Earlier this week, a recently published viewpoint in JAMA, co-authored by NDEWS Deputy Director Dr. Joseph Palamar, and NDEWS colleague Dr. Alex Krotulski, reported the infiltration of medetomidine, a veterinary tranquilizer, into the U.S. illicit opioid market. Medetomidine, often referred to as “rhino tranq,” is increasingly being found mixed with fentanyl and xylazine, further exacerbating the opioid crisis. Medetomidine’s potency, which is 200-300 times greater than xylazine, makes opioid overdoses more difficult to reverse with naloxone alone. NDEWS will continue to monitor various data sources for shifts in medetomidine poisonings. Read the viewpoint here.

This week, NDEWS highlights observations from biospatial detailing the utilization of naloxone in opioid-involved nonfatal overdoses. Among states with at least 75% coverage, the five with the highest rate of nonfatal opioid overdose dispatches per 10,000 population are shown above (Kentucky, Maine, South Carolina, Alaska, and Florida). Read more here.
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What is etomidate? Etomidate is a short-acting intravenous anesthetic drug marketed under the brand name Amidate. It has been used as a component in lethal injection protocols. 

What was found? Etomidate discussion has had a consistent upward trend since the beginning of December 2023.

How is it being discussed? Online commenters generally do not recommend etomidate for recreational use due to its very short duration of effects. Discussants warn that using etomidate while ill could be dangerous due to its adrenal suppression effects. A small number of Reddit users reported presence of etomidate as an adulterant in heroin supplies. Commenters compared Etomidate effects to methaqualone, benzodiazepines, or barbiturates.

Drug Terms: Etomidate, Amidate

NDEWS Deputy Director, Dr. Joseph Palamar featured in Rolling Stone

Matthew Perry, Ketamine, and Me: For one writer, the drug proved to be a life-altering treatment. Why did Perry’s experience end in tragedy? Read more here.

A recently published analysis in JACEP Open, co-authored by NDEWS colleagues Dr. Barry Logan and Dr. Alex Krotulski, highlights a concerning trend in opioid overdoses among emergency department patients from 2020 to 2021. The study reveals that among 168 patients with suspected heroin overdoses, 88% tested positive for fentanyl or its analogs, whereas only 27% had biomarkers for heroin. In a broader sample of 406 patients, 78% were found to have fentanyl or its analogs, compared to just 15% with heroin biomarkers. These findings show a significant gap between reported heroin use and actual opioid detection, indicating that fentanyl is frequently involved in cases initially suspected to be heroin overdoses. Read the article here.

Earlier this week, National Institute on Drug Abuse Deputy Director Dr. Nora Volkow published a blog discussing International Overdose Awareness Day, where she presented new data from the CDC showing a 7.5% decline in overall overdose deaths in 12 months ending in March 2024, the largest drop in decades. Despite this progress, Dr. Volkow drew attention to a nearly five-fold increase in overdose deaths among non-Hispanic Black men aged 55 and older between 2015 and 2023, with 2023 rates nearly three times the national average for their age group. This alarming trend, particularly pronounced in cities like Baltimore, is driven by the rise in fentanyl-related overdoses, often compounded by stimulants like cocaine. Dr. Volkow emphasized the critical need for interventions addressing structural racism, healthcare disparities, and social isolation, which disproportionately affect older Black men and contribute to their escalating overdose rates.
Read the full blog post here.

The Drug Enforcement Administration (DEA) released its 2024 National Drug Threat Assessment (NDTA) highlighting the severe impact of illicit fentanyl and other synthetic drugs. The report states that synthetic opioids, primarily fentanyl, were involved in 74,225 deaths in 2022, accounting for 68% of the total 111,036 drug-related deaths that year. Additionally, provisional data for the first half of 2023 indicates that nearly 38,000 people died from synthetic opioid overdoses, mostly due to fentanyl. The report highlights that synthetic drugs, such as fentanyl and methamphetamine, are now responsible for nearly all fatal drug overdoses in the United States. Read the full report here

This month marks a time to remember the lives lost to suicide, the millions who have struggled with suicidal thoughts, and the individuals, families, and communities that have been impacted. All month mental health advocates, prevention organizations, survivors, allies, and community members unite to promote suicide prevention awareness. Click here for additional resources.

Join us in recognizing the first annual 988 Day on September 8 as part of the national initiative dedicated to raising awareness about the 988 Suicide & Crisis Lifeline and emphasizing the importance of mental health and suicide prevention.

The 988 Lifeline is available 24/7/365, offering judgment-free support for mental health, substance use, and more. All conversations are free and confidential. Call, text, or chat - learn more about 988 here.

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