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Issue 219: February 21, 2025
 
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NDEWS ORIGINAL CONTENT

 
 

NDEWS Special Report: EMS encounters for nonfatal and fatal heroin-related overdoses in the US January 1, 2023 – December 31, 2024

 
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NDEWS highlights observations from biospatial.io detailing EMS encounters for nonfatal and fatal heroin-related overdoses in 2023 and 2024. The graph included in this report depicts a decline in overdoses over time in EMS encounters for nonfatal heroin-related overdoses as well as fatal heroin-related overdoses. Among states with at least 75% coverage,* between January 1, 2023, to December 31, 2024, there were 116,221 nonfatal heroin-related overdoses and 2,403 fatal heroin-related overdoses identified by biospatial.io.

To view the entire Special Report from the weekly briefing, click here.

Click here to learn more about NDEWS Hotspot Alerts
 
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Alert from the NDEWS Web Monitoring Team: Methallylescaline

 
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What is Methallylescaline? Methallylescaline is a synthetic analog of mescaline. It is a 5-HT receptor agonist.

What was found? Analysis indicates that Reddit discussion on methallylescaline has been increasing since late 2023. There has been a recent spike since November.

Past Reports: May 10, 2024

How is it being discussed? Methallylescaline is discussed primarily in the context of its psychedelic effects, which are frequently compared to those of mescaline. Discussions often warn of methallylescaline's steep dose-response curve, where small dosage changes can dramatically alter the experience. Some users experiment with polysubstance use where methallylescaline is combined with other substances like etizolam. Since the last report there has been increased discussion on the nausea and "body load" caused by the heavily stimulating properties of the substance

Other Terms: MAL, methallylescaline
Click here to read more about NDEWS Online Monitoring.
 
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An analysis of the size of law enforcement seizures of illicit fentanyl in the United States, 2018–2023

 
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A new analysis in Drug and Alcohol Review by Dr. Palamar (NDEWS Deputy Director), Dr. Fitzgerald (NDEWS and NIDA T32 alum), and Dr. Carr (NDEWS SAG member) examined U.S. fentanyl seizures (2018–2023) using High Intensity Drug Trafficking Areas (HIDTA) data. Annual Percentage Change (APC) showed a decline in large fentanyl powder seizures (≥400 grams [g], APC = -5.3%) but increases in small powder seizures (1–4g, APC = 5.6%) and large pill seizures (400–3999 pills, APC = 14.0%; ≥4000 pills, APC = 12.6%). These trends indicate a shift toward fentanyl pill distribution, raising concerns about overdose risk and harm reduction efforts.
Read more here.
 
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RECENTLY PUBLISHED

 
 

The prevalence of fentanyl in New York City’s unregulated drug supply as measured through drug checking offered at syringe service programs

 
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A new study in Drug and Alcohol Dependence by Estrada et al. examines fentanyl prevalence in New York City’s unregulated drug market through 1,644 drug samples analyzed at syringe service programs (2021–2023). Using fentanyl test strips (FTS), Fourier-transform infrared (FTIR) spectrometry, and secondary lab testing, researchers found 95.3% of opioid samples contained fentanyl, while fentanyl was rarely detected in samples sold as cocaine or methamphetamine.

These findings align with emerging data from Washington State, where ongoing drug-checking efforts highlight the increasing complexity of the unregulated fentanyl supply. Analysis of samples sold as fentanyl in 2024 reveals significant variability in composition, with fentanyl analogues, xylazine, and novel substances such as BTMPS (Bis[2,2,6,6-tetramethyl-4-piperidyl]sebacate) frequently detected. Some fentanyl analogues, including carfentanil, are significantly more potent than fentanyl, exacerbating overdose risks.

Read more here.
 
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Characterization of xylazine-related overdose deaths in Maryland (2020–2023)

 
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A new study in Drug and Alcohol Dependence by Wang et al. examines xylazine-related overdose deaths (XRODs) in Maryland (2020–2023). Among 8,721 fentanyl overdose deaths, 20.6% tested positive for xylazine, with rates peaking in 2021 before declining. White individuals (aOR=1.18), adults aged 31–40 (aOR=1.25), and those with co-occurring morphine (aOR=1.36), methadone (aOR=1.41), benzodiazepines (aOR=1.20), or tramadol (aOR=2.12) had higher odds of XROD. While Black individuals experienced the highest overall burden of overdose, xylazine presence was more common among White decedents.
Read more here.
 
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Naloxone distribution amidst shifting drug use patterns: Insights from a needs-based syringe services program

 
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A new short communication in Drug and Alcohol Dependence by Eger et al. examines naloxone distribution trends in a Southern California syringe services program (SSP), analyzing 1,260 encounters (January–June 2024). 44% of encounters included naloxone, but distribution rates varied significantly by supply type. Naloxone was provided in 30% of encounters involving pipes only, compared to 42% with syringes only, 58% with both, and 71% with neither pipes nor syringes. Despite differences in naloxone access, there was no significant variation in reported overdose responses using naloxone by supply type over 14 days.
Read more here.
 
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Synthetic cannabinoid use among noninstitutionalized individuals in the United States, 2021-2023

 
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A new short communication in Drug and Alcohol Dependence by NDEWS Deputy Director, Dr. Joseph Palamar, and colleagues reports a 50% increase in synthetic cannabinoid use from 2021 (0.17%) to 2023 (0.26%) based on National Survey on Drug Use and Health (NSDUH) data. The largest increases were among adults 35+ (255.3%), low-income individuals (242.1%), and those with methamphetamine use (184.6%). Given health risks and potential misreporting due to novel cannabis products, the authors emphasize the need for continued surveillance.
Read more here.
 
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DEA TOX: Third quarter 2024 report

 
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A new DEA Toxicology Testing Program (DEA TOX) report for Q3 2024 analyzed 147 biological samples from 134 cases across 21 states, identifying 1,056 drug and metabolite detections, including 102 novel psychoactive substances (NPS), 432 traditional recreational drugs (TRD), and 356 prescription/OTC drugs. Key findings include a high presence of fentanyl (36.6% of cases) and NPS detection in 31.3% of cases.
Read more here.
 
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IN THE NEWS

 
 

 ‘One of the larger mysteries I’ve ever seen’: Industrial chemical found in illicit fentanyl

 
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A recently published JAMA study has identified BTMPS (bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate)—an industrial plastic additive—in high concentrations within illicit fentanyl samples across the U.S. The average BTMPS content was 8.6% by mass, with some samples exceeding 56% BTMPS. The study, conducted by researchers at UCLA, analyzed drug samples from nine community-based drug-checking programs over four months. Findings suggest that BTMPS is being intentionally or accidentally introduced at the manufacturing level, possibly through changes in synthesis methods or dilution processes. Health concerns include cardiotoxicity, reproductive defects, lung damage, and overdose risks due to potential lowered fentanyl tolerance following exposure.
Read more here.
 
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Calls to reassess cannabis risks: New research reported

 
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A recent Addiction Outlook column in Psychology Today, Dr. Mark Gold highlights the growing public health risks of cannabis legalization, citing a 42.7% increase in cannabis use disorder (CUD) and a doubling of cannabis-related poisonings in states with medical cannabis laws. Another JAMA study found teen cannabis users were 2–4 times more likely to develop psychiatric disorders, depression, and suicidality.
Read more here.
 
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UPCOMING WEBINARS & EVENTS

 
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Addiction medicine grand rounds: The Canadian experience with supervised injectable opioid agonist treatment

 
 

📅 Date: February 25, 2025
⏰ Time: 2:30 pm to 3:30 pm ET
📍 Location: Hybrid (Yale School of Public Health & Zoom)

Learn more here.
 
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Stimulants and hallucinogens:  New and old drugs, and their impacts and challenges in intoxication and death

 
 

📅 Date: February 26, 2025
⏰ Time: 2:30 pm to 3:30 pm ET
📍 Location: Virtual

Learn more here.
 
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Call for submissions: Cannabis Clinical Outcomes 2025 Research Conference 

 
 

📅 Dates: May 29 - May 30, 2025
🗓️ Submission deadline: March 2, 2025
📍Location: UF Academic and Research Center at Lake Nona, Orlando, FL

Learn more here.
 
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Testing the Waters 8 International Conference on Wastewater-based Epidemiology
 

Call for submissions: Testing the Waters 8th Conference in Tacoma, WA

 
 

📅 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
 
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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.
 
 
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