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National Drug Early Warning System (NDEWS) Funded to the University of Florida by the National Institute on Drug Abuse
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Publications Overview

Publications

Dissemination of findings is crucial to the NDEWS mission, as a warning from an Early Warning System is not effective unless recipients know they have been warned. Our plan for dissemination is 14-fold:

  • Indicator Dashboards: Modeled after the Florida Drug-Related Outcomes Surveillance and Tracking System (FROST), directed by Co-Investigator Dr. Bruce Goldberger, NDEWS will build interactive dashboards on our website to display indicator data that our sentinel sites collect on an ongoing basis. This means that at any point in time, interested parties can access the most up-to-date NDEWS data without waiting for static tables in annual reports. Dashboards will include query options for sentinel site locations, indicators, substances, and time periods, and data will be updated on a monthly basis.
  • NDEWS COVID-19 Response: To rapidly improve our understanding of the impacts of COVID-19 on drug-related mortality, health services, drug treatment programs, and syringe exchange services, the NDEWS Coordinating Center conducted systematic, semi-structured interviews with three groups of key informants in all 18 sentinel sites: funeral directors, emergency medical services (EMS) personnel, and syringe exchange program (SEP) workers. Each key informant group has unique knowledge about overdoses, drugs used, and other consequences of COVID-19 that are not easily obtained elsewhere or would not be knowable for some time. Results and identified themes can confirm conclusions drawn from available quantitative data as well as guide new research and prevention efforts. Baseline interviews measured community changes retrospectively, by comparing current events to previous events, and subsequent follow-up interviews measured changes prospectively, by examining how events change during the COVID-19 crisis. Findings were rapidly disseminated via peer-reviewed publications, webinars, and media outreach.
  • NDEWS Hotspot Alerts: Each week, NDEWS will publish a Hotspot Alert in our Weekly Briefing newsletter. All NDEWS Hotspot investigations will occur in response to an outbreak of significant proportion that needs an immediate evaluation of the depth, cause, and impact of the drug-related event. NDEWS Hotspot Alerts is a dynamic notification system that quantifies the degree to which the observation deviates from the expected range of values over an 84-day window provided by biospatial.io. Alerts are limited to US states with statewide partnerships with biospatial.io: Alabama, Alaska, Arkansas, California, Colorado, Florida, Georgia, Idaho, Illinois, Kansas, Kentucky, Maine, Michigan, Mississippi, Montana, New Mexico, New York, Rhode Island, South Carolina, Tennessee, Utah, Virginia, Wisconsin, and Wyoming.
  • NDEWS Weekly Briefings: Each week, NDEWS will send out a Weekly Briefing newsletter with curated information on recent and relevant news, articles, and data related to drug trends in the United States and globally. Subscribe here to receive the Weekly Briefing in your email. While this communication method is primarily unidirectional (e.g., there is no ability to “reply all”), we also welcome questions from the scientific community and public at large, which we will include in the following week’s Briefing as relevant.
  • NPS Discovery Anonymous Drug Testing: NDEWS recently partnered with the Center for Forensic Science Research & Education (CFSRE)’s NPS Discovery to assist in investigations of exposures involving novel or unknown substances. Requests for assistance can be submitted to NDEWS, and NPS Discovery will facilitate the comprehensive testing of the drug and/or drug paraphernalia for the identification of drugs and adulterants, including a wide array of novel psychoactive substances (NPS). It can be completed with strict anonymity. While the form asks for identifiers, when you submit the material, it will be anonymous. Complete the query form here.
  • Peer-Reviewed Publications: NDEWS will submit manuscripts to peer-reviewed journals on findings alongside sentinel site directors and collaborators to ensure the highest standards of science. All publications will also be listed on our website.
  • Poison Control Data: The Florida Drug-Related Outcomes Surveillance and Tracking System (FROST), directed by NDEWS Co-Investigator Dr. Bruce Goldberger, is an interactive, publicly available data dissemination tool for researchers, public health professionals, and the general public to quickly explore drug-related outcomes in the state of Florida. The FROST Tableau dashboards have information on topics ranging from Prescription Drug Monitoring Program (PDMP) data, national drug-related data and statistics, drug arrest data, and extensive information on drugs identified in deceased persons sourced from the CDC WONDER database. NDEWS indicator dashboards will be modeled after FROST. Visit the FROST website to explore data concerning drug trends in Florida.
  • Rapid Street Reporting: Rapid Street Reporting (RSR) is a national venue-intercept study planned for the 17 NDEWS Sentinel Sites. Over the next five years, RSR will take place in at least six sentinel sites per year over a weekend period. All findings will be published in the Weekly Briefing. This initiative uses a modified version of Co-Investigator Dr. Joseph Palamar’s validated rapid survey, which has been previously used to survey over 4,500 nightclub attendees. The rapid survey is programmed to assess the use and correlates of use of over 100 drugs, many of which are new psychoactive substances (NPS), and queries whether users experienced acute adverse effects from specific drugs used. Biological testing is important when investigating NPS, which is why NDEWS is adding hair testing of surveyed individuals. Dr. Palamar has been detecting extensive underreported NPS use via hair testing, as many individuals were unknowingly exposed through adulterated drugs. Specimens will be tested by Dr. Alberto Salomone with three published methods utilizing ultra-high performance liquid chromatography–tandem mass spectrometry (UHPLC-MS/MS). Two of these methods (developed by Dr. Salomone) are capable of detecting over 100 NPS––mostly synthetic cannabinoids, synthetic cathinones (“bath salts”), and now fentanyl analogs and other potent opioid NPS.
  • Real-time 911 Dispatch Data: NDEWS has partnered with biospatial.io to access electronic patient care reports (ePCRs) from thousands of emergency medical services (EMS) providers in over 40 US states. Seventy-five percent of 911 dispatch data is reported within 24 hours of the event. NDEWS is currently monitoring several categories of events, including: opioid and specifically heroin overdoses; non-opioid overdoses; alcohol-related events; methamphetamine-related events; suicide attempts and suicide ideation; and mental health-related events. View the full reports here.
  • Site Reports: All sentinel sites will submit annual site reports on drug use and trends in their communities. The NDEWS Coordinating Center will also publish an annual report with cross-site comparisons.
  • Virtual HealthStreet: Virtual HealthStreet will extend UF HealthStreet’s tradition of excellence in providing quality data and empirically driven policy change, with a new focus on drug use. A national expert panel of people with histories of drug use will be recruited to participate in periodic special topic surveys specifically aimed at garnering a better understanding of emerging drug trends across the US. We aim to recruit 26,000 individuals to participate in the study over a 5-year period.
  • Wastewater Epidemiology: ‘Real time’ data will be identified by measuring human excreted chemicals or biological surrogate molecules in wastewater. Initial efforts have led to the development for quantifying fentanyl and metabolites in wastewater collected from 4 NDEWS sentinel sites, and will be applied to a suite of over 70 other drug targets. Data trends will be released soon through our Weekly Briefing, and all reports will be stored here for reference. View the full dashboard here.
  • Webinars: NDEWS will host quarterly national town hall meetings, titled NDEWS Webinars, modeled after Our Community, Our Health (OCOH), conducted by Dr. Cottler’s community engagement program HealthStreet. These national town halls promote bi-directional communication between researchers and the communities they serve, addressing relevant health topics and disseminating research findings. The events will be streamed nationwide and will be interactive, using social media for Q&A in real-time.
  • Web Surveillance: In collaboration with the Machine Perception and Cognitive Robotics (MPCR) Lab, under the direction of Dr. Elan Barenholtz, PhD candidate Paul Morris, and PhD student Daniel Van Zant the NDEWS Coordinating Center has developed a web monitoring platform for early detection of NPS in drug subreddits. Trends in drug discussion are quantified through anonymized, aggregate keyword counts derived from algorithmic monitoring of ~80 drug-oriented subreddits. Keyword metrics count mentions over time of keywords that refer to a drug. Machine learning models are employed for automated detection and aggregation of drug keywords. In combination, these methods detect drug-related activity that is anomalous and potentially indicative of an emerging trend in the development or use of novel substances. Validation on historical trends reveals that detection of an NPS in drug subreddit discussion is predictive of its subsequent emergence in toxicology data and other real-world signals. Early detection of NPS trends by web monitoring serves as a source for further investigation and collaboration with NDEWS partners.

The National Drug Early Warning System (NDEWS) is funded by the National Institute on Drug Abuse (U01DA051126) to the University of Florida (PI: Cottler; Co-Is: Goldberger, Nixon, Striley), New York University (Co-I: Palamar), and Florida Atlantic University (Co-I: Barenholtz).