This week's briefing begins with a revisit of suspected nonfatal overdoses involving methadone which we first published in a January NDEWS analysis of 911 dispatch calls. Interest in methadone has resurfaced following discussions at the 2026 College on Problems of Drug Dependence (CPDD) conference, inquiries from colleagues nationwide, and signals detected by the NDEWS Early Warning Network. The January report covered January 2023 through December 2025; this report goes through July 2026. Among the 4 Regions, the Western and Northeastern regions dropped 2 counties from the January report and picked up 2 different ones in the top ten for suspected nonfatal overdoses involving methadone. The Midwest region dropped 1 and picked up 1 county in the top ten for suspected nonfatal overdoses involving methadone. The Southern region replaced 3 counties with 3 different counties. Overall, 80% of the counties remained in the top 10 for nonfatal overdoses that involved methadone.

Our NDEWS Web Monitoring Report is next, followed by a report from Scientific Advisory Group member Dr. Jennifer Havens from University of Kentucky, on her NIDA funded study of 825 rural Appalachians who use drugs. Among them, 67.4% reported lifetime use of methadone to get high.

And finally, we remind you of the NDEWS Webinar of Dr. Christopher McCurdy who will speak about 7-OH and other synthetics scheduled by the DEA. The webinar is September 24th from 1 to 2 pm Eastern Time.

As always, we welcome your input.

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What is Methadone? Methadone is a long-acting synthetic full mu-opioid receptor agonist commonly dispensed through specialized clinics for opioid use disorder maintenance and tapering, as well as prescribed for moderate to severe chronic pain. While primarily distributed through regulated clinical programs, discussions online also reference diverted prescription products and illicitly acquired formulations.

Why are we reporting on this? Reddit discussions include patterns such as attempts to modify therapeutic effects, withdrawal complications, concurrent use with illicit opioids and benzodiazepines, and the sourcing of diverted or illicitly acquired formulations.

Previous NDEWS Web Monitoring Reports:
- January 16, 2026

Public Health Impacts: Reddit discussants report adverse effects associated with methadone, frequently highlighting nausea, prolonged withdrawal symptoms, and acute anxiety or panic episodes. Commenters describe difficulty tolerating rapid dose reductions, noting physiological distress when tapering off maintenance therapy. Furthermore, multiple individuals recount concurrent use of central nervous system depressants, such as benzodiazepines, which discussants note can increase the risk of respiratory depression and compounded dependence.

How is it Being Discussed? Reddit commenters frequently discuss methadone in the context of transitioning from high-potency synthetic opioids like fentanyl, often debating its effectiveness in controlling persistent drug cravings. Multiple discussions center on the pharmacological effects of high maintenance doses on other opioids, with individuals actively inquiring about doses required to experience euphoric effects despite receptor saturation. There is also recurring dialogue concerning self-directed tapering schedules, sudden cessation due to missed clinical supplies, and the use of adjunct medications or unregulated research substances to mitigate withdrawal symptoms. Some discussions involve attempts to use methadone recreationally or to enhance its effects through other substances or medications. Methadone is also discussed in combination with substances including benzodiazepines, stimulants, ketamine, gabapentinoids, clonidine, kratom, and other opioids. Additionally, discussants share inquiries regarding the potentiating effects of other pharmaceuticals and novel routes of administration such as insufflation or injection.

Read more about NDEWS Web Monitoring Reports.

The following is a recent report on methadone use in rural Appalachia from NDEWS Scientific Advisory Group member Jennifer Havens, PhD, MPH, of the Center on Drug and Alcohol Research, Department of Behavioral Science, at the University of Kentucky College of Medicine.

In a cohort of 825 rural Appalachian people who use drugs recruited between 2023 and 2024, 556 (67.4%) reported lifetime use of methadone for the purpose of getting high, with the majority of methadone available on the street being diverted from prescriptions for pain management. Of those with lifetime use of diverted methadone, 14.9% reported past year use and 12.6% indicated use in the past six months. Of those participants reporting past 6-month use, 1.3% described methadone as the drug they most often used to get high and only 2 participants reported methadone injection. The median number of days using in the past month was 2 (interquartile range: 0, 20 days) and of the 132 past six-month overdoses reported by participants, none described methadone involvement. Further, no participants reported testing methadone with fentanyl test strips. In a 2025/2026 follow-up survey, a 75% reduction in past six-month methadone use was noted.

Data collected under R01DA033862 and R01DA055872.

A recent publication in JAMA Network Open by Kleinman et al. compared methadone and buprenorphine-naloxone among individuals with a past-year opioid overdose who initiated opioid agonist treatment in Ontario, Canada. In a matched cohort of 5,882 individuals, starting methadone was associated with a lower hazard of death during the subsequent year compared with starting buprenorphine-naloxone. Treatment duration was short for both medications, though significantly longer among individuals starting methadone, and there was no significant difference in opioid overdose during the year after treatment initiation. The authors note that epidemiologic studies and pragmatic trials in other jurisdictions are needed to confirm these findings.

Read the full study here.

A recent publication in Journal of Addiction Medicine by Miller et al. reviewed international evidence on methadone diversion, diverted methadone-involved overdoses, and methadone treatment delivery systems. Across 29 studies from seven countries, diverting methadone was most often done to help friends or partners, while common reasons for using diverted methadone were preventing withdrawal and avoiding opioid use. The review found that the link between specialty-care-only policies and lower diversion and overdose risk is not supported by the reviewed literature. The authors conclude that policymakers should weigh diversion risks against the benefits of lives saved through expanded methadone treatment access.

Read the full study here.

Christopher R. McCurdy, Ph.D., FAAPS, is a broadly trained medicinal chemist, behavioral pharmacologist and pharmacist whose research focuses on the design, synthesis and development of drugs to treat pain and drug abuse. During the upcoming NDEWS Webinar on September 24, Dr. McCurdy will discuss 7-hydroxymitragynine (7-OH) and other recently scheduled synthetic substances.

📅 Date: September 24, 2026

🕑 Time: 1 pm - 2 pm ET

📍 Location: Virtual via Zoom

Register for the webinar here.

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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.

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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 Special Reports 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). 

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