This week’s NDEWS Special Report features a heatmap highlighting trends in nonfatal fentanyl-related overdoses by time and day of the week across the U.S. from August 1 to November 30, 2024.

To view the heatmap in greater detail and see demographic breakdowns, click here for the full report.

Click here to learn more about NDEWS Hotspot Alerts.

What is Avizafone? Avizafone is a prodrug of diazepam (Valium), belonging to the benzodiazepine class of drugs. Initially developed as an antidote for nerve agent gas poisoning, it has since found its way into recreational use. Avizafone is chemically distinct from diazepam and has a higher molecular weight, which may affect dosage calculations.

What was found? Avizafone discussion has increased since August plateauing at a new high since October 4, 2024, when NDEWS last reported on the substance. Avizafone activity is currently more than 3 times what it was, in our last report (see more below).

Previous reports:
• October 4, 2024
• April 26, 2024

How is it being discussed? Online discussions about avizafone primarily revolve around its dosage and effects. People who use this drug are particularly interested in its potential as an alternative to diazepam for recreational or therapeutic purposes, and they report that the effects of avizafone last longer than those of diazepam. There is also a discussion warning that the potency of acquired avizafone can vary significantly and that dosing can be challenging. Since our last report, there has been an increase in discussion on combining Avizafone with other substances especially Rilmazafone.

Drug Terms: Avizafone

Click here to read more about NDEWS Online Monitoring.

A recent study in Contemporary Drug Problems, co-authored by NDEWS Scientific Advisory Group (SAG) members, Drs. Lee Hoffer and Georgiy Bobashev, examines brokering in illicit drug markets among people who inject drugs. Analyzing data from 241 participants in Ohio syringe service programs, the study found 75% engaged in brokering within the past 30 days. On average, brokers purchased drugs for seven individuals from four sellers, with 84% using drugs with recipients, 49% inflating prices, and 27% taking a portion before delivery. 

Read the study here.

A recent study by Giorgetti et al. in the Journal of Forensic Sciences analyzed hair samples from 88 individuals diagnosed with substance use disorder (SUD) at a Bologna addiction treatment service in 2023. 95.5% of participants tested positive for at least one substance, with 11.9% showing both traditional drugs of abuse (DoA) and new psychoactive substances (NPS). Ketamine was detected in 8.0% of samples, frequently co-occurring with cocaine (85.7%). Fentanyl was found in 3.4% of samples, primarily alongside opioids. Younger patients under 30 had significantly higher rates of NPS and DoA co-use (p = 0.025).

Read the study here.

A recently published study by Culbreth et al. in Substance Use & Misuse examined factors associated with suicide attempts among emergency department (ED) patients presenting after nonfatal opioid overdoses. Using data from the Toxicology Investigators Consortium Fentalog Study (September 2020–November 2023), researchers tested for over 1,200 substances in residual serum samples from 1,259 patients across 10 U.S. medical centers. Findings revealed that 6.4% of opioid overdoses were classified as suicide attempts. Suicide attempts were associated with use of prescription opioids, particularly oxycodone, rather than illicit opioids like fentanyl.

Read the study here.

Adolescent substance use in the U.S. remains at historically low levels, continuing trends observed since the COVID-19 pandemic, according to the Monitoring the Future survey funded by the National Institute on Drug Abuse (NIDA). The 2024 survey, conducted by the University of Michigan with over 24,000 students in grades 8, 10, and 12, shows stable or declining rates for most substances when examining use within the past year. Use of illicit drugs other than marijuana fell to 3.4% among 8th graders, while narcotic use (excluding heroin) among 12th graders reached an all-time low at 0.6%. The survey also measured Delta-8-THC for the first time, with 2.9% of 8th graders and 7.9% of 10th graders reporting use.

Read the NIDA press release here.

Full results are available through the University of Michigan.

A recent Addiction Outlook column in Psychology Today by Dr. Mark Gold examines rising trends in drug use as the opioid crisis evolves. Historical patterns suggest stimulant use, particularly methamphetamine and cocaine, often follows opioid epidemics. The growing combination of stimulants with fentanyl, known as “speedballing,” is contributing to increased overdose deaths. At the same time, psychedelics like LSD, psilocybin, and MDMA are gaining popularity, driven by Silicon Valley endorsements and therapeutic interest for conditions like depression and PTSD. While psychedelics are used intermittently and rarely lead to addiction, stimulants’ highly addictive nature makes them more likely to drive the next epidemic.

Read the article here.

Rhode Island has opened the nation’s first state-authorized overdose prevention center (OPC) in Providence. Operated by Project Weber/RENEW, the facility offers a medically supervised space to prevent overdose deaths, alongside mental health support and substance use treatment referrals. Funded primarily through opioid settlement dollars, the center does not use taxpayer funds. Final licensing from the Rhode Island Department of Health is underway, with operations expected to begin in the coming weeks. In 2023, Rhode Island reported 404 overdose deaths, while nationwide fatalities reached over 107,000, mostly from fentanyl.

Read the article here.

📅 Dates: 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.

📅 Dates: June 2 – 4, 2025, submissions close March 1, 2025

📍 Location: University of Puget Sound, Tacoma, WA

Learn more here.

📅 Dates: November 17 – 19, 2025, submissions close January 27, 2025

📍 Location: University of Puget Sound, Tacoma, WA

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.