This week's NDEWS Hotspot Alerts report highlights 15 counties with higher-than-expected drug-related 911 dispatch counts over the 7-day period from August 27 to September 2, 2024. The incidents include methamphetamine, opioid, and non-opioid-related dispatches based on real-time emergency medical services data, including overdose surveillance and other drug-related emergencies. Click here to read the full report. Click here to read more about NDEWS Hotspot Alerts.

What is 3-MMC? 3-MMC, also known as Metaphedrone, is a synthetic stimulant cathinone similar in structure and effects to 4-MMC (Mephedrone). It typically comes in the form of a white powder. 3-MMC has both stimulant and euphoric effects. 3-MMC has "stronger amphetamine-like stimulant properties" when compared to 4-MMC according to at least one pharmacological study.

What was found? 3-MMC has had an upward trend since mid-April. It has seen a larger spike in discussion since mid-July. It has had almost an 18% increase since the web monitoring team last reported on it on July 12th.

How is it being discussed? Commenters most frequently reported 3-MMC's use as a "party drug". 3-MMC was compared to other stimulants like cocaine and MDMA. Online discussions of 3-MMC often focus on its effects and comparisons to other stimulants. Reddit users report that 3-MMC has greater stimulant effects with less empathogenic effects as compared to 4-MMC. A unique aspect of 3-MMC discussions is the focus on its odor with both the drug, and the body odor it supposedly causes, being described as unpleasant. Many Reddit users report severe negative after-effects including anxiety, depression, vomiting, and lack of sleep with commenters reporting that these after-effects are more pervasive with frequent use. Taking another dose of 3-MMC before the effects of the previous dose have worn off is commonly reported as an issue. Commenters caution each other to take 3-MMC in small amounts and to avoid taking other substances. Since the last report there has been increased discussion on 3-MMC testing showing contamination of 3-MMC with other synthetic cathinones and novel psychoactive substances (NPS). At raves and music festivals in the Netherlands, there have been warnings about contamination of 3-MMC.

Drug Terms: 3-MMC, Metaphedrone, 3-MC

Mushroom-Laced Candy Recall Highlights F.D.A.’s Limited Safety Role. Read the article here.

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Earlier this week, the Journal of Forensic Science published an article detailing the detection of medetomidine, a veterinary sedative, in Maryland’s drug supply through a real-time monitoring initiative. Medetomidine was first identified in a sample from July 2022 and has since been found in five different samples, including residues from syringes and capsules, often alongside fentanyl and xylazine. Analysis using Direct Analysis in Real Time Mass Spectrometry (DART-MS) and Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) confirmed these findings, revealing that medetomidine is being detected in multi-drug mixtures. Following last week’s NDEWS briefing on medetomidine, this highlights growing overdose risks and the urgent need for enhanced surveillance and expanded drug testing. Read the article here.

A recent study, published in Drug and Alcohol Dependence, surveyed 171 people who use drugs (PWUD) in Massachusetts to assess drug use practices and wound care in the context of xylazine adulteration. The study found that 87% of participants had experienced a xylazine-related wound in the past 90 days, with subcutaneous injection being nearly ten times more common among this group. The study also found that 74% of participants with xylazine wounds reported facing healthcare stigma when seeking treatment, and 58% experienced inadequate pain and withdrawal management. Many engaged in self-treatment, using alcohol-based sanitizers (56%) and hydrogen peroxide (40%), with only 66% using proper wound coverings. Read the study here.

A recent study in Journal of Analytical Toxicology examined the prevalence of novel synthetic opioids (NSOs), specifically fluorofentanyl, in accidental overdose deaths in San Francisco during 2022. Of the 649 overdose deaths analyzed, 7.8% (48 cases) involved NSOs, with fluorofentanyl detected in 6.5% (40 cases). The study highlighted the co-occurrence of other substances in these cases, including fentanyl (89.6%), methamphetamine (70.8%), and cocaine (33.3%). Estimated concentrations of fluorofentanyl in postmortem femoral blood ranged from 0.1 to 8.9 ng/mL. Read the study here.

A recent report from the CDC, published in Morbidity and Mortality Weekly Report (MMWR), examined data from 29,861 middle and high school students from the 2024 National Youth Tobacco Survey. The survey found that current e-cigarette use declined from 7.7% in 2023 to 5.9% in 2024, with approximately 1.63 million students still using e-cigarettes. Among those who used e-cigarettes, 38.4% reported frequent use, and 26.3% reported daily use, with disposable e-cigarettes being the most common type (55.6%), followed by prefilled pods (15.6%). Nicotine pouch use remained unchanged at 1.8%, with 68.7% of students using nicotine pouches preferring ZYN. Read the report here.

Date: Monday, November 11th to Wednesday, November 13th, 2024

Location: Philadelphia, Pennsylvania, USA

Learn more here. 

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