NDEWS highlights observations from biospatial detailing EMS encounters for nonfatal drug overdoses and suicide ideation in the US during 2024. Among states with at least 75% coverage, between January 1 to December 31, 2024, there were a total of 493 alerts across 27 states, from 278 different counties, identified by biospatial.

Of the 493 alerts, 160 (32.5%) were for nonfatal drug overdose only, 156 (31.6%) were for suicide ideation only, and 177 (35.9%) were for nonfatal drug overdose with suicide ideation.

To view the Special Report and a breakdown of the top 5 US states ranked by alert type, click here for the full report.

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What is Quetiapine? Quetiapine (Seroquel) is an antipsychotic medication primarily used to treat schizophrenia, bipolar disorder, and major depressive disorder, and as a sleep aid. As of 2023, it was the most prescribed antipsychotic in the United States.

What was found? The web monitoring team was originally alerted to the substance from a report on quetiapine overdoses in Tennessee. Discussion online has steadily increased within the past year, with a peak in November and a more recent trend upward since late December.

How is it being discussed? Analysis of online discussions reveals significant ongoing conversation about both prescribed and illicit use of quetiapine. Illicit use includes its' use as a "trip killer" for psychedelics, as a "comedown" aid for stimulants, and as an unprescribed sleep aid. Discussion frequently centers around dosage levels based on intended effects. Adverse effects mentioned include residual sedation, weight gain, and seizures. Reddit users frequently mention its interaction risks with other substances, particularly noting dangers when combined with stimulants or psychedelics. Commenters frequently highlight concerns about cognitive impairment, potential development of movement disorders, and increased dementia risk with long-term use.

Drug Terms: Quetiapine, Seroquel

Click here to read more about NDEWS Online Monitoring.

A recently published study in the International Journal of Mental Health and Addiction analyzed quetiapine’s role in fatal and nonfatal overdoses in Tennessee from 2019–2022. The study identified 622 nonfatal overdoses (397 unintentional, 225 intentional) and 144 unintentional fatal overdoses involving quetiapine. Among nonfatal cases, 24.4% were ≥55 years, 24.1% were <25, and 65% were White, while intentional overdoses were more common in those <25 (31.6%) with higher rates of polysubstance use. Fatal overdoses were 89.6% White, 63.2% female, and 63.9% aged 35–54. Co-occurring opioids appeared in 81% of fatalities, with fentanyl (54.0%) and prescription opioids (43.8%) most common. Compared to all Tennessee overdose deaths, quetiapine-involved fatalities had higher benzodiazepine (30.6% vs. 14.0%) and gabapentin (32.2% vs. 11.6%) prescriptions.

Read more here.

Image source: Luke-2, CC BY-SA 2.5, via Wikimedia Commons

A JAMA research letter published this week reports the detection of bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS), a UV stabilizer used in plastics, in the illicit fentanyl supply across nine U.S. locations. Testing of 770 drug product and residue samples from June to September 2024 found BTMPS in 35% of drug product samples from Los Angeles and Philadelphia and 13% of trace residue samples from other sites, with rising prevalence over time. BTMPS concentrations varied widely, often exceeding fentanyl content, suggesting possible changes in synthesis methods or dilution strategies. Samples containing BTMPS had significantly lower fentanyl levels (3.1% vs. 8.7%, p < 0.001). With BTMPS’s unknown health effects in humans and potential synthesis role, further monitoring is critical.

Read more here.

A study published in Drug and Alcohol Dependence used Ecological Momentary Assessments (EMA) to analyze daily and hourly polysubstance use among 117 people who used opioids (PWUO) in Oakland, CA. Participants reported substance use via a smartphone app three times daily for 28 days, with a 64.6% response rate. Prevalence of same-day polysubstance use was 77%, while same-hour use was 71%. Over half of the combinations occurred daily (59%) and included opioids with stimulants, alcohol, benzodiazepines, or multiple opioids; the rate dropped to 51% when excluding prescribed methadone. Opioid-stimulant combinations were most common, followed by opioids with alcohol or additional opioids.

Read more here.

A recent study in The American Journal of Drug and Alcohol Abuse, co-authored by Oliver Grundmann and Kirsten E. Smith, NDEWS collaborators, used latent class analysis to identify four distinct groups of US kratom consumers (n=395). The largest (32.4%) used kratom for chronic pain, while 19.2% with high substance use disorder (SUD) substituted it for other substances. Another 24.8% used it for anxiety and depression with lower kratom use disorder (KUD), while 23.5% had higher recreational use, KUD, and psychiatric symptoms.

Read more here.

A recent systematic review and meta-analysis in the Journal of Substance Use and Addiction Treatment examined risk factors associated with nonfatal opioid overdose (NFOD) across 53 studies, utilizing self-reported data to include individuals not engaged in medical treatment. Key risk factors for NFOD included polysubstance use, particularly benzodiazepines and problematic alcohol consumption, prior incarceration, homelessness, unemployment, psychiatric comorbidities, suicidal ideation or behavior, and prior, but not current, opioid agonist therapy (OAT). Current OAT use was protective, though overdose risk increased in the initiation phase.

Read more here.

A recent Addiction Outlook column in Psychology Today by Dr. Mark Gold reviews progress on opioid crisis initiatives since Volkow and McLellan’s 2016 NEJM recommendations. Opioid prescriptions have dropped from 81.3 per 100 people in 2012 to 43.3 in 2023, but some patients now turn to illicit opioids. Naloxone access has expanded, though fentanyl's potency complicates overdose reversal. Methadone remains underutilized due to regulatory barriers, and stigma still limits opioid use disorder treatment. Alternative therapies like cannabis and acupuncture are gaining use, while new research, such as Yale’s work on cannabinoid-based pain relief, offers hope.

Read more here.

The FDA has approved Vertex Pharmaceuticals' Journavx, a non-opioid painkiller designed to eliminate addiction and overdose risks associated with traditional opioids. Intended for short-term pain following surgery or injuries, Journavx blocks pain-signaling proteins before signals reach the brain, offering a novel mechanism compared to opioids like Vicodin and OxyContin. Clinical trials in over 870 patients showed the drug provided more relief than a placebo but was not more effective than standard opioid-acetaminophen combinations. Despite its innovative approach, concerns remain over its high cost ($15.50 per pill) and modest efficacy.

Read more here.

📅 Date: February 14, 2025

⏰ Time: 10:00 am to 3:45 pm ET

📍 Location: Virtual

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📅 Date: February 26, 2025

⏰ Time: 2:30 pm to 3:30 pm ET

📍 Location: Virtual

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📅 Dates: May 29 - May 30, 2025

🗓️ Submission deadline: February 19, 2025

📍Location: UF Academic and Research Center at Lake Nona, Orlando, FL

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📅 Dates: June 2 - 4, 2025

🗓️ Submission deadline: March 1, 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 EMS 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.