A study published earlier this week in Drug and Alcohol Dependence, authored by NDEWS researchers Drs. Joseph Palamar, Nicole Fitzgerald, Bruce Goldberger, and Linda Cottler investigated potential indicators of illicit pentobarbital use and availability in the US to determine whether this drug is becoming an emerging public health concern. NDEWS requested information on pentobarbital from its Sentinel Site Directors as well as other collaborators and also conducted a search of current literature. The results showed that pentobarbital has been detected since 2020 with multiple batches of counterfeit M30 pills confiscated near the Southwest border as recently as early 2024. Read the study here.

This week, NDEWS highlights counties with the highest alert counts for nonfatal opioid or non-opioid overdoses. There were a total of 9 alerts and 1 alert with both nonfatal opioid and non-opioid overdoses across 2 states and 3 counties from July 1 to July 31, 2024. Read more here. Click here to read more about NDEWS Hotspot Alerts.

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 was found? NDEWS leadership recently published a paper on illicit pentobarbital use and availability. The Web Monitoring team last reported on discussion trends surrounding pentobarbital on April 12th. Since then, discussion of the substance has nearly doubled, and discussion of non-suicidal recreational pentobarbital use, in particular, has increased.

Expert Insight: "Through collaboration with our NDEWS sentinel sites and affiliates, we have learned that there have been seizures of counterfeit pills pressed as M30s found to contain pentobarbital in addition to fentanyl and xylazine. There have also been several recent diversions of prescription pentobarbital, large seizures of pentobarbital powder, and there have been some recorded deaths involving the drug, often with suicide being the cause of death. We need to continue to monitor this potent barbiturate as it has the potential to further complicate the opioid crisis."

-NDEWS Deputy Director Joseph Palamar

How is it being discussed? The discussion still mostly revolves around the use of the substance for suicide. Commenters are particularly interested in how to acquire the substance, how to ensure its authenticity, and what additional actions need to be taken to ensure suicide. The discussion primarily revolves around the proper dosage and potential health issues. There has been a comparatively higher volume of discussion in the past four months surrounding pentobarbital's recreational use. A primary discussion of recreational use revolves around using small amounts of pentobarbital for opioid-like effects, benzodiazepine-like effects, as a sleep aid, or for chronic pain management. Reddit users comment on the relative ease of acquiring the substance compared to barbiturates with similar effects. Discussion around polysubstance use of pentobarbital has increased significantly. Commenters most commonly discuss combining pentobarbital with otherwise legal psychoactive substances such as aspirin or caffeine as well as a much smaller amount of discussion surrounding combining pentobarbital with psychedelics.

Drug Terms: Pentobarbital, pento

We are leaning on NDEWS Briefing Readers to share their input as part of our emerging trends reporting network to assist with on-the-ground investigations and dissemination of results to the field.
 
Note: Limited NDEWS staff have access to the response form and inbox so your responses will remain anonymous.  All responses will be aggregated by region without identifiers. Sharing your insight will aid NDEWS in continuing to serve as a vital source of scientific information about emerging drugs and drug trends. Please let us know:

Have you observed an increase in recreational MDMA (also known as "Molly" and "Ecstasy") use in your area? Include any information on multi- or polysubstance use that involves use of MDMA.

Tell us what you know about Diamond Shruumz* brand candies (chocolate bars, cones, and gummies) - have you or someone you know experienced adverse effects after consuming these products? What about adverse effects of other recreational mushroom use in your area? If applicable, tell us more *Note that all Diamond Shruumz-brand products were recalled by the FDA in July 2024 - ensure to discard these products if you have them. If you become ill after consuming these products, please contact your healthcare provider and/or call the Poison Help Line at 1-800-222-1222.

NDEWS is interested in what you have heard about recreational use of 7-OH (also known as “7-hydroxymitragynine,” “7HMZ,” or “7(omega)MZ.”) in your area as there are diverse opinions on kratom and kratom-like products.

Please submit any information you have on the following questions here.

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Earlier this week, the National Institute on Drug Abuse announced that the National Institutes of Health has launched a program that will support Native American communities to lead public health research to address overdose, substance use, and pain. The program titled the Native Collective Research Effort to Enhance Wellness (N CREW) Program with funding totaling approximately $268 million over seven years will support research projects that are led directly by Tribes and organizations that serve Native American communities. Read the press release here.

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