A new study by NDEWS Deputy Director, Dr. Joseph Palamar, published in JAMA, reports a 38% rise in pharmaceutical ketamine diversions from 2017 (195 cases) to 2023 (230 cases). By 2023, transit losses became the most common diversion type, representing 45.2% of reports. Diversions from practitioners and hospitals, while decreasing from 48.7% and 36.4% in 2017 to 36.1% and 23.9% in 2023, remained the leading sources overall. These findings highlight shifting patterns in ketamine diversion and underscore the need for enhanced safeguards in distribution channels.

Click here to read the full research letter.

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This week’s NDEWS Special Report highlights counties with the highest frequency of nonfatal drug overdoses per 10,000 residents over the past three months (September 7 – November 30, 2024), across 28 states and districts with statewide data coverage. Eleven counties ranked in the top five at least twice, with the District of Columbia leading, appearing in the top five every week during this period.

Click here to read the full report.

Click here to learn more about NDEWS Hotspot Alerts.

What is Bromazolam? Bromazolam is a federally unscheduled benzodiazepine. It is the bromo analog of alprazolam, more commonly known as Xanax.

Expert Insight: Dr. Goldberger, Professor and NDEWS Co-I, notes that bromazolam is increasingly identified in DUI casework and in decedents. Bromazolam is a potent central nervous system depressant often ingested with other illicit substances including cocaine, fentanyl, and methamphetamine.

What was found? Bromazolam has seen a sharp increase in discussion since mid-October, seeing over a 50% increase in discussion within the past two months, and nearly a 200% increase since our last web monitoring alert.

Previous reports:
      • March 29, 2024

How is it being discussed?Bromazolam is often discussed as a substitute for alprazolam. Many commenters state that it is more desirable than alprazolam due to its longer-lasting effects. The discussion on purpose of ingestion range from recreational to mitigating anxiety to muscle relaxant. Perception is mixed, and commenters warn against the substance's potential for addiction. Since the last report there is increased discussion on how quickly the tolerance of the substance can be raised, and how withdrawal symptoms can start when ingesting the substance consistently, even for time periods as short as a few days. There has also been an increase of commenters warning that the substance has not been well tested on humans and that there are many unknowns.

Drug Terms: Bromazolam, Brom, Bromaz

Click here to read more about NDEWS Online Monitoring.

A recent study, co-authored by NDEWS collaborators in Addiction, highlights the rise of semi-synthetic 7-hydroxymitragynine products, containing up to 98% of this potent kratom alkaloid—14–22 times more binding to mu opioid receptors than morphine. These products, often marketed as kratom, bypass metabolism, increasing toxicity and risks of opioid-like dependence. Fatalities may be misattributed to kratom due to forensic reliance on mitragynine markers.

Read the article here.

A recent publication in Contemporary Drug Problems by Caty Simon, a NDEWS Sentinel Site Director (SSD), introduces Narcofeminism Storyshare, a groundbreaking model by North Carolina Survivors Union. This process leverages autobiographical storytelling by women and gender-diverse individuals who use drugs to disrupt stigmatizing narratives, promote healing, and drive structural change. Rooted in narcofeminism, narrative disruption, and stigma theory, the model reframes lived experiences to challenge systemic marginalization, reduce stigma, and inspire advocacy and policy reform.

Read the article here.

A short communication by Glick et al. in Drug and Alcohol Dependence Reports highlights a 70% decline in syringe distribution by syringe services programs (SSPs) in King County, Washington, from 2020 to 2023, coinciding with the rise in fentanyl smoking. SSPs, which provide harm reduction services like syringe access, naloxone distribution, and linkage to care, saw stable client encounters overall. However, SSPs offering safer smoking supplies, such as pipes, experienced increased visits, reflecting a shift from injection to smoking. 

Read the article here.

A recent study published in Frontiers in Pharmacology by Laffont et al. compared the effectiveness of intranasal (IN) naloxone and nalmefene in mitigating cardiac arrest caused by synthetic opioid overdoses, including fentanyl and carfentanil. Using a validated translational model, simulations demonstrated that a single dose of IN nalmefene (3 mg) significantly outperformed IN naloxone (4 mg) in reducing cardiac arrest rates. The findings underscore the potential of IN nalmefene as a more effective first-line treatment for synthetic opioid overdoses in an era where fentanyl is implicated in over 90% of opioid overdose deaths in the U.S.

Read the article here.

A recent Addiction Outlook column in Psychology Today by Dr. Mark Gold highlights overdose as a crucial intervention point for individuals with substance use disorders (SUDs), including over 2 million older adults aged 65 and above who face addiction. The column emphasizes the importance of medication-assisted treatments (MAT), such as methadone and long-acting injectables like Sublocade or Brixadi, which can reduce mortality by up to 70%. Barriers such as high costs and insurance limitations are identified as challenges to MAT access. The column advocates for leveraging the post-overdose "teachable moment" to initiate MAT, distribute take-home naloxone or nalmefene, and provide comprehensive care for underlying medical and psychiatric conditions to enhance long-term recovery outcomes.

Read more here.

Date: January 13 – 17, 2025
Time: 8:45 am – 12:00 pm ET (Daily)
Location: Virtual

This year’s symposium, which features presentations by scientists from academia, government, and industry, will focus on knowledge, best practices, and advances in science that can help improve effectiveness and efficiency.

Learn more here. 

Date: January 15, 2025
Time: 1:00 pm – 2:30 pm ET
Location: Virtual

Learn more here. 

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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.