This week, the NDEWS Weekly Briefing focuses on the NDEWS Early Warning Network, including the April 2026 Sentinel Site Directors' (SSD) report, which highlights trends observed related to adulterants, specially "pharmacological" adulterants.

As always, we welcome your input.

Our Sentinel Site Directors were recently asked about trends observed related to adulterants, specially "pharmacological" adulterants, including non‑opioid sedatives, such as xylazine, medetomidine, and benzodiazepines; and local anesthetics (commonly referred to as “‑caines”). Our sites last reported on this in the July 2025 report.

Note: The terminology used may vary slightly from site to site. The data for many sites is labeled as preliminary and is subject to change. Availability of data and type of indicators varies by site, therefore reporting varies by site. Lack of information about a particular substance or trend from a site director does not indicate that the drug is not available or that the trend not apparent at that site. While trends observed may not be representative of broader trends within the US, responses provide insight of local context for changes in substance use and overdose patterns.

The tables below summarize changes in "pharmacological" adulterant prevalence across the 14 NDEWS Sentinel Sites over the past 6 months by US region.

Below we have highlighted more of their insights on "pharmacological" adulterant-related trends by region. To read the full report click here.

Click here to learn more about the NDEWS Sentinel Sites

In a 2018 article published in Science, Jalal and Burke used an exponential growth model to analyze US overdose deaths from 1979-2016. Building on this work, a recent short report published in the International Journal of Drug Policy led by Joseph Friedman and co-authored by NDEWS Co-Director Joseph Palamar, SAG member Dan Ciccarone, and Sentinel Site Director Annick Bórquez, recreated the Jalal-Burke curve to assess updated overdose trends through 2024 including trends by specific substances. The analysis found that overdose deaths involving heroin began declining around 2016, followed by prescription opioids, which peaked in 2017 and then decreased. Decreases in fentanyl-only deaths began in 2022, while deaths involving fentanyl mixed with stimulants saw declines as of 2024. Despite these encouraging trends, important challenges remain. Deaths involving stimulants alone (without fentanyl), as well as those involving xylazine, showed no decline in 2024. These patterns highlight the need for continued surveillance and more targeted prevention and intervention to address evolving public health concerns. Read the full short report here.

If you did not get a chance to give your feedback in our recent Weekly Briefing survey, please do so by clicking the link below to our Reader Response form! We believe that feedback is a gift!

Are you committed to advancing the science of substance use and public health? The University of Florida’s NIDA-funded T32 Training Program offers predoctoral and postdoctoral scholars an exceptional opportunity to launch impactful research careers focused on NDEWS!

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- Interdisciplinary training at the intersection of addiction science, epidemiology, and surveillance
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- A collaborative, inclusive research community committed to reducing the burden of substance use

Eligibility:
- US citizens or permanent residents
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Dear friends of NDEWS,

Have you ever been to a College on Problems of Drug Dependence meeting? If not, you are missing an opportunity to learn about drugs from the bench to the community. Many of us have made lifelong friends by attending the annual meeting. This year, the conference will be held on 13 - 17, 2026 in delightful Portland, Oregon! If you have never been before and want to learn more about the meeting and organization, click here.

Register for CPDD’s 88th Annual Meeting here.

We’d also love to see you at the Annual NDEWS Summit, which will be held as a hybrid event on Saturday, June 13 from 2:00–6:00 PM PT. While it is held in conjunction with CPDD, registration for the CPDD conference is not required to attend the NDEWS Summit.

Register for NDEWS Summit here.

📅 Date: Saturday, June 13, 2026

🕑 Time: 2:00 pm - 6:00 pm PT

📍 Location: In person at the Oregon Convention Center & Hyatt Regency Portland or virtually via Zoom.

We hope to see you there!

The NDEWS team

The NDEWS Weekly Briefing curates emerging data and findings from across the Early Warning Network, which includes three core components: our Scientific Advisory Group (SAG), comprised of national experts and federal partners; our Sentinel Site Directors (SSDs), who lead local surveillance in key geographic regions; and our Community-Based Health Experts, who provide on-the-ground insights from populations most impacted by drug trends. Together, these contributors generate timely, multidisciplinary and impactful information, ranging from peer-reviewed research findings to local surveillance data. These contributions inform public health and research communities.

You can share the NDEWS Weekly Briefing with friends, colleagues, and others who would benefit from information on recent and relevant news, articles, and data related to novel drug trends in the US and globally by clicking here.

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For more information on NDEWS' efforts, visit our website.

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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 (MPI: Cottler (contact), Co-Is: Goldberger, Nixon, Striley), NYU Langone Health (MPI: Palamar), and Florida Atlantic University (Co-I: Barenholtz).Any item may be reproduced provided the source is acknowledged.