In this week’s report, NDEWS highlights observations from biospatial.io detailing the EMS encounters in the US for nonfatal methamphetamine-related overdoses among younger adults (18-64) and older adults (65+) in 2024. The data shows that adults 65 of age and older experience a slightly earlier peak (between 14:00 and 18:59) in nonfatal methamphetamine-related overdose encounters than younger adults, who experience their overdoses between 17:00 and 21:59. Among states with at least 75% coverage,* from January 1 to December 31, 2024, there were 151,586 such encounters among younger adults, and 5,312 among older adults.

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

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What was found? According to information from the Palm Beach County Sheriff's Office, "mushroom gummy" products have been found to contain 4-acetoxy DET and 4-hydroxy DET. These are synthetic tryptamines that are controlled substances in many states. Analysis of online content reveals a downward trend in discussion about synthetic mushroom gummies over the past several months. 

How is it being discussed? Online discussion talks about acquiring commercial "mushroom gummies" in head shops, smoke shops, and gas stations. Reddit users warn that based on personal laboratory testing, the products may not contain actual psilocybin mushrooms but instead contain various research chemicals (RCs), particularly 4-ACO-DMT. Commenters report experiencing severe adverse reactions including nausea, dizziness, extreme anxiety and vomiting after consuming these products. Many describe completely different effects from the same branded products. Discussions frequently reference the CDC warning about Diamond Shruumz products. Online users who have tested the substance report results showing combinations of compounds including ibotenic acid, muscimol, pregabalin (Lyrica), and various Kava compounds in certain products. Some discussants report experiencing HPPD (Hallucinogen Persisting Perception Disorder) symptoms, including persistent visual disturbances that continue long after consumption. Several accounts mention requiring emergency medical attention after consuming recommended or advertised doses. 

Drug Terms: mushroom gummies, mushroom gummy, Diamond Shruumz, Road Trip Desert Stardust

Click here to read more about NDEWS Online Monitoring.

A recently published commentary in the Lancet Regional Health – Americas by Drs. Zhu and Palamar (NDEWS MPI) warns of the increasing presence of medetomidine, a potent α2-adrenergic receptor agonist originally for veterinary use, in illicit fentanyl supplies across the U.S. First detected in Maryland in mid-2022, medetomidine has since been linked to overdose clusters in Philadelphia, Pittsburgh, and Chicago (2024). With 200–300 times the potency of xylazine, it presents heightened risks of prolonged sedation, bradycardia, and respiratory depression. The authors call for expanded epidemiological surveillance, medetomidine-specific clinical guidelines, and rapid testing access, drawing on strategies used to monitor xylazine. NDEWS is actively tracking its spread, but the authors emphasize the need for policy action, drug-checking expansion, and research into potential antidotes like atipamezole. 

Read more here.

Related NDEWS Materials
· Medetomidine Infiltrates the US Illicit Opioid Market | Substance Use and Addiction Medicine | JAMA | JAMA Network
· Archived Alerts from the Web Monitoring Team

A recently published study in JAMA Network Open by Jacobson and Powell surveyed 1,515 U.S. adults between June 7th and June 29th, 2024, including 512 reporting opioid dependence, to assess naloxone knowledge, carrying, purchase, and use. Nearly 90% of respondents with opioid dependence correctly identified naloxone's purpose, compared to 46% of the general population. Naloxone carrying was higher among those at risk, with 60.5% of opioid-dependent respondents carrying naloxone, compared to 10.6% in the general sample. However, most naloxone was not purchased, suggesting pharmacy sales and insurance data underestimate actual access.

Read more here.

A recently published study in Drug and Alcohol Dependence by Bredenberg et al. including NDEWS SAG member, Dr. Matthew Ellis, found significant gaps in naloxone possession and knowledge among 5,663 adults entering opioid use disorder (OUD) treatment in 2022. Only 49% owned naloxone and 64% knew where to obtain it. Possession was lowest among oxycodone users (25%) and highest among those using heroin (49%) or fentanyl (55%). Patients who injected drugs (61%) or had a prior overdose (59%) were more likely to carry naloxone. 

Read more here.

A recently published study in the Journal of Forensic Sciences by Ballotari et al. including NDEWS Co-Investigator Dr. Bruce Goldberger, optimized gas chromatography–mass spectrometry (GC-MS) to detect bromazolam, etizolam, and flualprazolam in postmortem blood from Florida medical examiner cases (2022–2023). Of 35 screened cases, 21 tested positive for at least one designer benzodiazepine, with bromazolam detected in 20 cases (range: 5.9–352 ng/mL, median: 28.5 ng/mL). Polydrug use was present in all cases, with fentanyl, methamphetamine, and cocaine being the most common co-detected substances.

Read more here.

A new study in Experimental and Clinical Psychopharmacology by Schepis et al. analyzed national U.S. data (2015–2020) to examine stimulant use disorder (SUD) severity across different psychostimulant use patterns. Findings show that individuals using methamphetamine or multiple stimulants (polystimulant use) had significantly higher rates of SUD, more symptoms, and greater disorder severity compared to those who misused prescription stimulants (NUPS) or used cocaine only. Depending on DSM criteria, 34%–47% of polystimulant users and 48%–54% of methamphetamine users met SUD criteria, compared to 9%–17% for NUPS-only and 16%–24% for cocaine-only.

Read more here.

In Psychology Today’s Addiction Outlook column, Dr. Mark Gold discusses that teen nonmedical misuse of medications like dextromethorphan (DXM) and promethazine may be more widespread than previously recognized. Dr. Linda B. Cottler, Director of NDEWS, warns, “Parents should be aware of these combinations and talk to their children about avoiding ‘cough’ medicines acquired from friends, friend’s siblings, or friends’ parents.” The NDEWS web monitoring team issued an alert on February 14, 2025, after detecting a surge in Reddit discussions about DXM and promethazine since August 2024. 

Read more here.

📅 Date: March 13, 2025

📍Location: Online

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📅 Date: Thursday, March 20, 2025

🕑 Time: 2 p.m. ET

📍 Location: Online

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📅 Dates: May 29 - May 30, 2025

🗓️ Submission deadline: March 2, 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.