A viewpoint paper published this week in JAMA Psychiatry, co-authored by NDEWS Deputy Director Dr. Joseph Palamar, discussed the rapidly changing landscape of ketamine both as a medical therapeutic and as a recreational substance. The authors highlighted several key points that healthcare practitioners, policymakers, and patients and their families should be aware of. Read the paper here.

A case report recently published in the Journal of Forensic Sciences detailed a new synthesis of illicit ketamine derived from seized lab materials and products. It was confirmed that cyclopentanone p-toluenesulfonylhydrazone and 2-chlorobenzaldehyde were used as novel starting materials for ketamine synthesis, being the first reported case to do so. This finding may increase awareness for law enforcement and forensic practitioners on novel substances used for the synthesis of illicit ketamine. Read the report here.

This week’s MMWR discussed a cluster of three young adult patients who were treated at local emergency departments for hyperthermia, seizures, and myocardial injury after consuming bromazolam disguised as alprazolam. The authors noted that the signs and symptoms in this case series are unexpected for a benzodiazepine overdose. They also stress the importance of physicians, medical examiners, toxicology laboratories, public health officials, and emergency responders to be aware of the increased presence of bromazolam both in polydrug ingestions and in substance use disorder patients who report the use of benzodiazepines. Read the report here.

Last month, NPS Discovery released a monograph on ortho-methylfentanyl, a novel synthetic opioid with structural similarity to fentanyl, that was detected for the first time in samples analyzed at their laboratory. Read the report here.

The DEA Toxicology Testing Program (DEA TOX) recently published a Third Quarter 2023 Report presenting results of cases analyzed and completed between July 1, 2023, and September 30, 2023. During this period, 119 biological samples from 113 cases originating from 16 states were submitted to DEA TOX. A total of 730 drugs and metabolites were identified and confirmed. Read the full report here.

A study published in Clinical Toxicology assessed the trends and characteristics of xylazine-involved deaths in Michigan between October 2019 and June 2023. It was found that the percentage of xylazine-involved deaths increased during this time and all xylazine positive samples also contained fentanyl. In addition, naloxone detection was low, and xylazine was often detected with multiple other drugs. These findings are consistent with national trends of xylazine presence in drug-involved deaths and highlight the importance of naloxone distribution efforts and the need for further research to contextualize the clinical significance of xylazine involvement in opioid overdoses. Read the study here.

A recent editorial published in Addiction discussed the differences in substance use patterns between North America and countries in the EU to gain insight into the possible trends of opioid use in the EU in the coming years. While synthetic opioids pose a large public health emergency in North America, heroin is still a drug of main concern in the EU. The authors note that understanding opioid use trends is crucial in preparing to respond to potential synthetic opioid use spikes if substance use trends shift from heroin use and the demographic of use shifts to younger age cohorts. Read the editorial here.

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