since the last web monitoring report, there has been increased discussion of the substance as a longer-lasting alternative to α-PiHP and MD-PHP. Additional ingestion methods have been mentioned, such as boofing and insufflation, as well as modification to existing ingestion methods, such as combining MD-PiHP with acetone for vaping purposes. Many commenters have also talked about negative side effects, such as anxiety and vasoconstriction, especially at higher doses.

Drug Terms: MD-PiHP, MDPiHP

Click here to read more about NDEWS Online Monitoring.

NDEWS Co-investigator Dr. Bruce Goldberger co-authored a case study titled “A postmortem case report involving fentanyl, desalkylgidazepam, and bromazolam” that was recently published in the Journal of Analytical Toxicology.

The study provides toxicological findings of postmortem specimens that resulted from a fatal overdose involving high concentrations of the designer benzodiazepine desalkylgidazepam, which is an active metabolite of the prodrug gidazepam, and bromazolam, an analogue of alprazolam.

Read the study here.

This week, NDEWS Deputy Director Dr. Joseph Palamar was quoted in a Vox article about tusi that was titled “What in the world is pink cocaine.” The article also mentions NDEWS and links to the NDEWS website.

Read the article here.

Photo illustration by JooHee Yoon for Vox

As part of its Morbidity and Mortality Weekly Report, the CDC published an article titled "Notes from the Field: Ketamine Detection and Involvement in Drug Overdose Deaths — United States, July 2019 – June 2023."

While ketamine was detected in less than 1% of overdose deaths from July 2019 to June 2023, according to the article, overdose deaths with ketamine detected increased from 0.3% to 0.5%. About 82% of these cases involved other substances, particularly fentanyl or stimulants. The article also notes a lack of uniform testing for the substance, and increases in polysubstance use, the use of ketamine for treatment-resistant depression, and its use in compound formulations.

Read the article here.

Harm Reduction International released The Global State of Harm Reduction 2024, its biannual report on the status of worldwide harm reduction services. The report noted a slight increase in the availability of harm reduction services compared to that reported in the previous report.

According to the report, 108 countries currently include harm reduction in their national policies, while 94 offer medication-assisted treatment for opioid use disorder, and 93 provide at least one syringe program. Only 34 countries offer take-home naloxone programs, a slight decrease from the previous report.

Download the full report here.

The Opioid Industry Documents Archive is a free public resource created in 2021 by Johns Hopkins University and the University of California San Francisco. This collection of images is extracted from publicly disclosed industry documents, many of which were created for internal company audiences and board members. It provides valuable insight into the practices that shaped the opioid crisis. In addition to browsing through the images, researchers can also view the source documents in the archive, which currently includes more than 16.2 million pages in 3.5 million documents. 

View the image archive here.

NIDA Director Dr. Nora Volkow and Deputy Director Dr. Wilson Compton published an editorial in the American Journal of Psychiatry, titled “Reductions in Substance Use as Outcome Targets for Treatment Development.”

The editorial calls for the development of new medications and treatments for substance use disorders while highlighting a recent study published in the same journal by Erin A. McClure and colleagues that provides first-time evidence that reductions in cannabis use were beneficial to patients with a cannabis use disorder.

Read the editorial here.

Researchers from RTI International, the University of Louisville, and West Virginia University published an article in the International Journal of Drug Policy titled “Use of fentanyl test strips by people who inject drugs: Baseline findings from the South Atlantic Fentanyl Test Strip Study.”

In-person surveys with 541 people who inject drugs were conducted between June 2021 and March 2022 as part of their NIDA-funded study. The team found that the use of fentanyl test strips overall is declining, which is consistent with the steady declines in use reported by syringe services programs in recent years.

Read the article here.

Photo credit: Addiction Policy Forum 

Dr. Mark S. Gold wrote an article about clinical trials and recreational use of hallucinogens for Psychology Today titled “LSD: The Bad and Potentially Good Sides." 

The article indicates that recreational use is at historically high levels among young adults, with an estimated 9% of adults between the ages of 19 and 30 having used hallucinogens compared to 4% of 35- to 50-year-olds.

Read the article here.

Photo Credit: Microgen/Adobe Stock

Location: Virtual 

Learn more here. 

This course, developed by the Addiction Policy Forum, National Association for Children of Addiction (NACoA) and JCOIN, will provide educational material about the latest stigma research while also equipping them with tools to respond to and reduce stigma in health and justice settings.

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 here. 

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

Location: Virtual

Learn more 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.

Date: December 5, 2024, 10 a.m. – 4:30 p.m. EST

Location: Virtual

Learn more here. 

Attendees will gain knowledge in how to strengthen seized drug analysis and reporting of drug-related substances; how the GUARDS method was developed and validated at the DEA Special Testing & Research Laboratory; how to adopt the GUARDS method at their laboratory; and how to confidently transition from helium to hydrogen as GC-MS carrier gas. 

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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.