Two first-authored articles by Dr. Fitzgerald made the list for Psychology Today’s Top Addiction Findings and Research Articles of 2024, selected by Dr. Mark Gold.

Ranked #6 in Psychology Today’s top addiction findings of 2024, Fitzgerald et al.'s study on polysubstance use (PSU) patterns sheds critical light on the ongoing evolution of the opioid crisis. Nearly all individuals testing positive for fentanyl (93%) had co-ingested additional substances, with cocaine-alcohol combinations being among the most common. When combined, cocaine and alcohol produce cocaethylene, a psychoactive compound that intensifies addiction risk and health consequences. The analysis from the Knackstedt and Cottler NIDA-funded PSU study also identified distinct hour-level patterns of PSU, highlighting the temporal dynamics of drug combinations. These findings position PSU as a hallmark of the opioid crisis' "fourth wave," where fentanyl is rarely consumed without other drugs.

Ranked #10 in Psychology Today’s top addiction research article of 2024, a collaborative review led by NDEWS team highlights the critical role of public health surveillance in addressing emerging drug threats. The research highlights the growing dangers of new psychoactive substances (NPS) like xylazine, a drug adulterant associated with severe side effects, including “zombie-like” behavior. The review showcases innovative monitoring methods developed by the NDEWS team, including wastewater analysis, poison control data, and cutting-edge nightclub surveillance to track NPS trends in real time.

Read more about the Top Findings on Addiction in 2024 here.

Read more about the Top 10 Addiction Research Articles of 2024 here. 

What is 2-FXE? 2-FXE, also known as CanKet, 2F-NENK, and 2F-NENDCK, is a dissociative drug similar in structure to phencyclidine compounds with a 2-halogen and a 2'-Oxo substitution. It was first discovered by CanTEST, a Canberra, Australia-based testing service, in samples that were sold as ketamine.

What was found? 2-FXE has been consistently increasing in popularity with a recent upward trend starting in late November. Discussion is currently over 4x higher than it was at our last report.

Previous reports:
June 5, 2024

How is it being discussed? Online discussions compare 2-FXE to other dissociative drugs such as ketamine. It is described as a longer-lasting, higher potency, more sedating ketamine, by some Reddit users. However, there are subjective reports of very adverse trips with disturbing "body horror" visuals. Some commenters have also reported kidney damage from ingesting 2-FXE. Since the last report discussion has increased comparing 2-FXE to 2F-DCK as well as increase in discussion from commenters claiming that the substance does not appear on drug tests. There are also comments stating experiences of bladder related effects, such as increased urinary frequency and kidney stones.

Drug Terms: 2-FXE, CanKet, 2F-NENK, 2F-NENDCK, 2-F-2-Oxo-PCE

Click here to read more about NDEWS Online Monitoring.

A recent Viewpoint article in The Lancet by Dr. Joseph Friedman and NDEWS SAG member, Dr. Daniel Ciccarone, highlights the escalating danger of counterfeit pills containing synthetic drugs like fentanyl and nitazenes. These pills, now constituting nearly 50% of illicit fentanyl seizures in the U.S., mimic authentic medications such as oxycodone and alprazolam, contributing to rising overdose deaths among adolescents and tourists. The article cites cases in Mexico, where independent pharmacies sell counterfeit pills containing fentanyl and methamphetamine, and in Canada, where 50% of tested diverted pills contained unexpected substances, including novel benzodiazepines. The authors recommend education campaigns, pill-testing programs, and safer supply options to address this growing global crisis.

Read the study here.

A recent study by Martin et al., published in the International Journal of Drug Policy, analyzed 2,210 drug samples from Maryland’s Rapid Analysis of Drugs (RAD) program (October 2021–October 2023) to examine wound-associated adulterants in the unregulated drug supply. Xylazine, detected in 33.4% of samples, primarily co-occurred with fentanyl and other opioids, showing a decreasing trend statewide but remaining highly prevalent in Cecil County. Levamisole (1.9%) and medetomidine (0.7%) were less common but appeared with cocaine and opioids, posing risks such as wounds and respiratory depression. Over 63% of fentanyl-positive samples contained xylazine, which complicates overdose reversal due to naloxone resistance.

Read the study here.

Find xylazine (also known as tranq) harm reduction, wound care and other resources here.

A recent study by Cano et al., published in the International Journal of Drug Policy, analyzed 26,635 law enforcement-reported overdoses from Pennsylvania’s Overdose Information Network between 2018 and mid-2024, highlighting the challenges of opioid-stimulant co-involvement. The study found naloxone was administered in 72% of suspected opioid-only overdoses but dropped to 55% for opioid-cocaine cases and 52% for opioid-methamphetamine cases. Survival rates mirrored this trend, with 82% of opioid-only overdoses resulting in survival, compared to just 59% for opioid-cocaine and 57% for opioid-methamphetamine cases. Mediation analyses showed naloxone administration accounted for approximately 39% of the survival differences in opioid-stimulant overdoses.

Read the study here.

The Center for Forensic Science Research & Education (CFSRE) develops quarterly trend reports by using novel approaches of gas chromatography mass spectrometry (GC-MS) and liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) to analyze more than 1,200 drugs with a focus on novel psychoactive substances (NPS) and and their metabolites.

These trend reports are intended to provide near real-time information regarding NPS prevalence, positivity, and turnover by summarizing the number of NPS identified by CFSRE via sample-mining, data-mining, routine testing, and esoteric testing. Samples are acquired from recreational drug materials, drug equipment, medicolegal death investigations, clinical intoxications, and/or impaired driving investigations.

Notable NPS in the trend reports include ohmefentanyl (also known as β-hydroxy-3-methylfentanyl, OMF and RTI-4614-4), carfentanil, nitazene analogues, bromazolam, and synthetic cannabinoids such as MDMB-4en-PINACA, 5F-ADB and more.

Follow the links below to view each individual trend report:

     • NPS Benzodiazepines
     • NPS Opioids
     • NPS Stimulants & Hallucinogens
     • Synthetic Cannabinoids

Access all reports here.

In Salon’s recap of 2024’s defining drug trends, Dr. Joseph Palamar, NDEWS Deputy Director, discusses the growing popularity of "pink cocaine," also known as “tuci.” This drug, a vibrant pink powder, is a mix of substances like MDMA, ketamine, and 2C-B but rarely contains actual cocaine. Its unpredictable composition makes it difficult to track and heightens the risk for people who use tuci. Dr. Palamar expressed concern over the potential for fentanyl contamination in tuci, which could turn the drug from a recreational novelty into a deadly threat. The spread of pink cocaine in Latin America, Europe, and the U.S. highlights the challenges of monitoring and mitigating risks associated with unregulated drug cocktails.

Read the article here.

In her latest blog post, Dr. Nora Volkow, Director of the National Institute on Drug Abuse (NIDA), reflects on 50 years of advancements in addiction science while emphasizing priorities for 2025. Despite a 17% decline in overdose deaths from July 2023 to July 2024, she highlights ongoing racial disparities, particularly among Black and American Indian/Alaskan Native populations, and the need for further action.

Dr. Volkow outlines four critical areas of focus: preventing drug use and addiction by addressing prenatal exposures, adverse childhood experiences, and early psychiatric disorders; overdose prevention, including expanding naloxone access through mobile distribution and exploring novel treatments for methamphetamine overdoses; improving treatment access, such as piloting methadone distribution through pharmacies and implementing contingency management for stimulant use disorders; and leveraging new technologies, including GLP-1 agonists, neuromodulation, and AI to enhance research.

Read the article here.

In the Seattle Times, Dr. Caleb Banta-Green, a NDEWS Sentinel Site Director, discusses the shifting landscape of street drugs in the “era of synthetics," in which new substances are introduced into the unregulated drug supply including sedatives, animal tranquilizers and an industrial chemical (BTMPS). In addition to researchers and care providers struggling track these shifting trends, a less reliable drug supply increases risks for people who use drugs as potency changes occurring in the drugs and/or added contaminants may expose people to substances that they are unknowingly consuming and could cause overdose reversal drugs like naloxone to be ineffective.

In response to these unpredictable changes in the drug supply, Seattle and King County is making efforts to reduce and protect against overdoses including increasing drop-in addiction services and Narcan distribution, opening a postoverdose recovery center and piloting a program allowing Seattle firefighters and EMTs to administer buprenorphine. But Dr. Banta-Green notes that in addition to these efforts, there is a need to increase accessibility to medications like buprenorphine and methadone.

Read the article here.

Between June 1-November 30, 2024, the Addictions, Drug & Alcohol Institute (ADAI) at the University of Washington has identified over 237 unique drugs and substances in 816 samples via community drug checking. While some results highlighted cutting agent (adulterants or co-occurring substances that are typically not psychoactive like baking soda, sugar, etc., and are unlikely to contribute to accidental substance poisoning, although some may be associated with other health risks), others results detected unexpected contaminates such as chemical compounds and substances not approved for human consumption or have other proposes such as local anesthetics including procaine and lidocaine, and xylazine, a veterinary sedative.

For more information on drug checking results in Washington

for samples submitted for confirmatory testing to ADAI

📅 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.

📅 Date: January 16, 2025
Time: 12:00 pm – 1:00 pm ET
📍Location: Virtual

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📅 Date: January 29, 2025
Time: 10:00 am – 11:00 am 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.