A study recently published in the American Journal of Preventive Medicine, authored by NDEWS Deputy Director, Dr. Joseph Palamar, examined data from the 2022 National Survey on Drug Use and Health. The results showed that while the prevalence of illicitly manufactured fentanyl use is rare in the general US population, past-year (mis)use of other drugs was not consistently associated with illicitly manufactured fentanyl use. Cannabis, cocaine, methamphetamine, heroin, and prescription opioid use disorder, however, were associated with higher odds of illicitly manufactured fentanyl use, suggesting that more severe use of various drugs is more of a risk factor than use. Read the study here.

A paper published earlier this week in Current Opinion in Psychiatry, led by NIDA T32 predoctoral fellow Nicole Fitzgerald and co-authored by NDEWS Director Cottler, and Deputy Director Palamar, summarized the most recent literature on approaches for monitoring new psychoactive substance (NPS) use and adverse events related to use. A variety of approaches have recently been employed for surveillance of NPS and associated harms, including the use of toxicology testing of patients in emergency departments, surveys of sentinel populations, drug checking and syringe service programs, wastewater-based epidemiology, and retrospective analysis of clinical samples and toxicology reports. Areas of particular interest for future research include drug-checking services and the development of methods for wastewater-based monitoring of NPS, studies that combine self-report data with toxicology testing, and the harmonization of multiple indicators. Read the paper here.

Last week, NDEWS received a media request asking for insight on pentobarbital trends in response to the recent DEA news release. According to the news release, the DEA recently seized five kilograms of pentobarbital along with other drugs (methamphetamine, cocaine, heroin) when agents busted a cartel-linked drug operation in Texas. If you have any data or information regarding pentobarbital or phenobarbital use in your area please share it using this form.

What is pentobarbital? Pentobarbital is a short-acting barbiturate. In the past it has been used as a sedative, to control convulsions, and for short-term treatment of insomnia. It has also been used in some US states for lethal injections, as well as by other countries, such as the Netherlands, for physician-assisted suicide. 
 
What is phenobarbital? Phenobarbital is also a barbiturate. It is most frequently used as an epilepsy treatment in developing countries, as well as a veterinary medicine in developed countries. It is also occasionally used to treat sleep and anxiety disorders and substance withdrawal symptoms. 
 
What was found? 5kg of pentobarbital were seized in southern Texas according to a recent DEA news release. Pentobarbital/phenobarbital discussions on Reddit have seen an increase for several years, as well as a more pronounced spike since late 2023. 
 
How is it being discussed? The discussion almost exclusively revolves around the use of either substance for suicide. Commenters are particularly interested in how to acquire these substances, how to make sure they are authentic, and what additional actions need to be taken to ensure suicide. The discussion primarily revolves around the proper dosage and potential health issues. Primary discussion of recreational use revolves around using small amounts of phenobarbital for opioid-like effects. Reddit users were willing to pay high amounts of money for phenobarbital/pentobarbital compared to typical novel psychoactive substances observed on the site. 
 
Drug Terms: Pentobarbital, phenobarbital, pentobarbitone, phenobarbitone, phenobarb, yellow jacket, Nembutal, Luminal 
 
Methodological Note: Data was collected and analyzed by the NDEWS Web Monitoring Team, led by Dr. Elan Barenholtz and NIDA T32 predoctoral fellow Daniel Van Zant of the Machine Perception and Cognitive Robotics (MPCR) Lab at Florida Atlantic University. Metrics are based on post counts derived from algorithmic monitoring of ~80 drug-oriented Subreddits. No personally identifiable or post-specific information is incorporated into this monitoring process. Due to modifications in our data collection protocols, the NDEWS Web Monitoring Team is currently unable to collect data for substances that generate high volumes of posts (e.g. xylazine or psilocybin). This temporary restriction, which is anticipated to persist until early June, reflects recent revisions to Reddit's Terms of Service on data gathering. For more methodological details, see our publication. 

In this week’s State Report, NDEWS highlights opioid and non-opioid overdose alerts for New York during 2023. These alerts indicate days in which the number of overdoses exceeded the expected number for that county. This expected count, or threshold, is calculated through biospatial, and accounts for population, seasonality, and other factors. Between January 1st and December 31st, 2023, there were a total of 31,382 opioid-involved nonfatal overdoses and 28,525 non-opioid-involved nonfatal overdoses identified in biospatial. The maps above indicate the frequency of alerts for non-opioid- or opioid-involved nonfatal overdose dispatches. Counties with three or more alerts during the reporting period are labeled. View the full report here.

People who have used drugs are invited to join Virtual HealthStreet to participate in periodic anonymous, special topic surveys specifically to get a better understanding of emerging drug trends across the US. Join here.

Earlier this week NPS Discovery published its Q1 2024 NPS Trend Reports. Trend reports are available for NPS benzodiazepines, NPS opioids, NPS stimulants and hallucinogens, and synthetic cannabinoids. Read the reports here.

Date: Wednesday, April 24, 2024

Time: 2:00 p.m. ET

Register here.

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