In this week’s report, NDEWS highlights observations from biospatial.io detailing the EMS encounters in the US for nonfatal opioid-related overdoses that also indicated suicide ideation, in 2023 and 2024. The data shows that all five counties with the highest rates of both nonfatal overdoses and suicide ideation over 24 months were in the lower half of the United States. Among states with at least 75% coverage,* 4,613 such encounters were identified in 2023, and 4,416 in 2024.

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

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What is Rilmazafone? Rilmazafone is a prescription drug used in Japan that acts as a prodrug to rilmazolam. It is primarily used medically for its' fast-acting sedative, anxiolytic, and soporific effects. Although not a benzodiazepine itself, it has several benzodiazepine metabolites.

What was found? Analysis of Reddit discussions indicates that rilmazafone has seen a significant increase in activity over time. Discussion of the substance has been on an upward trend since November, and it is currently at an all-time peak. Discussion has more than doubled since the previous report.

Past Reports: May 17th, 2024

How is it being discussed? Reddit users note diverse reasons for ingesting rilmazafone. Some of the primary ones are as "landing gear" to end trips early, to enhance the effects of alcohol or opioids, to mitigate social anxiety, or as a sleep aid. Many users also note that they prefer it to other benzodiazepines such as etizolam due to its' lesser sedative effects. Addictiveness, memory loss, and sleepiness are mentioned as negative side effects. Commenters also state that rilmazafone is sometimes sold by vendors mislabeled as other drugs like pyrazolam.

Other Terms: Rilmazafone, rilmazolam, rhythmy, 450191-S, リスミー

Click here to read more about NDEWS Online Monitoring.

A recent report from the Centers for Disease Control and Prevention (CDC) Newsroom indicates a decline in drug overdose deaths in the United States. Provisional data shows about 87,000 drug overdose deaths from October 2023 to September 2024, down from around 114,000 the previous year. This is the fewest overdose deaths in any 12-month period since June 2020. The CDC reports are based on provisional data from the National Vital Statistics System (NVSS), which collects and analyzes death certificate data from all 50 states and the District of Columbia. The decline in drug overdose deaths suggests that public health efforts aimed at addressing the opioid epidemic, such as increased access to treatment and overdose prevention programs, may be having a positive impact. However, the CDC cautions that the ongoing pandemic of overdose deaths requires continued attention and resources to prevent further decline.

Read more here.

A BMJ editorial by Guilamo-Ramos et al. examined the 22% decline in U.S. overdose deaths (August 2023–August 2024) and its potential policy implications. The authors attribute reductions to expanded naloxone access, increased opioid use disorder (OUD) treatment, and harm reduction efforts but note rising fentanyl-related deaths in Western states. They highlight disparities in overdose mortality, with Native American, Black, and Latino communities experiencing greater increases (140%, 126%, and 109%) compared to white populations (26%). 

Read more here.

A JAMA study by Dekker et al. analyzed data on 3.8 million buprenorphine prescriptions from 345,024 patients in California (2017–2022). Researchers found that emergency department (ED) buprenorphine prescribing increased from 0.1% to 5% of all initiations, while the proportion of ED clinicians prescribing buprenorphine rose from 2% to 16%. One-third of patients who received an ED-initiated prescription filled a second prescription, and 1 in 9 continued treatment for at least 180 days. 

Read more here.

A recently published JAMA editorial co-authored by Dr. Jeanmarie Perrone (NDEWS Sentinel Site Director), based on the JAMA study “Emergency clinician buprenorphine initiation, subsequent prescriptions, and continuous prescriptions” above, highlights California’s success in expanding emergency department (ED)-initiated buprenorphine. The number of ED buprenorphine prescribers increased 23-fold, showing a shift toward integrating opioid use disorder (OUD) treatment into emergency care. The authors urge national adoption of California’s model, emphasizing state funding, clinician training, and real-time support to reduce overdoses and expand access to lifesaving treatment.

Read more here.

A recently published Drug and Alcohol Dependence study by Madera-Garcia et al. on non-fatal opioid overdose and unmet need for medications for opioid use disorder (MOUD) among recently incarcerated people who inject drugs (PWID) reveals significant findings. Among the 1,648 participants from 20 large U.S. cities, 28% reported an unmet need for MOUD, and 39% experienced a non-fatal opioid overdose in the past year. The data indicates that PWID with unmet MOUD needs were 1.4 times more likely to report a non-fatal overdose compared to those without such needs in the past 12 months. 

Read more here.

In Psychology Today’s Addiction Outlook column, Dr. Mark Gold discusses the recent FDA approval of nicotine pouches for adults. The FDA cites the potential health benefits for adult, but Gold cautions that the growing popularity of nicotine pouches among adolescents could lead to nicotine addiction and potentially be a gateway to vaping or smoking. Nicotine pouch usage, like the brand Zyn, was found to be used increasingly among high school students according to the 2024 annual Monitoring the Future (MTF) study. Tenth-grade use increased 1.9% in 2023 to 3.4% in 2024. For seniors, use doubled, from 2.9% in 2023 to 5.9% in 2024. The discreet nature of pouch use and appealing flavors of products like Zyn may increase popularity among teens. In 2024, 7.8% of high school students were estimated as having used e-cigarettes, making it the most commonly used tobacco product among this group. The data highlights a disconnect between the FDA’s analysis of teen use and the apparent growing popularity of nicotine pouches among adolescents. 

Read more here.

📅 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.

📅 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.