# Opioid Data Lab > Science and public health from the University of North Carolina at Chapel Hill: street drugs, overdose, fentanyl, epidemiology, harm reduction. Public Ghost content for AI and LLM tooling. This file includes a bounded export of public pages first, then recent public posts. Append `.md` to any post or page URL to get the content in Markdown (for example, `/example-post.md`). ## Pages ### All the Details URL: https://www.opioiddata.org/coming-soon-2/ Last updated: 2024-08-29T21:16:23.000Z Check out [Drug Checking Basics](https://uncopioid.atlassian.net/servicedesk/customer/kb/view/183336962) Research Studies ### Have we seen it...? URL: https://www.opioiddata.org/section-four/ Last updated: 2024-11-15T14:57:19.000Z These two apps list all substances we've identified in the drug supply, including when and where we saw it. Helpful for FTIR technicians and drug nerds. First is a live report of recent new substances. Second is an interactive app of all substances all time, and what else they were found with. [Newly Detected Last Month](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823?utm%5Fcontent=2f2c3288-10a7-4e03-a6c2-57bb006b5823) [Drug Supply App](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3) ### Start Drug Checking Now URL: https://www.opioiddata.org/section-one/ Last updated: 2024-11-15T15:49:59.000Z No machine? No problem. Any public health harm reduction organization in the US can get 5 free kits. Within North Carolina our service is free. We offer [affordable](https://uncopioid.atlassian.net/wiki/external/Nzk4NWZhYWRlYTBkNDdlOTkzMTNlODkxNmU0ODlkNjA) mail-in GCMS service nationwide. Our service is free to drug user unions. New FTIR? Awesome! We offer complementary "confirmatory" lab services for [FTIR drug checking programs](https://uncopioid.atlassian.net/servicedesk/customer/kb/view/136708220). Check out our [program requirements](https://uncopioid.atlassian.net/wiki/external/ZmVkODA2NjZmZWMwNDNlNGE4NjBmZTI5NGQyNjU1OWY), [pricing](https://uncopioid.atlassian.net/wiki/external/Nzk4NWZhYWRlYTBkNDdlOTkzMTNlODkxNmU0ODlkNjA), [terms of service](https://uncopioid.atlassian.net/wiki/external/NGM2MGM1NGYxMDVkNDcwMDgwZGQxYjBkN2MwNGU0MzM), [lab methods](https://uncopioid.atlassian.net/wiki/external/MzM2ODI4NGYzZmE4NDczNGIyZDNjZjE3NDc5NWFiMjU), [how to interpret results](https://uncopioid.atlassian.net/servicedesk/customer/kb/view/141983772), [media requests](https://www.streetsafe.supply/contact), [funders](https://www.opioiddata.org/funders/), [research study support](https://uncopioid.atlassian.net/wiki/external/NGRhZGMxMmM1NWU0NDlhYzg5NGMxYzQyZjVlNWE5ZTc), [contact info](https://www.opioiddata.org/contact/). [Order kits](https://www.streetsafe.supply/contact) [Pending samples](https://github.com/opioiddatalab/drugchecking/blob/main/status/pending.csv) ### How to Use the Kits URL: https://www.opioiddata.org/section-five/ Last updated: 2024-07-18T19:33:09.000Z _No content available._ ### Contact URL: https://www.opioiddata.org/contact/ Last updated: 2024-07-18T19:35:42.000Z ## Email Our shared team inbox is [opioiddatalab@unc.edu](mailto:opioiddatalab@unc.edu) ## Phone Our direct phone number is: (919) 966-5725 ## IRL We are located on the campus of UNC in Chapel Hill, NC. We welcome visitors! Let us know if you’d like to come for a lab tour and see the facilities. ## Current status We update our [main website](https://streetsafe.supply/) if we have planned service pauses. ## Newsletter We will be launching a monthly newsletter and refreshed blog in Summer 2024\. ## Sign up for Opioid Data Lab Street Drug Analysis Lab @ UNC Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ## Pending sample queue List of pending samples that have been received by the lab can be [found here](https://github.com/opioiddatalab/drugchecking/blob/main/status/pending.csv). Updated daily. ### UNC Watchlist URL: https://www.opioiddata.org/unc-watchlist/ Last updated: 2024-11-21T20:25:30.000Z 👀 In no particular order, these are the most prominent drug trends in the United States that we are tracking right now. Feel free to use any of the graphs, data, text, images, or whatever from here. It's all for you! [BTMPS](https://www.opioiddata.org/unc-watchlist/#btmps) [Xylazine & (dex)medetomidine](https://www.opioiddata.org/unc-watchlist/#xylazine-dexmedetomidine) [Carfentanil](https://www.opioiddata.org/unc-watchlist/#carfentanil) [Nitazenes](https://www.opioiddata.org/unc-watchlist/#nitazenes) [2-fluoro-2-oxo-PCE + fentanyl](https://www.opioiddata.org/unc-watchlist/#2-fluoro-2-oxo-pce) [Shift to smoking](https://www.opioiddata.org/unc-watchlist/#shift-to-smoking) --- Also, check out our monthly list of newly detected substances [Newly Detected SubstancesData apps for data scientists and data analysts.![](https://deepnote.com/static/apple-touch-icon.png)DeepnoteOpioid Data Lab![](https://deepnote.com/project/2f2c3288-10a7-4e03-a6c2-57bb006b5823/social-image)](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823) --- # BTMPS **"Tinuvin" or bis (2,2,6,6,-tetramethyl-4-piperidyl) sebacate** An industrial chemical added to plastic, an adhesive for stickers on foods, and a fragrance. Cough, blurred vision, chemical smell. Emerged Summer 2024, and spread quickly. All the details are below, including FTIR resources, pharmacology, scientific information, media talking points, etc. [Mystery Substance Summer 2024 bis(2,2,6,6-tetramethyl-4-piperidyl)Detection and characterization of bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate \[Tinuvin® 770\]![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/EPRipley_230912_32121-copy.jpg)](https://www.opioiddata.org/mystery-substance-summer-2024/) You can see all the samples we've received at the link below. [bis(2,2,6,6-tetramethyl-4-piperidyl) sebacateData apps for data scientists and data analysts.![](https://deepnote.com/static/apple-touch-icon.png)DeepnoteOpioid Data Lab![](https://deepnote.com/project/57aada26-47f7-4095-a52e-f6f334b086e8/social-image)](https://deepnote.com/app/opioiddatalab/bis2266-tetramethyl-4-piperidyl-sebacate-57aada26-47f7-4095-a52e-f6f334b086e8) We also did a FOIA request for the manufacturer's toxicity studies. Historical documents below. [Uncovered: 1970s BTMPS tox studiesFreedom of Information Act information from FDA on bis(2,2,6,6,-tetramethyl-4-piperidyl) sebacate![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/Screenshot-2024-09-10-at-9.12.32-PM.png)](https://www.opioiddata.org/btmps-toxicity-foia/) --- # Xylazine & Dexmedetomidine We've been tracking xylazine since 2021, and (dex)medetomidine is a closely related molecule that could replace xylazine on the street. The graph from our live tracker of the two molecules shows an increase in fentanyl samples containing (dex)medetomidine starting in June 2024\. Button below takes you to our street sample data on xylazine. We've seen it now in half the country. See where exactly and combined with what substances. [Nationwide UNC xylazine samples](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3?selected%5Fsubstance=xylazine) If you're into academic commentaries, [this is a good primer](https://link.springer.com/article/10.1186/s12954-023-00879-7) on xylazine. If video is more your speed, [this great webinar](https://youtu.be/orzgwi7sxFM) by wound care nurse Jason Beinart will get you up to speed on wound care. If you're in a clinical setting, [here is a case report](https://www.psychiatrist.com/pcc/xylazine-masking-benzodiazepine-withdrawal/) of xylazine masking benzo withdrawal. How does it show up in the drug supply? Here's [our take on the 5 ways](https://x.com/nabarund/status/1646138465602371584) we've seen it in our samples. This is live report for NC xylazine samples: [NC XylazineAnalytical chemistry and epidemiology of street drugs![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/1f97d.png)Streamlit![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/Home_Page.png)](https://ncxylazine.streamlit.app/) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/image-12.png) From "[Xylazine is Different](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/3t946221f?locale=en)" Our partner lab at UNC also discovered that xylazine is a [kappa opioid agonist](https://www.sciencedirect.com/science/article/pii/S2772392524000142). This is our [explainer thread](https://x.com/nabarund/status/1799117187220992146) for dex(medetomidine). The [CSFRE alert](https://www.cfsre.org/nps-discovery/public-alerts/toxic-adulterant-alert-medetomidine-dexmedetomidine) also has useful information. You can check out a live report of where we've seen dex(medetomidine) and mixed with what by clicking on the button below. [UNC data on (dex)medetomidine](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3?selected%5Fsubstance=medetomidine) --- # Carfentanil [It's around](https://www.millenniumhealth.com/signalsalert/carfentanil/), but different than before. Unlike in 2017, we now see carfentanil in mostly ***trace*** abundance. Unlike in 2017, we are ***not*** hearing of major spikes in overdose. On the contrary, we are hearing of ***declines*** in overdose death rates across multiple states. Still, we are watching this carefully, but are not in a panic. Our live data are updated daily. [carfentanilData apps for data scientists and data analysts.![](https://deepnote.com/static/apple-touch-icon.png)DeepnoteOpioid Data Lab![](https://deepnote.com/project/0e647c95-ec05-4dd9-8ec8-3f2d1b1765b9/social-image)](https://deepnote.com/app/opioiddatalab/carfentanil-0e647c95-ec05-4dd9-8ec8-3f2d1b1765b9) **Remember, potency of a molecule alone doesn't predict human overdoses.** --- # Nitazenes As a class, relatively little is known about nitazenes in humans. Some are potent opioids (mu receptor agonists), and other nitazenes are weaker than typical synthetic opioids on the street. Naloxone is believed to be effective against most nitazenes studied at the current time, but there are some doubts. Here is our tracker app for the samples we've seen: [Nitazene trackerData apps for data scientists and data analysts.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-5.png)DeepnoteOpioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/social-image-2)](https://deepnote.com/app/opioiddatalab/Nitazene-tracker-bf05bd9a-a8e1-448f-9e56-87615fd02bde?utm%5Fcontent=bf05bd9a-a8e1-448f-9e56-87615fd02bde) Nitazenes are the synthetic opioid most common in Europe (not fentanyl). Nitazenes have been in the US for years, for example in [Wisconsin and Illinois](https://pmc.ncbi.nlm.nih.gov/articles/PMC8141068/) in 2020 and [Tennessee](https://www.cdc.gov/mmwr/volumes/71/wr/mm7137a5.htm) in 2019\. They were [initially developed](https://en.wikipedia.org/wiki/List%5Fof%5Fbenzimidazole%5Fopioids) by the CIBA pharmaceutical company, but aren't on the market anywhere in the world that we know. In the United Kingdom nitazenes have been found in pressed pills, but in the US it's in powder (check the live report to see if that's changed). The most common of these "benzimidazole opioids" we have see are [protonitazene](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3?selected%5Fsubstance=protonitazene) and [metonitazene](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3?selected%5Fsubstance=metonitazene). Fentanyl is also found in about half the nitazene samples, and about the same for xylazine. These combos can be really sedating. On the other hand, nitazenes may find favor among those with big established fent habits. --- # 2-fluoro-2-oxo-PCE This has traditionally been a nightlife party drug (for lack of a better term!) in the [club scene in Australia](https://www.cahma.org.au/article/safer-using-canket/). (Here's how [harm reduction drug checking](https://theconversation.com/an-entirely-new-illicit-drug-has-been-discovered-by-australian-chemists-heres-how-they-did-it-192855) was central in detecting it.) But in 2024 we started seeing it the United States, mixed with fentanyl, tiletamine, and potent benzodiazepines. It was causing overdose deaths. In hospital tox screens, it often causes false positives for ketamine. **Simply put, this is not a dissociative/sedative that people using fentanyl are expecting in the United States.** Our awesome partners in Edgecombe County EMS picked up on this trend early. (Also props to Ali Ingersoll of WRAL for this great piece of local news reporting!) We understand it is still circulating locally in North Carolina, as of mid-September 2024, mostly in the eastern part of our state. But it's not just NC. Here's where else we've seen it and mixed in which specific other drugs: [Nationwide samples of 2-fluoro-2-oxo-PCE](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3?selected%5Fsubstance=2-Fluoro-2-oxo+PCE) --- # Shift to Smoking In the last few years there has been a major change in how people consume non-pharmaceutical fentanyl in the US. We've been hearing about this for years, but now even the [national overdose data have caught up with the shift](https://www.cdc.gov/mmwr/volumes/73/wr/mm7306a2.htm). Yes, sterile syringes and preventing HIV/hepatitis remain important. But glass smoking supplies are going to become increasingly important. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/image-11.png) Tanz et al., MMWR, Feb 15, 2024 Why is this happening? Maybe getting people to find alternatives to injection has been effective. Maybe dabbing and vaping gets people to think about smoking in different ways. Maybe smoking fentanyl allows better titration to make up for fentanyl potency. Maybe fake M30 pills lend themselves to smoking more than injecting pill binders. Maybe high quality smoking supplies have expanded with cannabis legalization. Maybe syringe paraphernalia has been heavily prosecuted. 🤷🏾 --- # And Also... These are other things we are keeping and eye on. We'll update these with data and links in the coming weeks. - **K2/Spice** \- Can synthetic cannabinoids get adulterated with other drugs? - **High dose kratom** \- Do people know what they are buying? - **Substituted cathinones (bath salts)** \- diversifying slowly - **Tianeptine** \- weak opioid, can return atypical withdrawal that gets lots of media attention - **Tusi/2CB/"pink cocaine"**\- Various nightlife drugs (2CB and related), as well as their knockoffs (tusi) that contain inconsistent combinations of ketamine and MDMA. --- # Retired Watchlist ⌛ These substances were previously on the UNC Watchlist, but no longer are being active monitored. Data apps and live reports will continue to auto-update, and these may pop up occasionally, but we recommend focusing on other issues in the drug supply instead. ## Insecticide: Acetamiprid **Retired November 2024** Insecticides-in-dope is a trope, and doesn't feel inherently unsurprising. But "insecticide" is a marketing label given to a set of commercial chemicals that are pharmacologically diverse. Therefore, we urge us to focus on the specific substance (acetamiprid) and the specific experience of people exposed right now. This insecticide was found in a handful of samples during the Summer of 2024\. We haven't seen it spread further, but we also don't know what we are missing. We were about to take this off the watchlist on November 1, 2024 but it popped back up in one sample (by itself) in October. We'll keep monitoring and if there are no more samples, we'll retire it from the watchlist by yearend year's end. [🪲 Insecticide: acetamiprid💡In late August 2024, FTIR-based drug checking programs in Seattle and New Mexico identified an insecticide in street samples. It has also been reported in the midwest. This is a toxin and should not be in the drug supply. Our Take On This Insecticides-in-dope is a trope, and doesn’t feel![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/EPRipley_230912_32096.jpg)](https://www.opioiddata.org/insecticide-acetamiprid-2/) --- # Xylazine & Dexmedetomidine ## Watchlist updates to your inbox Free monthly newsletter Get Watchlist Updates Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### Service Stats URL: https://www.opioiddata.org/section-three/ Last updated: 2025-08-25T16:25:01.000Z _No content available._ ### Tags URL: https://www.opioiddata.org/tags/ Last updated: 2024-09-03T18:25:29.000Z _No content available._ ### Watchlist 👀 URL: https://www.opioiddata.org/section-two/ Last updated: 2024-09-11T03:14:21.000Z Top drug trends we are keeping our eyes on nationwide. [See The List](https://www.opioiddata.org/unc-watchlist/) ### Authors URL: https://www.opioiddata.org/authors/ Last updated: 2024-09-11T03:19:12.000Z _No content available._ ### Funders URL: https://www.opioiddata.org/funders/ Last updated: 2024-09-12T16:45:31.000Z ## We are grateful to our generous funders! Y'all make our work possible. 🎤 Studies and writings at the [Opioid Data Lab](https://www.opioiddata.org/) and [UNC Street Drug Analysis Lab](https://streetsafe.supply) are conducted by independent scientists and do not necessarily represent the views of funders or partners. **We do not accept any funding from the pharmaceutical industry or drug checking equipment manufacturers.* --- # FORE 2022-2024: The [Foundation for Opioid Response Efforts](https://forefdn.org/) was our first major funder. They took the chance on us and it's been an amazing ride. We wouldn't have gotten off the ground without your support! Ken Shatzkes and Karen Scott have been unwavering champions of our work. We told them we'd get 8 sites for drug checking, but ended up with 140\. This grant ended in September 2024, but we will find ways to work together again. [See work done with FORE funding](https://www.opioiddata.org/tag/fore/) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/B1050CC4-04ED-422B-834F-791A3F1099C6_1_105_c-1-1.jpeg) At the Grantee meeting in DC, September 2023 --- # NC Collaboratory North Carolina General Assembly via the [NC Collaboratory](https://collaboratory.unc.edu/), using Opioid Settlement Funds (2023-24, operations; 2024-26 equipment) [See work done with NC Collaboratory funding](https://www.opioiddata.org/tag/collaboratory) --- # Vital Strategies 2023-2025: [Vital Strategies](https://www.vitalstrategies.org/) funded us to improve our data systems to enabling more effective sharing with community, and to ensure that our services are reaching communities of color in North Carolina. We have had a great time working with Kat Humphries and Kasia Zuk! [See work done with Vital Stategies funding](https://www.opioiddata.org/tag/vital-strategies/) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Vital-strategies-1-1.JPG) --- # NACCHO 2024: For expanding lab based capabilities. [See work done with NACCHO funding](https://www.opioiddata.org/tag/naccho/) --- # NC DHHS [Injury and Violence Prevention Branch](https://injuryfreenc.dph.ncdhhs.gov/) of the NC Department of Health and Human Services, via funding from the Centers for Disease Control and Prevention (2023, data visualizations) --- # NIH One GCMS instrument was funded through a NIH grant to the Department of Chemistry. ### 📸 Image Dump URL: https://www.opioiddata.org/image-dump/ Last updated: 2024-09-11T17:42:55.000Z ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/B1050CC4-04ED-422B-834F-791A3F1099C6_1_105_c-1.jpeg) At the Grantee meeting in DC, September 2023 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Vital-strategies.JPG) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Screenshot-2024-09-11-at-1.26.57-PM.png) ### We want you! URL: https://www.opioiddata.org/signup/ Last updated: 2024-09-18T14:08:31.000Z ## Sign up for Opioid Data Lab Welcome to the Street Drug Analysis Lab @ UNC, a public service of the University of North Carolina at Chapel Hill. We provide chemistry services and information for public health. Our [blog](https://www.opioiddata.org/) will be updated weekly, and our data are updated daily. Stay in the loop to get the latest! Subscribe Email sent! Check your inbox to complete your signup. Always free. No spam. Unsubscribe anytime. About once a month. ### How folks are using the kits URL: https://www.opioiddata.org/how-folks-are-using-the-kits/ Last updated: 2024-12-11T15:29:11.000Z Our information empowers people to answer questions of local relevance. **Questions we have helped answer** - Is there fentanyl in black tar heroin? - Are nitazenes causing these overdoses? - What is causing a patient’s atypical withdrawal? - Can xylazine explain these skin wounds? - How accurate are these test strips? - Can black lights identify xylazine and fentanyl? - What killed my husband? ### How to Interpret Results URL: https://www.opioiddata.org/how-to-interpret-results/ Last updated: 2025-02-26T00:43:38.000Z **A sample's chromatogram is its visual fingerprint.** Each substance in the drug mix is usually represented by a separate peak, so more peaks means more substances. This is important: This method does not provide purity or quantification, and the height of the peaks just gives a rough idea of how much is in there. Tall peaks are the major components, and smaller blips are trace amounts. **Reading the graph.** The "relative abundance" on the vertical axis is a rough relative estimate of how much is present. It is not quantification. The time (min) on the horizontal axis means the time at which each of the substances was detected. But you can also look at the overall pattern to get a sense of what's common in your area. Also, similar substances can sometimes clump together into one peak, so we may run more tests to get separation. When we list the substances above, we've taken a whole set of lab tests into account, and it's not just looking at results from one graph. **The GCMS method is really sensitive.** We can pick up on trace amounts, and sometimes those can be cross-contamination. They may not be relevant for your context, but know that’s what we found in there. That's why we ask you to wear gloves and use the paper cloth when collecting the sample. The substances that drive the high are in the major peaks. Sometimes there can be side effects from the smaller peaks as well. **What the peak numbers mean.** The peak numbers are provided for transparency and completeness. The peak number is when (in minutes) the GCMS machine to identify the substance. The number itself isn’t all that important by itself - think of it like a label. If advanced methods (see below) were used, the peak numbers may not match up exactly. And some smaller peaks may be artifacts that we investigated and ruled out. **What we can and can't tell.** The GCMS method is most reliable for psychoactive substances. For cuts and fillers (like sugars) we may need to use other tools. If you see "FTIR" or "Derivitized GCMS" or "Exactive GCMS" in the Methods description above, we found additional substances when we used one of these advanced techniques. The graph above doesn’t include the peaks from these advanced methods right now because the graphs are too complicated. ### Pricing URL: https://www.opioiddata.org/pricing/ Last updated: 2025-03-03T20:50:56.000Z 💡 This page explains pricing at the UNC Street Drug Analysis Lab. This page will be helpful for those looking for information on getting started with us or writing proposals. # First 5 Kits Free **Any** [**eligible organization**](https://uncopioid.atlassian.net/wiki/spaces/ED/pages/106299397/Program+Requirements) **can get 5 startup kits for free.** No commitment. Order kits [here](https://www.streetsafe.supply/contact). We offer both pre- and post-paid options. Invoicing is done monthly (or quarterly by arrangement). The laboratory service and methods are the same for all levels of pricing. We currently do not offer quantification services. We welcome research collaborations, but our first priority is direct service to public health programs. ### Our Data URL: https://www.opioiddata.org/data-details/ Last updated: 2026-04-24T17:58:42.000Z # Individual Results We make all our drug checking results public. These are updated throughout the day as our lab finalizes interpretation. You can search by substance, location, or sample ID number: [UNC Street Drug Analysis ResultsAnalysis of results completed by the UNC Opioid Data Lab and gathered by our service partners![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-20.ico)![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image-5)](https://results.streetsafe.supply) --- # Data Use Policy Our programs can use their data however they would like. For everyone else, please review our [data use policy](https://results.streetsafe.supply/data-use). --- # Data for Our Programs If you are using our service, we can provide a private link to all your sample results in CSV format. These results can be imported into statistical software, data visualizations, or reports. Drop us a note to set up your custom data feed: opioiddatalab@unc.edu. Each version of our [data collection cards are archived here](https://cdr.lib.unc.edu/concern/multimeds/5d86p887m?locale=en). See the [technical detail documentation](https://www.opioiddata.org/wrap-up-2025-newsletter/) for codebook, starter code, and tips. --- # Live Reports Live reports are like dashboards, but tailored to specific drugs or questions. [This essay](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2022.306871) in the *American Journal of Public Health* explains our approach to publishing Live Reports. All stats and graphs on these apps are public and can be reused with attribution and without asking additional permission. [Live Reports & DataData reports on fentanyl and other substances from the UNC Street Drug Analysis Lab.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/OpioidDateLab_logo-comic_v1__01-blue-5.jpg)](https://www.opioiddata.org/data/) ### Team Roster URL: https://www.opioiddata.org/team-roster/ Last updated: 2026-04-08T16:58:25.000Z ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/OpioidDataLab_portrait_sketch_NabarunDasgupta.jpg) ## Nabarun Dasgupta, Epidemiologist, Data Services & Research ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/paula-portrait.jpg) ## Paula Gildner, Project Director ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/erin.jpeg-1.png) ## **Erin Tracy, Research Chemist** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/UNC_portraits_June2025_02__Ilyana--1-.jpg) ## **Illyana Massey,** Community Liaison ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/UNC_portraits_June2025_01__Adams--1---1-.jpg) ## Adams Sibley, Research ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/UNC_portraits_June2025_02__Shay--1-.jpg) ## Shay Louis, Production Manager for Kit Shipping and Operations ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/UNC_portraits_June2025_01__Jalice--1---1-.jpg) ## Jalice Manso, Research Chemist ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/UNC_portraits_June2025_01__David--1---1-.jpg) ## David Marshall, Software Developer & Data Services ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/UNC_portraits_June2025_02__Dmitri--1-.jpg) ## Dmitri Fisher, Student Research Assistant ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/UNC_portraits_June2025_02__Colton--1-.jpg) ## David Colston, Student Research Assistant ## **Current Team Members** - Project Director: Paula Gildner - Community Liaison: Illyana Massey - Production Manager for Kit Shipping and Operations: Shay Louis - Laboratory services: Erin Tracy and Jalice Manso - Data services: Nabarun Dasgupta and David Marshall - Research: Adams Sibley, David Colston (student), Liz Joniak-Grant, Nabarun Dasgupta - Student Research Assistant: Dmitri Fisher (student) ## **Beyond Street Drug Analysis Lab** - IPRC Director: Beth Moracco - Mass Spec Core Lab Director in Dept. of Chemistry: Brandie Ehrmann - Shared Services: Leslie Heal, LaMonda Sykes, Bridgette Mountain, Meredith Kitson - Terms and conditions, legal: Kim Austin, Martin Maloney, Ginger Morgan - Media relations: Carol Shirley, Cat Long, Matthew Chamberlin, Brigitta Shouppe - Innovation@Gillings: Anne Glauber - Special projects: Maryalice Nocera - Illustrator: Brittain Peck - Photographer: Pearson Ripley ## **Past Team Members** - Mary Figgatt - Colin Miller - Natalie Sutton - Anuja Pantari - Bryn Haden - Mabeki Mvuendy ## **Advisors** - Louise Vincent - Don Jackson ### Live Reports URL: https://www.opioiddata.org/live-reports/ Last updated: 2026-05-28T13:10:28.000Z Live Reports are like dashboards, but tailored to specific drugs or questions. [This essay](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2022.306871) explains our approach. We do not identify program names in reports. If you're like to learn how to use our data, head to [this page](https://www.opioiddata.org/data-details/) instead. These reports are aggregated data. All stats and graphs on these apps are public and can be reused with attribution: "UNC Street Drug Analysis Lab at opioiddata.org" 📍 All samples are donated voluntarily. We get more more samples from certain states. Not all regions of a state will be covered. Most of our samples are post-consumption, and people may preferentially send us samples because they caused unusual reactions. There is no possible data source on street drugs that fully represents the entire drug supply. [Coverage SummaryData apps for data scientists and data analysts.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-19.png)DeepnoteOpioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/social-image-7)](https://deepnote.com/app/opioiddatalab/Coverage-Summary-543893b6-9663-4db0-b010-30911a71eb39) What states our samples are coming from ## American Drugs ****Have we seen it in the drug supply?** ## Regional What drugs are most common by US Region? This interactive page shows you 90 substances through April 2026 that show up disproportionately by location. [American Drugs are Highly RegionalizedOf 90 substances detected by the UNC Street Drug Analysis Lab from January 2022 through April 2026, only 20 turn up everywhere at similar rates. The other 70 are regionally concentrated. There is no single American drug supply — there are at least four.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)UNC Opioid Data LabUNC Street Drug Analysis Lab![](https://opioiddatalab.github.io/dataviz/regional_drugs_preview.png)](https://opioiddatalab.github.io/dataviz/regional/regional%5Fdrugs%5Finfographic.html) ## Substances Detected List of all substances detected by GCMS at UNC. Provides regional breakdown and time trends. [Substances Detected SummaryData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/b04afe83-611a-4953-aaa1-5c6743cc6677/social-image)](https://deepnote.com/app/opioiddatalab/Substances-Detected-Summary-b04afe83-611a-4953-aaa1-5c6743cc6677) ## New Substances Detected Focus on new substances detected last month, including links to index samples. Updated on the first of each month. [Newly Detected SubstancesData apps for data scientists and data analysts.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-18.png)DeepnoteOpioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/social-image-6)](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823) ## What else and where? Shows what substances we have detected, how often, what others substances are found with them, and in which states. [What else and whereData apps for data scientists and data analysts.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-17.png)DeepnoteOpioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/social-image-5)](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3) ## Specific Drugs Emerging drug trends ## Orphines Rare new class of synthetic opioids including cychlorphine. [OrphinesData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/bf899b81-e39f-4ab1-9b8d-651fe73b0f32/social-image)](https://deepnote.com/app/opioiddatalab/Orphines-bf899b81-e39f-4ab1-9b8d-651fe73b0f32?utm%5Fsource=status-bar&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=bf899b81-e39f-4ab1-9b8d-651fe73b0f32) ## Nitazene Tracker Varied class of synthetic opioids undergoing major changes. [Nitazene trackerData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/bf05bd9a-a8e1-448f-9e56-87615fd02bde/social-image)](https://deepnote.com/app/opioiddatalab/Nitazene-tracker-bf05bd9a-a8e1-448f-9e56-87615fd02bde) ## Fentanyl and Analogues Trends of fentanyl-related substances (FRS) [Fentanyl Related Substances TrackerData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/682659e2-84cb-4763-90b8-fef13780c786/social-image)](https://deepnote.com/app/opioiddatalab/Fentanyl-Related-Substances-Tracker-682659e2-84cb-4763-90b8-fef13780c786) ## **Carfentanil** Potent synthetic opioid [carfentanilData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/0e647c95-ec05-4dd9-8ec8-3f2d1b1765b9/social-image)](https://deepnote.com/app/opioiddatalab/carfentanil-0e647c95-ec05-4dd9-8ec8-3f2d1b1765b9) ## BTMPS Dope additive bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate ([details](https://www.opioiddata.org/mystery-substance-summer-2024/)) [bis(2,2,6,6-tetramethyl-4-piperidyl) sebacateData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/57aada26-47f7-4095-a52e-f6f334b086e8/social-image)](https://deepnote.com/app/opioiddatalab/bis2266-tetramethyl-4-piperidyl-sebacate-57aada26-47f7-4095-a52e-f6f334b086e8) ## Heroin Tracker Yes, there is still real heroin out there. [Heroin TrackerData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/ab307d4b-2ce7-40f2-ae27-404a4367030d/social-image)](https://deepnote.com/app/opioiddatalab/Heroin-Tracker-ab307d4b-2ce7-40f2-ae27-404a4367030d?utm%5Fsource=status-bar&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=ab307d4b-2ce7-40f2-ae27-404a4367030d) ## Xylazine and (dex)medetomidine Powerful sedatives (alpha-2 adrenergic agonists). Xylazine is being replaced. [(dex)medetomidine TrackerData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/a401c37e-5255-4d15-87a1-252ee09f360d/social-image)](https://deepnote.com/app/opioiddatalab/dexmedetomidine-Tracker-a401c37e-5255-4d15-87a1-252ee09f360d) ## Methamphetamine Purity Tracker How likely is meth to contain something other than meth? [Methamphetamine TrackerData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/dc555ee4-5c80-4fcd-b64b-c360d0e4ce07/social-image)](https://deepnote.com/app/opioiddatalab/Methamphetamine-Tracker-dc555ee4-5c80-4fcd-b64b-c360d0e4ce07?utm%5Fsource=status-bar&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=dc555ee4-5c80-4fcd-b64b-c360d0e4ce07) ## By Request Specific Live Reports requested by community partners 💡 Got an idea? Let us know at opioiddatalab@unc.edu. ## List of NC Substances List of substances detected in the North Carolina drug supply. [List of NC Substances DetectedData apps for data scientists and data analysts.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-16.png)DeepnoteOpioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/social-image-4)](https://deepnote.com/app/opioiddatalab/List-of-NC-Substances-Detected-7b5cdce6-0679-4a07-b43c-0881db667307?utm%5Fsource=app-settings&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=7b5cdce6-0679-4a07-b43c-0881db667307) ## Methamphetamine Adulteration in Wisconsin What substances are found along with methamphetamine in Wisconsin. [Wisconsin MethamphetamineData apps for data scientists and data analysts.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-20.png)DeepnoteOpioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/social-image-8)](https://deepnote.com/app/opioiddatalab/Wisconsin-Methamphetamine-e4ae559b-9c7c-4fdc-92f6-9d5cb344556e?utm%5Fsource=app-settings&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=e4ae559b-9c7c-4fdc-92f6-9d5cb344556e) ## Acetamiprid Bug spray in dope, last seen in 2025. [acetamipridData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/caafa973-a110-454e-8225-fa8864567dfd/social-image)](https://deepnote.com/app/opioiddatalab/acetamiprid-caafa973-a110-454e-8225-fa8864567dfd?utm%5Fsource=status-bar&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=caafa973-a110-454e-8225-fa8864567dfd) ### Drug Checking Chemical Dictionary URL: https://www.opioiddata.org/drug-checking-chemical-dictionary/ Last updated: 2026-05-20T15:59:30.000Z ## Because no single expert speaks all four languages of the drug supply Drug checking has a communication problem. When a substance is identified in drug checking, the substance means something very different to a forensic chemist, an clinician/pharmacologist, a harm reduction outreach worker, and an epidemiologist. Each of them holds a piece of the picture. None of them holds the whole thing. The Drug Checking Chemical Dictionary is an attempt to create shared metadata database that speaks all four professional languages simultaneously, linking laboratory detection to clinical care, harm reduction practice, and population-level health trends. And it'll all be public. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/04/chemdictionary_comic.png) ## Four domains of drug knowledge Understanding what is in the street drug supply requires expertise that does not exist in any single profession. 1. IDENTIFICATION: A forensic chemist can tell you exactly what molecule is present and in what quantity. 2. BIOMEDICAL: A pharmacologist can characterize a new substance in the lab. A toxicologist or pharmacist can tell you what that molecule does to the human body. An addiction medicine specialist can tell you about dependence potential. 3. STREET SMARTS: A harm reduction worker knows behaviors, what it is called on the street, how it's used, and what people actually need to know. 4. TRENDS: An epidemiologist knows whether it is new, spreading, and how it fits into trends over time and geography. OG drug scientists can provide historical context. International partners can help us see across borders. **These four domains of knowledge are rarely held by the same person, and no profession has full expertise across all four domains.** | Domain | Core expertise | | -------------- | ------------------------------------------------------------------- | | Identification | Analytical chemistry, forensic science, machine-based drug checking | | Biomedical | Toxicology, addiction medicine, pharmacology | | Street smarts | Harm reduction outreach, lived experience, peer knowledge | | Trends | Epidemiology, regulatory context, history, geographic patterns | The Chemical Dictionary is designed to sit at the center of all four domains, to be a shared reference that makes each professional more effective without requiring anyone to become an expert in everything. --- ## Synchronizing Drug Names The names of substances found in street drugs were not designed for public health communication. They were assigned by chemists for chemists, according to nomenclature conventions that vary by discipline, country, and decade. The UNC Street Drug Analysis Lab has confirmed over 500 unique substances in community-donated samples since 2021\. Partners at the University of Victoria have identified over 700\. Without a shared naming and classification layer, data from these programs cannot be meaningfully combined to understand broader patterns. Emerging substances detected in one city cannot be efficiently flagged across a national network. And when a sample donor or drug checking technician sees a result containing a name they have never seen, they paste it into a search engine and get a scientific journal abstract or a DEA scheduling notice, neither of which tells them what they actually need to know. Garbage, and a frustrating waste of time. The same substance can appear as *medetomidine* in an analytical chemistry report, *dexmedetomidine* in a clinical record, and be called *tranq* on the street. General use, AI, and specialized search engines do not treat these as synonyms, resulting in missed information. Programs trying to aggregate findings across sites can find their naming systems to not align perfectly, leading to tedious recoding by hand. 💡 NIST has convened a national working group to standardize these naming conventions, including creating a canonical list of synonyms. UNC Street Drug Analysis Lab is a participant in that process, and we will defer to NIST's decisions, and provide input. --- # Why we're building this The absence of a chemical classification layer creates concrete knowledge gaps. Here are are few examples we have faced, and could name dozens more! 1. If two samples contain `fentanyl` and `metonitazene`, there is currently no reliable programmatic way to identify that both are synthetic opioids. A human expert knows this. The data system does not. 2. Naming of orphines is a mess: N-propionitrile chlorphine = chlorphine = cychlorphine. So which one do we use? 3. There is no reliable way to systematically identify substances that naturally occur together to differentiate from adulterants, like heroin impurities `6-MAM`, `acetylcodeine` , etc. But it would be helpful for sample donors to know what naturally occurs in heroin to focus unwanted cuts. Luckily, a [recently completed project](https://cph.uky.edu/research/projects/DMI2EpiTool) (funded by FDA, led by the University of Kentucky) hand-coded thousands of name variants and substances to create roll-up categories to simplify substance identification. We will rely on this incredible resource to help classify substances. 4. A relatively new ketamine-like dissociative can be called: `2F-NENDCK` (in Australia), `CanKet` on the street, `2-fluoro-*N-*ethylnordeschloroketamine` by chemists, `2-FXE` online, and `2-fluoro-2-oxo-PCE` by drug checking programs. Comparing across countries is really difficult, and search engines aren't great at figuring out these related names. And what do you tell someone who's sample contains it? --- # What it will contain Each entry in the chemical dictionary is anchored to a [PubChem CID](https://pubchem.ncbi.nlm.nih.gov/) — the National Library of Medicine's unambiguous chemical identifier — and then extended across 12 structured fields designed to serve every audience simultaneously. Here is a simplified example: | # | Field | Description | Example | | -- | --------------------------- | ------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------- | | 1 | Preferred name | Standardized name provided by NIST | p-fluorofentanyl | | 2 | Identification | Tags for molecular properties and classifications | opioid; synthetic; opioid analogue | | 3 | Biomedical | Tags for pharmacological properties, toxicology biological effects, addiction med/science, health risks | overdose risk; CNS depressent; dependence; tolerance | | 4 | Street Smarts | Tags for context of current real-world use | downer; smoked; snorted; injected; street | | 5 | Trending | Tags for trends in prevalence, rare vs. common, geographic distribution | common; declining \[USA\]; steady \[Canada\] | | 6 | PubChem CID linkage | Canonical NIH/NLM identifier for cross-database linkage | 62300 | | 7 | SMILES formula | Molecular structure in open-source notation for cheminformatics linkage | CCC(=O)N(C1CCN(CC1)CCC2=CC=CC=C2)C3=CC=C(C=C3)F | | 8 | Synonyms | Name variants across chemical conventions, abbreviations, countries | para-fluorofentanyl; 4-fluorofentanyl; | | 9 | Pronunciation guide | Plain-language syllable guide for clinical and outreach settings | pee-FLOOR-oh-FEN-tuh-nil | | 10 | Six-word summary | Plain-language description for sample result delivery, app integration, and field communication | *Fentanyl-like opioid, overdose risk* | | 11 | Vernacular and street names | Slang and brand names to aid website search and harm reduction communication | *down* | | 12 | References | Curated links to scientific literature for in-depth learning | PubMed, scientific articles, news articles, videos, trip reports | *A later phase may also include another field for harm reduction advice, but we believe so much of that is dependent on local and individual context.* --- # Why Tags? Most classification systems are hierarchical and put things in boxes. But you may need more flexibility depending on your information needs. For example, you may want to classify all your samples by if they are plant-grown or synthetic. Or, you may want to differentiate GABAergic versus noradrenergic activity. Or, you may want to pick out uppers vs. downers vs. hallucinogens to figure out what a mix of substances in a sample may feel like. Our flexible tagging structure let's you building your own classification system (ontology). It also helps the different expertise on our team stay in their lanes. This is some super nerdy data engineering, but it could lead to data analyses that are much more real-world salient. --- # How we are building it The development process runs in 6 phases, drawing on diverse expertise and review before public release. University of Victoria and the American College of Medical Toxicology will be collaborating with UNC to make this happen. We expect completion sometime in 3Q2026. ### Phase 1 — Data collection Collect examples of [similar](https://vimeo.com/showcase/10532006) [classification](https://health-infobase.canada.ca/drug-analysis-service/drug-classification.html) [efforts](https://substancesearch.org) [by](https://adf.org.au/insights/drug-wheel/) [others](https://frdd.cfsre.org/), and decide which makers to collaborate with as starting point. Got others? Share them with us at opioiddatalab@unc.edu. ### Phase 2 — Name standardization Compile naming conventions from across drug checking and forensic sciences, surface conflicts, and establish standardized naming convention. \[Now being conducted by NIST 🙏🏽\] ### Phase 3 — Classification Tag each substance across the four knowledge domains using input from chemists, toxicologists, harm reduction specialists, and epidemiologists. Substances will carry tags from more than all four domains. ### Phase 4 — Discrepancy review Adjudicate primary identifiers for each substance and determine preferred name variants through expert review, scientific literature, and professional consensus. ### Phase 5 — Community feedback & revision Once a working prototype has been developed, we will invite the Alliance for Collaborative Drug Checking (ACDC) network and selected international partners to kick the tires and make suggestions. Feedback will be incorporated into a revision. ### Phase 6 - Public release Release via public website, RESTful API, and downloadable CSV, and full documentation. Devise plan to keep updated. --- # Who this serves ChemDict is designed for many audiences, each of whom has different needs from the same underlying metadata. ### Harm reduction programs Frontline staff who communicate drug checking results directly to sample donors. The six-word summaries are designed for rapid, plain-language delivery in the field, where a long chemical name and a Google search result are not useful to anyone. The vernacular field connects laboratory terminology to the language that donors actually use. ### Data analysts Epidemiologists and data scientists who analyze tabular drug checking data and need to group substances by pharmacological class. The classification layer makes it possible to ask population-level questions — how many opioid samples, how many stimulant samples, how many samples containing novel psychoactive substances — that are currently unanswerable at scale. Applicable to drug checking data, clinical data, and autopsy lab outputs. ### Drug checking programs Chemistry labs newly entering the field who need a classification framework from day one. The synonym list and preferred name conventions allow a new program to align its data output with established nomenclature without building its own classification system from scratch. ### Clinicians When a new substance is detected in the clinic or hospital, having a quick resource to help contextualize it can speed up the process of figuring out how to treat the patient. Fewer delays, fewer name mixups, better care. ### Software developers Teams building dashboards, reporting tools, apps, or alert systems from drug checking data who need a ready-made categorization layer. The RESTful API enables real-time lookup so that applications can classify substances programmatically without manual intervention. --- # Preview A working prototype of the Chemical Dictionary Explorer is publicly available. It currently covers 200+ substances with approximately 70 classification tags. It's not complete, but more a demo of where we are headed. [ChemDict ExplorerData apps for data scientists and data analysts.![](https://static.ghost.org/v5.0.0/images/link-icon.svg)DeepnoteOpioid Data Lab![](https://deepnote.com/project/3e23f525-d8bc-4a6e-9c0d-d8ad2f13b7a2/social-image)](https://deepnote.com/app/opioiddatalab/ChemDict-Explorer-3e23f525-d8bc-4a6e-9c0d-d8ad2f13b7a2) ## Prototype We are building an advanced curation platform to consolidate the information. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/05/image-6.png) Substance specific display prototype. Will be adding more fields. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/05/image-7.png) Harm reduction messaging tool (messages are placeholders) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/05/image-8.png) Detailed codebook ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/05/image-9.png) Data export feature --- # Who's Involved ## Makers - [Street Drug Analysis Lab](https://opioiddata.org) at the University of North Carolina at Chapel Hill - [University of Victoria, BC, Canada](https://substance.uvic.ca/) - [American College of Medical Toxicology](https://www.acmt.net/) - [Center for Prevention Services](https://www.preventionservices.org/) & Queen City Harm Reduction (Charlotte, NC) ## Collaborators - National Institute for Standards and Technology (NIST) [RaDAR](https://www.nist.gov/programs-projects/radar) - Center for Forensic Science Research and Education ([CFSRE](https://www.cfsre.org/)) - Alliance for Collaborative Drug Checking (ACDC) ## Funder - Foundation for Opioid Response Efforts ([FORE](https://forefdn.org/)) ## Public Input We will be soliciting input from drug checking service providers and people with lived experience during the development process. ## Get updates during the development process Our newsletter is where you'll get all the details as we go along. Free sign up; we never share your info. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ## Posts ### How to get good at saving lives URL: https://www.opioiddata.org/how-to-get-good-at-saving-lives/ Last updated: 2026-07-30T10:12:31.000Z Every day in this country, people who use drugs bring other people back from overdose. Almost none of it is counted, and none of it is paid. In a [new paper in *Social Science & Medicine*](https://www.sciencedirect.com/science/article/abs/pii/S0277953626006362), we interviewed 74 people who had administered naloxone within the past year, recruited through harm reduction programs in western Pennsylvania, western Michigan, and central California. We wanted to understand something that overdose education and naloxone distribution (OEND) programs rarely ask about: **Not whether people can be trained to respond, but how they actually get good at it.** [](https://www.sciencedirect.com/science/article/abs/pii/S0277953626006362) [Habitus of CareOverdose normalization, reversal expertise, and the invisible moral labor of peSibley 2026 - Habitus of Care naloxone - SSM.pdf494 KBdownload-circle](https://www.opioiddata.org/content/files/2026/07/Sibley-2026---Habitus-of-Care-naloxone---SSM.pdf "Download") The scale surprised us. Thirty-four participants had reversed more than ten overdoses. Four had done it hundreds of times. In our [earlier analysis](https://pubmed.ncbi.nlm.nih.gov/41134828/) of 17 years of data from Prevention Point Pittsburgh, EMS were involved in just 8% of 5,521 community reversals. The overwhelming majority of overdose response in America happens in living rooms, cars, and alleys — performed by people whose formal training was a short video and a few minutes of instruction at a syringe program. ## This is expertise, not luck Paramedics receive hundreds or thousands of hours of training. Our participants received minutes. And yet what they described is exactly what the literature on expert performance in firefighting, combat, and emergency medicine describes: pattern recognition, calm under pressure, and rapid intuitive judgment. > "It's like second nature. I don't need to be reading instructions. It's just bing, bang, boom. On to the next one." *(Pat, MI, 30+ reversals)* > "The more experience you get under your belt, it's better. Because then I'm just like, I'm fast-acting instead of delaying my reactions. I used to freeze up... I was like, 'come on, brain, work!'" *(Molly, CA, 200+ reversals)* Participants distinguished a nod from an overdose without checking vitals. They titrated doses based on someone's tolerance history. They managed bystanders, delegated 911 calls, and coached themselves through the mechanics. One warned about drawing air into the syringe if you pull the plunger too fast. Felicia (CA, 6 reversals) described holding a pulse, counting between doses, running compressions, and controlling a crowd all at once: "If you don't stay calm, you're gonna get blew up." Skill accrues the way it does in any profession — through repetition. As Abby (MI, 20 reversals) put it: "I've been through the Narcan trainings... but it's like changing a tire, it's like you know what to do, until you're doing it." Community naloxone reversals have a [98% survival rate](https://pubmed.ncbi.nlm.nih.gov/41134828/). Reversing opioid overdoses and providing compassionate aftercare by people who use drugs helps reduce 911/EMS burden, allowing them to focus on other emergencies. This benefit of community naloxone distribution is rarely acknowledged in public health circles. ## Demanded, devalued, unpaid Here is the part that should give us pause, an appreciation of humility. Despite mastery comparable to professional emergency response, our participants refused credit. > "I'm just a vessel to help administer the medicine. I'm not, I'm not a supreme being. I don't save anybody." *(Terri, PA, 24+ reversals)* Asked why she wasn't on the same level as a firefighter, Beatrice (PA, 3 reversals) answered: "Maybe because we're doing something we're not supposed to be doing, I guess." That is a structural exclusion, internalized. Professional responders get counseling, paid time off, legal protection, and a title. Community responders get none of it — while carrying a heavier trauma load, because the person turning blue is usually a friend, a partner, or a neighbor. And there is no clocking out. > "You're trying to be really responsible in a way that I think a lot of us are trying to escape from. And now, like, now you gotta be doctor." *(Kia, CA, 20 reversals)* Pittsburgh has been here before. Freedom House Ambulance Service, staffed largely by Black community members, invented American paramedicine in 1967 and gave the first community dose of naloxone. It was disbanded in 1975, and many of its veterans were denied city employment for lacking credentials. The same currency — legitimacy — is still being withheld. ## Follow the money The BBC's *Business Daily* recently traced what it calls the antidote economy: a drug that costs pennies to make, sold over the counter for $52, and valued at $125 per kit in some opioid litigation settlements. In the final third of the episode, Sam Rivera of OnPoint NYC makes precisely our point, that the labor of reversal is the one input in this supply chain that nobody pays for. [BBC Audio | Business Daily | Follow the money: The antidote economyAn opioid overdose antidote costs a few dollars. Why doesn’t it always reach the patient?![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-32x32-e9763762-f0fa-4919-a754-ae0b27030a07.png)BBC News![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/p0p1521x-1b453df6-19c0-4260-a5e4-c4b97fcf06be.jpg)](https://www.bbc.com/audio/play/w3ct8gr4) Naloxone saturation is working. But it is a solution premised on a medical technology, not on the workforce that deploys it. If public health is going to keep relying on peer response, then debriefing, mental health care, legal shielding, and actual compensation are not extras. They are what we already give everyone else who does this job. 🙏 This work was supported by the ****U.S. Food & Drug Administration**. We appreciate FDA's willingness to fund qualitative work of this kind; our FDA colleagues helped shape the overarching research questions and reviewed the interview guide, while the UNC team retained full control over data collection, coding, and interpretation. ## Distribution models should rely on bulk Many public health programs pat themselves on the back for getting doses out the door, with no weighting on who was provided with the antidote. Prioritizing networks of people who use drugs should be the number one focus. Think about it this way – Is the person who you're giving naloxone to someone who is in the room when drugs are being used? If the answer is "no" then it's time to re-think your distribution strategy. Look, having naloxone available in schools and libraries helps with de-stigmatizing the intervention. However, let's be clear-eyed on what actually gets naloxone into people's bodies at the right time. Many participants reversed dozens of overdoses. Naloxone distribution models that only hand out a few doses, or rely on pharmacy purchase, clearly do not address the medication availability needs of [Super Savers](https://link.springer.com/article/10.1186/s12954-025-01255-3). ## Expertise in different forms ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/07/image-2.png) [Chain of survival for drug overdose](https://www.sciencedirect.com/science/article/pii/S2666520425001638) We have previously said that the [Chain of Survival](https://www.sciencedirect.com/science/article/pii/S2666520425001638) for overdose should incorporate high quality assessment and medical attention. We still stand by this; there are many reasons why someone could be down, beyond the overdose, and those conditions (like head wounds from the fall) may also need to be treated. Yet, the reality is that in the US there are waaaaaay more ODs than EMS can possibly handle. And the new study shows there is true expertise that develops. We've seen the same phenomenon arise naturally in other places in the US, Sweden, India, and Viet Nam... people who get a reputation (and responsibility) for reversing overdoses are the ones who get called to help when someone goes down. [What are we doing to support the trauma that accumulates?](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2822%2900011-1/fulltext) ### Acknowledgements We are grateful to the staff of **Prevention Point Pittsburgh** (Pittsburgh, Pennsylvania), **Red Project** (Grand Rapids, Michigan), and **SANE — Safer Alternatives through Networking and Education** (Sacramento, California) for their support and advocacy in completing this research. We are indebted to **Colin Miller** for his invaluable efforts during data collection. Most importantly, we thank the **74 participants** who selflessly shared their experiences and wisdom with us. Remedy Alliance is a non-profit organization that provides bulk naloxone to health departments and public health programs for free or at cost. ## Was this insightful? Sign up for the latest from the Opioid Data Lab with our free newsletter. (1-2 per month) Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. --- *Sibley AL, Joniak-Grant E, Colston DC, Bell A, Doe-Simkins M, Wheeler EJ, Dasgupta N. The habitus of care: Overdose normalization, reversal expertise, and the invisible moral labor of people who use drugs. Social Science & Medicine. 2026\.* [*doi:10.1016/j.socscimed.2026.119560*](https://doi.org/10.1016/j.socscimed.2026.119560) --- ***Use of generative artificial intelligence (AI)*** We used Claude Opus 4.8 to help generate starter text, that was manually edited. We used ChatGPT Sol 5.6 to generate the comic. In the study, AI tools were used to aid transcription of interviews, but all coding and analysis was done manually. ### Summer 2026 Newsletter URL: https://www.opioiddata.org/summer-2026-newsletter/ Last updated: 2026-07-07T10:31:51.000Z Happy Summer from the lab! ☀️ This edition is short and sweet, but always informative, of course. We're excited to share a few updates, reminders, and resources as we continue working together to keep communities informed through drug checking. Grab a cold drink, soak up the sun, and give us a few minutes of your time. We are glad you're here! ## Let's keep talking. Subscribe Email sent! Check your inbox to complete your signup. Be in the know with our free newsletter. # 〽️Service Stats & Updates As of **Tuesday July 7, 2026.**.. **22, 607** samples analyzed Serving **207** harm reduction programs Reaching **281** counties in **44** states **522** unique substances identified [UNC Watchlist](https://www.opioiddata.org/unc-watchlist/) --- # Don't miss the ACDC Drug Checking Summit! Looking to expand your knowledge of drug checking and connect with others from across the field? Join the **virtual ACDC Drug Checking Summit** for several days of engaging presentations, practical discussions, and the latest updates in harm reduction and drug checking- all from the comfort of your home or office. *Register today* and learn from experts and colleagues working to advance drug checking services! [ACDC Drug Checking Summit 2026 - OnlineACDC has been improving drug user-facing, harm reduction- based drug checking since 2019\. Attend our annual learning summit! (Español)![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-194x194-2665e88c-38d7-4bb7-9c95-4025647004a4.png)Eventbrite![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image-1c320702-6d4c-4128-b47f-aaa53689d18d)](https://www.eventbrite.com/e/acdc-drug-checking-summit-2026-online-tickets-1986997964400?aff=oddtdtcreator) --- # 📦 Service Updates ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/07/IMG_3760-1.jpg) CRUSHED BOX?! 😱 No worries! **Our shipping materials are built to protect your samples!** The photo above is from a recent shipment that arrived with a badly crushed box. Fortunately, every sample vial inside was completely intact thanks to the shipping materials included in our kits. While we truly appreciate programs wanting to purchase their own shipping supplies, this is exactly why we ask that **only our provided boxes, labels, and packing materials** be used. These materials have been selected to help protect your samples and ensure they arrive safely for analysis! **Reminder: Updated Mailing Address for Checks** If your program pays by check, please note our updated mailing address below. This information is included on all invoices and invoice emails, but in case you missed it, please use the following address for future payments: **UNC Street Drug Analysis Lab (IPRC)** **Attn: Nab Dasgupta** 725 MLK Jr. Blvd Campus Box 7505 Chapel Hill, NC 27599-7505 --- # Musicians for Overdose Prevention T-Shirt Memorial at NC State Capitol Watch this powerful tribute from Musicians for Overdose Prevention and the North Carolina Harm Reduction Coalition honoring the lives lost to overdose since 2020\. Learn how you can help commemorate those we've lost. --- # 🔎Ketamine Mixes There's two types of ketamine, S-ketamine and R-ketamine. S-ketamine is the active ingredient in Spravato, a prescription depression nasal spray, and it's about twice as strong as racemic ketamine and four times that of R-ketamine. Most other ketamine, including standard medical ketamine is racemic, a 50/50 mix of R and S. Findings show that street ketamine is also usually a 50/50 mix, resembling standard ketamine. So what's causing the differences in varying effects reported? It more likely comes down to purity, cutting agents, or dose. Not a shift in ketamine form.[ Read more here. ](https://chemrxiv.org/doi/full/10.26434/chemrxiv.15003278/v1) Note: We do not do this kind of detailed separation at our lab. --- # 📖 Reading Room Read up on articles we found engaging or maybe watch a video about- **FDA:** [Starting Doses of Buprenorphine to Reduce Non-Fatal Overdoses and Prevent Mortality](https://www.fda.gov/science-research/advancing-regulatory-science/starting-doses-buprenorphine-reduce-non-fatal-overdoses-and-prevent-mortality) **AJPH:** [Naloxone Distribution in the United States, 2018–2023.](https://ajph.aphapublications.org/doi/10.2105/AJPH.2026.308541?%5F%5Fcf%5Fchl%5Ff%5Ftk=Jo9EIkv1eoK8GpONvYSO6PWOvCgzAde7astyazumsXk-1783393175-1.0.1.1-w0nkqaHxcr3e8JpWMsX6TUSj4hyZ9Ur3C%5F4qaOceqME) Naloxone distributed to non–health care settings increased from 1.39 million units in 2018 to 16.1 million in 2023. **Assembly:** [From One Recovery to Another](https://www.theassemblync.com/news/health/hurricane-helene-substance-use-disorder-recovery-disasters/). How does a natural disaster affect recovery from substance use? Learn how Hurricane Helene disrupted treatment and recovery services across North Carolina and the lessons it offers for supporting communities before, during, and after a crisis. Find out about [Building a Safety Net for Harm Reduction During Disasters!](https://www.theassemblync.com/news/health/harm-reduction-substance-abuse-hurricane-helene/) Good coverage of cannabis in [The Assembly!](https://www.instagram.com/p/DZu5cFNDykp/?img%5Findex=2) **Barbers? Narcan?** [See how everyday community members are making a difference!](https://www.cbs17.com/news/local-news/two-wilson-barbers-talk-about-saving-a-life-with-narcan/) **Community News:** [Durham's HEART program shows major drop in crime reports since inception, reshapes crisis response](https://abc11.com/post/durhams-heart-program-shows-major-drop-crime-reports-inception-reshapes-crisis-response/19082404/) **Cumberland County NC:**[Using Demographic and Substance Use Features to Predict Suspected Xylazine-Associated Wound Development Among People Who Use Drugs in North Carolina](https://www.linkedin.com/posts/gregory-berry-839840353%5Fusing-demographic-and-substance-use-features-share-7463707591366443008-nhjO/?utm%5Fsource=share&utm%5Fmedium=member%5Fios&rcm=ACoAAAQ62DUBufbeTX7YLlr007Uf6f7KIKIf09U) **Filter:**[ Appalachians Want to Use Mobile Syringe Programs, If They’re Discreet](https://filtermag.org/appalachian-mobile-syringe-programs/) **Health Affairs:** [New ICD Codes For Xylazine-Associated Wounds: A Critical Tool, But Only If They’re Widely Implemented](https://www.healthaffairs.org/content/forefront/new-icd-codes-xylazine-associated-wounds-critical-tool-but-only-if-they-re-widely) **Hot Press:** [The Joint Committee on Drugs Use Final Report could herald the biggest shake up of drug laws in the history of the Irish state](https://www.hotpress.com/lifestyle-sports/the-joint-committee-on-drugs-use-final-report-could-herald-the-biggest-shake-up-of-drug-laws-in-the-history-of-the-irish-state-23146844) **Nature:** Researchers and science publishers need to seize the opportunity offered by the drastic shifts in the way news is produced — one reason ***Nature*** has joined TikTok. [The Future of Science.](https://www.nature.com/articles/d41586-026-01723-1) Check out **Remedy Alliance's** [2025 Impact Report!](https://www.canva.com/design/DAHDAfVmlI0/Ju7LgstBk0yqdWV4UwNIrA/view?utm%5Fcontent=DAHDAfVmlI0&utm%5Fcampaign=designshare&utm%5Fmedium=link2&utm%5Fsource=uniquelinks&utlId=h43a83a6115) **Stat News:**[Treatment for alcohol addiction is undergoing a seismic shift. Many say it’s overdue](https://www.statnews.com/2026/05/14/alcohol-use-disorder-treatment-landscape-changing-deadliest-drug-series-part-4/) **Science Direct:** [Pharmacokinetics of xylazine and fentanyl in patients presenting to the emergency department after non-fatal opioid overdose.](https://www.sciencedirect.com/science/article/abs/pii/S0376871626002097?dgcid=coauthor) --- # 🤗 Opportunities for Impact Please send us job postings, conferences, proposals, and other events for you harm reduction baddies and we will highlight in our next newsletter! **Wake County NC** is looking for a [Drug & Injury Prevention Unit Manager!](https://ewaketalent.csod.com/ux/ats/careersite/3/home/requisition/9449?c=ewaketalent&sq=injury) **Virginia Harm Reduction Coalition** is hiring a new Director of Operations! Read more below. [2026 VHRC Director of Operations JOB POSTING.docx2026 VHRC Director of Operations JOB POSTING.docx.pdf91 KBdownload-circle](https://www.opioiddata.org/content/files/2026/07/2026-VHRC-Director-of-Operations-JOB-POSTING.docx.pdf "Download") --- **Defining Practice: Competencies for Drug Checking Technicians**, a new toolkit, has been released to support the growth and professional development of the drug checking workforce. Developed through international collaboration with experienced drug checking technicians, the resource outlines core competencies, skill development, and guidance for training and supervision. While designed primarily for FTIR-based drug checking programs serving people who use drugs, many of the lessons can be adapted to fit a variety of program settings. Check it out! [Drug Checking ToolkitDrug Checking Toolkit.pdf6 MBdownload-circle](https://www.opioiddata.org/content/files/2026/07/Drug-Checking-Toolkit-1.pdf "Download") --- [](https://www.southpiedmontahec.org/event/75020) # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. **Send us more doodles and notes!** They sustain us. 💖 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/07/IMG_3807-1.jpg) --- ## Thanks from the Opioid Data Lab team! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/04/image-9.png) ### April Newsletter URL: https://www.opioiddata.org/april-newsletter-2026/ Last updated: 2026-05-20T16:27:52.000Z We have reached over 20,000 samples analyzed!!! 🎉 Wheeeewwww!!! What an amazing journey, it has been and I want to thank our entire team. From advocating and educating, ordering supplies, packing kits, FedEx runs, our lab crew, data team, researchers, and admin. We are small but we get it done! Also, we couldn't had done it without the support from all of you! From everyone who has entrusted us with your drug checking needs- we thank you **🫶** ## Let's keep talking. Subscribe Email sent! Check your inbox to complete your signup. Be in the know with our free newsletter. # 〽️Service Stats & Updates As of **Monday April 27, 2026.**.. **20,985** samples analyzed Serving **199** harm reduction programs Reaching **296** counties in **44** states **511** unique substances identified [UNC Watchlist](https://www.opioiddata.org/unc-watchlist/) --- # Nab's Testimony to US House of Representatives Health Subcommittee ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/04/image-4.png) Recently, *Dr. Nab Dasgupta* went in front of Congress to testify about the unintended consequences of scheduling xylazine — and why getting drug policy wrong can make a dangerous situation even **worse.** Check out his [written testimony](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/jh3448896?locale=en), watch the [web recording](https://energycommerce.house.gov/events/health-subcommittee-policies-to-protect-our-communities-from-illicit-drug-threats), or catch it on [YouTube](https://www.youtube.com/watch?v=XxbZA-wPVks&t=2957s)! We are all so proud! --- # ⚠️Bots Using Our Data We've heard your concerns about third parties scraping our drug results site and making apps, or using the data for AI training. We have revised our [Data Use & Protection policy](https://results.streetsafe.supply/data-use) to make it explicitly clear that these purposes are not allowed. --- # 📉 Department of Data What's going on with CDC's overdose prediction algorithm? It works great when trends are moving in a line (up or down). But when rates turn a corner and start to decline nationwide like in 2023, the model overshot. And, now with OD acceleration in some states, it's poised to underestimate. [The 2025 Drug Overdose Spike That Wasn’t: Neither Politics nor Data Errors Explain the Anomaly](https://ajph.aphapublications.org/doi/10.2105/AJPH.2025.308412) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/04/image-8.png) We also want to point out this [new CDC resource](https://www.cdc.gov/overdose-prevention/data-research/facts-stats/clinical-drug-test-dashboard.html) that shows the prevalence of cocaine, fentanyl, heroin and methamphetamine in clinical urine drug test samples collected by Millennium Health labs. --- [](https://3.basecamp.com/5250175/buckets/42795723/boosts/new?boost%5Bboostable%5Fgid%5D=Z2lkOi8vYmMzL1JlY29yZGluZy85ODE0ODcwODM5) # 👀 Have we seen cychlorphine? Yes, we've been tracking the-molecule-currently-known-as cychlorphine since our first detection in August 2024\. We haven't see it in NC samples, but if our service users suspect it, please note it down on the card. **Cychlorphine is a minor concern relative to fentanyl because it currently** **doesn't make up even 1% of the illicit opioid supply**. There are much more important and concerning things to pay attention to, namely medetomidine withdrawal heart attacks; it's not just about overdoses. Human effect information is limited. You can see all the samples under it's proper name [N-propionitrile chlorphine](https://results.streetsafe.supply/?query=N-propionitrile+chlorphine) and summarized in this [Live Report](https://deepnote.com/app/opioiddatalab/Orphines-bf899b81-e39f-4ab1-9b8d-651fe73b0f32). Naming of orphines is a mess. For example: N-propionitrile chlorphine = chlorphine = cychlorphine and "SR-17018" = 5,6-Dichloro Desmethylchlorphine. We are working with NIST to standardize naming, but be aware that this is in flux. [**Ibogaine:**](https://www.statnews.com/2026/04/20/trump-executive-order-psychedelics-republicans-veterans-ibogaine/) In light of last week's federal announcement on ibogaine, it's worth hearing from our friend Dimitri Mugianis who has more decades of experience with ibogaine and Bwiti in the US than just about anyone else. (Who was immortalized in this [Law & Order SVU episode](https://www.imdb.com/title/tt1536228/).) The main point? ["Without additional resources, psychedelics like ibogaine can’t support recovery or mental health."](https://archive.ph/JK3nE) --- # What we are actually worried about- As expected, [medetomidine](https://www.opioiddata.org/not-your-hospitals-precedex-why-street-medetomidine-hits-different/) is replacing xylazine in our samples. Good news, medetomidine doesn't cause horrific skin wounds. Bad news: Quitting cold turkey can give you a heart attack and land you in intensive care. In Pittsburgh, hospitals are filling up – not with overdose – but with people who tried to stop using what they thought was fentanyl but had medetomidine. It's a complicated weeklong hospital intensive care stay with 14 medications to treat these drug-induced heart attacks. Yet, medetomidine is a REALLY IMPORTANT medication in hospitals to sedate babies on respirators and adults after surgery. At Prevention Point Pittsburgh, where medetomidine is replacing fentanyl, they are telling folks who want to quit to skip the methadone/buprenorphine clinic and go wait in the hospital emergency room. Life threatening withdrawal doesn't happen to everyone, but can start 2 to 26 hours after last use. This will blow up all the MAT and telehealth services that you all worked so hard to build! This makes "just say no" potentially lethal advice, and abstinence-based residential treatment programs should be ready to provide transport to the hospital for new patients when withdrawal hits. Pay attention. [**This is the real drug story of the month**,](https://www.sciencedirect.com/science/article/pii/S0196064425014349) not cychlorphine or ibogaine. How do we keep it out of our communities? Can test strips empower people who buy drugs to push back on suppliers? We need to get creative, and we need to do this now. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/04/Unknown-54.png) --- # Heard of DFNZ? No, it's not Drug-Free New Zealand. 🇳🇿 A NIDA-led team of scientists from the US and Spain discovered a new molecule that could just be the holy grail in pain management. It's a high-efficacy "superagonist" at the µ-opioid receptor (e.g., great pain relief in animal models), with markedly less respiratory depression, tolerance, withdrawal, and reinforcement than standard opioid analgesics. Guess what? It's derived from a nitazene! *N*\-desethyl-fluornitrazene. Yeah, that same class of new synthetic opioids that the [media has been over-hyping](https://time.com/7317460/nitazenes-fentanyl-opioid-crisis-drugs) as the next dangerous thing in the illicit drug supply. But, the sad thing is it may never make it to medicine cabinets. Why? Because Congress is [poised to permanently ban](https://www.congress.gov/bill/119th-congress/house-bill/5032/text) ALL nitazenes, including DFNZ. 'Tis pity to be so shortsighted. [A µ-opioid receptor superagonist analgesic with minimal adverse effects - NatureN-desethyl-fluornitrazene is a µ-opioid receptor agonist derived from nitazenes that has supramaximal intrinsic efficacy that produces analgesia with minimal adverse effects in rodent models.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-f39cb19454.png)Nature Publishing Group UKJuan L. Gomez![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/41586_2026_10299_Fig1_HTML.png)](https://www.nature.com/articles/s41586-026-10299-9) --- # ✈️ Out and About ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/04/Screenshot-2026-04-27-at-11.29.55---PM.png) Illyana presenting at the 2026 Addiction Medicine conference in Asheville, Nc. Hosted by the [Governor's Institute. ](https://governorsinstitute.org/) --- # Jesse Bennett 🖤 We bid a sad farewell to Jesse Bennett, former head of the NC Harm Reduction Coalition, who passed away on April 15th in Raleigh, NC. An [NC State graduate](https://chass.ncsu.edu/news/2016/08/01/drawing-from-his-own-past-student-aims-to-help-others-fight-addiction/), and [dad of two two kids](https://www.forevermissed.com/jesse-t-bennett/about), who helped shepherd our movement in the South through a very influential period. See his bright smile in this [photo album](https://photos.google.com/share/AF1QipPJVkmrbIVWGqY67h-EoFxaUxh7jnjEnV308aB56vI5I%5FTgEOORsy1tmogT7WEhyA?pli=1&key=M3h6MmtoS2xsd1JUeTR5b3lmMS1GVTRIOFlWeEhB). Godspeed, friend. You did a world of good! --- # 📖 Reading Room Read up on articles we found engaging or maybe watch a video about- **Academic Emergency Medicine:** [Naloxone Administration in Relation to Fentanyl, Xylazine, CNS Depressants, and Stimulants Exposure After Suspected Opioid Overdose](https://onlinelibrary.wiley.com/doi/10.1111/acem.70280) [**Watch this fascinating interview** ](https://drogriporter.hu/en/ann-fordham-leaving-idpc-after-17-years/)with one of the brightest minds in international drug policy- **Ann Fordham**. She recently left her post at IDPC after 17 years. This is a reflection on the state of drugs globally over the last two decades. Produced by our friend [István](https://drogriporter.hu/en/author/idoru/) **Comms Resources from Prison Policy Initiative:** We recently learned about this great series of guides for data-based messaging from Wendy Sawyer at the Prison Policy Institute. Here's their [writing guide](https://www.prisonpolicy.org/trainings/writing%5Fguide.html), [advocacy toolkit](https://www.prisonpolicy.org/trainings/), guide to [managing and organizing](https://www.prisonpolicy.org/trainings/organizing%5Fdata.html) public data. Our fav was this guide to [designing effective visuals](https://www.prisonpolicy.org/trainings/design%5Fresources.html). [**Lighter content- Fast Fish Cocaine:**](https://www.smithsonianmag.com/smart-news/cocaine-pollution-seems-to-make-salmon-swim-faster-and-farther-than-usual-scientists-dont-know-the-long-term-consequences-180988600/) The illegal drug’s main byproduct, benzoylecgonine, caused more robust effects than cocaine itself. **NY Times:** [How the Internet Became the ‘Cookbook’ of the Drug Trade](https://www.nytimes.com/2026/03/31/science/drugs-psychoactive-nitazenes.html?searchResultPosition=2) **Syringes & War:** One of the unintended consequences of the War on Iran is that countries like South Korea are experiencing a [shortage of syringes](https://www.bloomberg.com/news/articles/2026-04-20/south-korea-targets-syringe-hoarding-as-war-rattles-supply-chain?embedded-checkout=true). We don't know if this will impact US hospitals and SSPs, but anything plastic in the supply chain is up for disruption. We haven't heard of this affecting the US yet, but it would be worth checking with suppliers if shortages are on the horizon. **The American College of Medical Toxicology** (ACMT) [supports the use of expired naloxone to reverse suspected opioid overdose in situations where unexpired drug is not available.](https://www.acmt.net/news/acmt-supports-the-use-of-expired-naloxone-when-unexpired-drug-is-not-available/) This is a clever and important paper from [**Caroline Copeland's team at Kings College London**](https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2601141). Nitazenes disappear in post-mortem toxicology. When blood samples are handled in the standard manner for autopsy, common nitazenes have less than 10% detectability. This will be a huge problem for OD death data if/when nitazenes emerge in force in the US. --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. Join **ACDC** for the seventh annual [Alliance for Collaborative Drug Checking (ACDC) Virtual Learning Summit](https://www.eventbrite.com/e/acdc-drug-checking-summit-2026-online-tickets-1986997964400?aff=oddtdtcreator)! **Durham NCHRC Drug Alert Bulletin:** An example of what programs are doing to convey drug checking data to participants! [Drug Supply Updates 03\_2026 NCHRCDrug Supply Updates 03\_2026 NCHRC.pdf2 MBdownload-circle](https://www.opioiddata.org/content/files/2026/04/Drug-Supply-Updates-03%5F2026-NCHRC.pdf "Download") **Edgecombe County** **Emergency Services** is currently accepting applications for a [Post Overdose Response Team (PORT) Community Paramedic](https://webform.edgecombecountync.gov/Forms/JobApplication)! **UC San Francisco** is hosting an OIDA symposium THIS May, [check it out!](https://www.linkedin.com/posts/industry-documents-library%5Fopioid-archive-healthjournalism-activity-7447678143093698560-ZxKg/?utm%5Fsource=share&utm%5Fmedium=member%5Fdesktop&rcm=ACoAAAVDbLQBoONi43UtIqEOLxQLg8z7zXy7cfs) **Welfare Research Inc.**, based in Long Island, NY is searching for a [drug checking technician](https://www.indeed.com/job/drug-checking-technician-3b06d710cd3a966a)! **The Hair Study Recruitment** study below will evaluate if environmental hair contamination can lead to positive hair drug tests and they are looking for volunteers! [FAIR HAIR Recruitment flyer ver 2FAIR HAIR Recruitment flyer ver 2.pdf309 KBdownload-circle](https://www.opioiddata.org/content/files/2026/04/FAIR-HAIR-Recruitment-flyer-ver-2.pdf "Download") --- # Expired Test Strips The shelf-life of BTNX xylazine test strips have been extended. Check lot numbers to be sure. Fentanyl test strips can also be used past expiration, but their limit of detection may shift- so that minuet amounts may be harder to detect. [Shelf Life Extension-XYL1000Shelf Life Extension-XYL1000.pdf210 KBdownload-circle](https://www.opioiddata.org/content/files/2026/04/Shelf-Life-Extension-XYL1000.pdf "Download") --- # 📦 Service Updates Thank you all for your continued partnership. We appreciate the important work you do in your communities! - Samples are **always voluntary**, and individuals must have access to their results! - Please **do not share kits** between programs-reach out to us if needed and the original kit owner will be responsible for the shipment/materials fee. - Use **only the materials and labels we provide** and ship via **FedEx only** - **Do not add water** to vials; if solution has evaporated (around 3 months), that’s okay, just contact us - Be mindful of **shipping timelines** when ordering and returning kits **Data Cards Reminder** Please fill out data cards as thoroughly as possible. Knowing the **expected substance** helps ensure accurate lab analysis, and **sensations data** are critical for understanding changes in potency and composition in the drug supply. **Mailer Update (Effective May 1)** Starting May 1, there will be a **$10 fee for additional mailers** for all programs, including those in North Carolina. One mailer is provided per 5 kits. We do not want you holding onto 1-2 samples for an extended time but also you can send more than 5 samples back in a box if necessary! This change helps us cover rising material and shipping costs, and we appreciate your understanding. Happy drug checking! --- ## Thanks from the Opioid Data Lab team! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/04/image-9.png) ### March 2026 Newsletter URL: https://www.opioiddata.org/march-2026-newsletter/ Last updated: 2026-05-20T16:28:18.000Z March is here, and we’re springing forward with fresh updates from the lab! 🌱 This month is an easy read and we’ve got a few highlights to share, with even more cool reads and insights coming your way in the next few weeks, so stay tuned. As always, we’re glad you’re here and part of the work helping keep communities safe & informed! ## Let's keep talking. Subscribe Email sent! Check your inbox to complete your signup. Be in the know with our free newsletter. # 〽️Service Stats & Updates As of **Tuesday March 24, 2026.**.. **19,103** samples analyzed Serving **192** harm reduction programs Reaching **296** counties in **43** states **488** unique substances identified [UNC Watchlist](https://www.opioiddata.org/unc-watchlist/) # 🔎 New Substances Detected Here are the 15 new things we found in the drug supply last month. You can see the [full list here](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823), updated monthly. Just because we are seeing it for the first time, doesn't mean it hasn't been circulating already. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/03/image--6-.png) - **Bromantane** – Russian adaptogen/stimulant, used for fatigue and cognitive enhancement - **Modafinil** – Prescription wakefulness agent (narcolepsy); widely used off-label as a cognitive enhancer (Provigil) **Dissociatives / Novel Psychoactives** - **3-Methoxy-2-oxo PCP** – Novel dissociative, PCP analog - **2C-C** – Phenethylamine psychedelic (Shulgin compound) - **5-MeO-DiPT** – Tryptamine psychedelic ("Foxy Methoxy") - **Isophenidine (isopropylphenidine)** – Dissociative NMDA antagonist, research chemical **Opioid-Adjacent / Kratom** - **Dihydro-7-hydroxy mitragynine (MGM-15)** – Potent semi-synthetic kratom alkaloid derivative with opioid activity **Anabolic Steroids / Hormones** - **Oxymetholone** – Anabolic steroid (Anadrol) - **Exemestane** – Aromatase inhibitor used in steroid cycling and breast cancer treatment - **Fluoxymesterone** – Potent anabolic/androgenic steroid (Halotestin) **Pharmaceuticals (unexpected in drug supply)** - **Nabumetone** – NSAID (anti-inflammatory) - **Sulfamethoxazole + Trimethoprim** – Antibiotic combination (Bactrim/Septra) - **Meclizine** – Antihistamine/antiemetic (motion sickness) - **Propylene glycol** – Solvent/excipient, not typically a standalone drug supply findings --- # 👩🏽‍🔬 Lab Visits We were delighted to host Union County NC. Thanks for driving all the way to discuss the benefits of drug checking and checking out where the magic happens! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/03/IMG_5994-2.jpg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/03/IMG_5995-2..jpg) --- # Congrats to the New Dr on our Team! 🎓 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/03/Colston_Headshot.jpg) We want to give a special shoutout to our team member David, who successfully defended his dissertation this month, an incredible accomplishment! We’re so proud of his hard work and dedication, and grateful to have him as part of our team. --- # 📦 Service Updates Thank you all for your continued partnership. We appreciate the important work you do in your communities! - Samples are **always voluntary**, and individuals must have access to their results! - Please **do not share kits** between programs-reach out to us if needed - Use **only the materials and labels we provide** and ship via **FedEx only** - **Do not add water** to vials; if solution has evaporated (around 3 months), that’s okay, just contact us - Be mindful of **shipping timelines** when ordering and returning kits **Data Cards Reminder** Please fill out data cards as thoroughly as possible. Knowing the **expected substance** helps ensure accurate lab analysis, and **sensations data** are critical for understanding changes in potency and composition in the drug supply. **Mailer Update (Effective May 1)** Starting May 1, there will be a **$10 fee for additional mailers** for all programs, including those in North Carolina. One mailer is provided per 5 kits. We do not want you holding onto 1-2 samples for an extended time but also you can send more than 5 samples back in a box if necessary! This change helps us cover rising material and shipping costs, and we appreciate your understanding. Thanks again and happy drug checking! --- # 📖 Reading Room Read up on articles we found engaging or maybe watch a video about- **Vital Strategies' Vital Stories:** [Q&A with Indigenous Harm Reduction Program Leaders](https://www.vitalstrategies.org/qa-with-indigenous-harm-reduction-program-leaders-philomena-kebec-kaya-littleturtle-and-tiffany-pyette/) Philomena Kebec, Kaya Littleturtle and Tiffany Pyette **StatNews:** [America must not learn to live with 72,000 overdose deaths a year](https://www.statnews.com/2026/03/09/drug-overdose-deaths-opioids-decline-plateau/) Why are we celebrating a death toll that exceeds total American combat fatalities in Vietnam *every year*? **Bellingcat:** [New Footage Shows Wanted Kinahan Cartel Kingpins Post-Sanctions](https://www.bellingcat.com/news/2026/03/07/new-footage-shows-wanted-kinahan-cartel-kingpins-post-sanctions/) **MBPOnline:** [As Mississippi waits to spend opioid settlement funds, children and families suffer](https://www.mpbonline.org/blogs/news/as-mississippi-waits-to-spend-opioid-settlement-funds-children-and-families-suffer/) **The Herald Sun:** [Probe confirms NC juvenile detention problems. Some kids locked up, isolated.](https://www.heraldsun.com/article314760983.html) Take a look at **Kentucky's Just Say Yes Icelandic Model** ⬇️ [2023KYHRSJustSayYesLessonsfromaKYCtyIPM2023KYHRSJustSayYesLessonsfromaKYCtyIPM.pdf6 MBdownload-circle](https://www.opioiddata.org/content/files/2026/03/2023KYHRSJustSayYesLessonsfromaKYCtyIPM.pdf "Download") --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. Join **MAHEC** for Community Wound Care: Strategies to Address Wounds Associated with Substance Use, Homelessness, and Trauma. [It is a full day training and you can learn more here!](https://mahec.net/home/event/77985) **NCHRC** is hiring a[**Outreach Specialist** ](https://docs.google.com/forms/d/e/1FAIpQLScuVjaz5AZ21Wm4%5F5HbSWUfMmJidwsLrRO0hTbeWkZBVgTElg/viewform)for Harnett County. **Guilford County** & [NC Survivor's Union](https://www.ncsurvivorsunion.org/) are hiring a Peer Support Specialist! [Job Description (1) (1)Job Description (1) (1).pdf88 KBdownload-circle](https://www.opioiddata.org/content/files/2026/03/Job-Description--1---1-.pdf "Download") We also want to shoutout **Guilford County** for installing a ***no cost naloxone vending machine!!*** The vending machine provides free access to naloxone, wound care kits, and fentanyl and xylazine test strips. [See more here. ](https://www.linkedin.com/posts/guilford-county%5Ftoday-guilford-county-public-health-in-activity-7430704732958224384-mG%5FF/?utm%5Fsource=share&utm%5Fmedium=member%5Fios&rcm=ACoAAAQ62DUBufbeTX7YLlr007Uf6f7KIKIf09U&skipRedirect=true) Need **drug checking training**? You may missed sample collection training for this month but head over to [Remedy Alliance Drug Checking for the People](https://www.drugcheckingftp.org/#about-us) to stay updated for more upcoming trainings! --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. **Send us more doodles and notes!** They sustain us. 💖 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/03/image-1.png) No box this month but we received these really adorable items! We appreciate all the goodies that we receive 😄 ## Thanks for reading!!! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/10/Black-And-White-Simple-Personal-Business-Card--1-.png) ### February 2026 Newsletter URL: https://www.opioiddata.org/february-2026-newsletter/ Last updated: 2026-05-11T14:46:56.000Z We hope everyone’s year wrapped up smoothly and the new one is off to a great start. Here’s to another year of sharing timely results, trusted data, and working together to keep our communities informed and safer! ## Let's keep talking. Be in the know with our free newsletter. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. # 〽️Service Stats & Updates As of **Monday February 9 2026.**.. **19,103** samples analyzed Serving **192** harm reduction programs Reaching **296** counties in **43** states **488** unique substances identified **Note to our service users**: If you’re using an older [version of our card](https://cdr.lib.unc.edu/concern/multimeds/5d86p887m?locale=en) to report test strip results, please specify if “MTS” means *methamphetamine* or *medetomidine*! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/IMG_3863.jpeg) Getting in the Olympic spirit with a team curling event! --- # A Special Thanks As many of you know, our very own Nab was recently named a recipient of the 2025 MacArthur Fellowship, “genius grant,” for his work in overdose prevention, an honor that is truly well deserved and a reflection of his deep commitment to the work. In his reflection on this achievement, he takes the time to acknowledge those who often go unnoticed and who aren’t in the spotlight, reminding us that the field of public health has long been described as an *invisible shield protecting our communities.* I can personally identify with that feeling, having entered the field a little over ten years ago when few people outside my cohort even understood what I was majoring in. [**We encourage you to take a moment to read his full reflection here**](https://ajph.aphapublications.org/doi/10.2105/AJPH.2025.308375). We want everyone to know that we see you, from peer support specialists, people with lived experience, clinical staff, outreach workers, case managers, educators, advocates, researchers, and beyond. Nab is shining a light on the state of public health and encouraging all of us to uplift one another and recognize the value each role brings. We will keep fighting the fight and never forget the many vital contributions in overdose prevention that continues keeping our communities alive-thank you for all that you do! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/image-11.png) ACDC Drug Checking session at DPA November 2025. --- # 📦 Service Updates As we begin the new year, we’d like to share a few important service reminders. Sample collection is always voluntary, and results must be returned directly to individual participants. With our program continuing to grow, some nearby programs may be tempted to share kits; however, we ask that you please avoid doing so and contact us if sharing becomes necessary. And remember to be mindful of shipping timelines when ordering kits and awaiting posted results. Happy drug checking! And please fill out as much of the data on the cards as you can. We **need** to know expected substance to do accurate lab analysis. And the sensations data are critical to undertanding changes in purity/concentration that are happening right now. Happy drug checking! --- # 2025 Recap In case you missed this, check out our [***Year in Drugs 2025*** ](https://www.opioiddata.org/the-year-in-drugs-2025/)report for a quick, eye-opening look at the latest trends and data shaping our communities: It’s an informative read packed with valuable insights and data to keep you and your community informed! [The Year in Drugs 2025This year was prelude to a pivotal 2026\. Our predictions on drug trends that will shape the coming year. Let’s not squander the opportunity.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-34.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image-21-1-1.png)](https://www.opioiddata.org/the-year-in-drugs-2025/) --- # Test strip Office Hours A place for public health department purchasers and opioid settlement fund spenders to meet **THE national expert** on test strips so that they can make better spending choices. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/EAED43E6-9EA7-4E6E-B990-569EC5404515-1.png) --- # 📣 Team Voices Current recommendations advise lay responders to call 911 after reversing an overdose, but we find for people who use opioids in rural Appalachian Ohio, this is not always practical. Participants recalled numerous instances in which they were able to successfully reverse an overdose on their own, making additional support from first responders feel unnecessary - especially given fears of being stigmatized or facing legal repercussions. [Our very own David C., Adams S., and others assessed preferences toward calling 9-1-1 during overdose in rural, Appalachian Ohio.](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0338689) --- # Congressional Budget Office [New report from CBO](https://www.cbo.gov/publication/62009) points to drug checking as a promising paradigm: "By providing crucial information to users before they consume drugs, the services enable users to make more informed decisions and thus reduce their risks… Lawmakers could expand access to drug testing programs by supporting community organizations carrying out harm-reduction initiatives that include drug testing services." --- # How are clinicians using buprenorphine? The key point is that there are many different ways clinicians are using buprenorphine these days, from microinductions to macroinductions to detox to maintenance. What’s right for patients will depend on their previous treatment experience and local drug supply. **Triangle CERSI** found that the most important question doctor’s can ask is *“What dose worked for you in the past?"* [Click here to read more!](https://trianglecersi.org/research/triangle-007) --- # 📖 Reading Room Read up on articles we found engaging and maybe watch a video about **90.5 WESA:** [Pittsburgh harm reduction experts warn about overdose reversal drugs ](https://www.wesa.fm/health-science-tech/2024-10-28/pittsburgh-harm-reduction-overdose-reversal-drugs) **The BMJ:** [Rise of synthetic drugs in Europe and how it intersects with what we will see in the US next.](https://www.bmj.com/content/392/bmj.r2653.full?ijkey=TfDa6fHhA22TASD&keytype=ref) **Brookings:** Data Drops. [The cost of chaos: A cracking windshield on substance use in the US](https://www.brookings.edu/articles/the-cost-of-chaos-a-cracking-windshield-on-substance-use-in-the-us/) **“If You’re Willing to Work…We Can Work With You”:** [Obligatory Labor at Residential Substance Use Services Providers in North Carolina](https://www.tandfonline.com/doi/full/10.1080/10826084.2025.2611422) [Check out this reel ](https://www.instagram.com/reel/DR2kbiCFWI0/?igsh=MTIwcWRhcHFubjRlcA%3D%3D)from **The Daily Show** *\-* I promise you’ll find it amazing regarding the “war on drugs”. It somehow manages to be both painfully accurate and laugh-out-loud funny. 😄 **American Journal of Preventive Medicine:** [Illicit drug use during pregnancy in states with and without punitive prenatal substance use policies](https://www.ajpmonline.org/article/S0749-3797%2825%2900623-3/abstract) **Opioid Settlement Spending in a Time of Budget Cuts:** Watch this [short fireside chat](https://www.youtube.com/watch?v=JxvZYOTGHeI) to explore how communities are navigating opioid settlement funding amid tightening budgets, with expert insight on emerging trends, tough trade-offs, and what it all means for prevention, treatment, and recovery efforts. **CDC Webinar:** [Clinical Implications of Medetomidine Mixed with Opioids](https://www.youtube.com/live/QuOHI3F4R0I) **Substance Use & Addiction Journal:** [Piloting a Point-of-Care Drug-Checking Service at Syringe Service Programs in New York City](https://journals.sagepub.com/doi/10.1177/29767342251376805) **BCCSU Drug Checking:** [Medetomidine Test Strip Pilot: Preliminary Results](https://drugcheckingbc.ca/wp-content/uploads/sites/4/2026/01/MTS-Pilot-Preliminary-Results-and-Interim-Recommendations.pdf) --- # ✈️Out and About ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/IMG_5215-1-.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/image--5--1.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/IMG_5223-1--1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/image--4--1.png) Nab presenting at **UNC Psychiatry Grand Rounds** and Illyana presenting at the **Florida Harm Reduction Conference**! --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. **Benevolence Farm** in NC is looking for a new [Deputy Director](https://docs.google.com/document/d/1GUHLCUExzbaoWlL3mntEdB33QPS9-7Wp1VmvRLl3rRk/edit?tab=t.0) and [Farm Manager](https://docs.google.com/document/d/1Iz4TyL%5FDjNvRouKkk-pK-HBfhvvFKP1PAsqZ81VErAU/edit?tab=t.0#heading=h.wvifmaogphxr). Benevolence Farm is nonprofit in North Carolina dedicated to empowering people affected by the criminal legal system by building leadership skills, supporting sustainable employment in rural areas. **San Francisco AIDS Foundation** is hiring for a [Bilingual (Spanish) Drug Checking Technician!](https://job-boards.greenhouse.io/sfaf/jobs/5105779008) **Becoming a Healer.** [Here's a list on where to listen](https://pod.link/healer/episode/NTI1YmNiNDItZWFmNy00YWY3LWIyOTgtYjg4NWM1ODBjYmNi)! [](https://www.southpiedmontahec.org/event/75020) --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. **Send us more doodles and notes!** They sustain us. 💖 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2026/02/IMG_4995-1.jpeg) ## Thanks for reading and Happy New Year! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/10/Black-And-White-Simple-Personal-Business-Card--1-.png) ### Wrap Up 2025 Newsletter URL: https://www.opioiddata.org/wrap-up-2025-newsletter/ Last updated: 2026-05-11T14:47:16.000Z As the year winds down, we’re reflecting on a journey full of positives, a few highs and lows, and a whole lot of heart. We're still thriving, still showing up, and still fighting the harm reduction fight together. We hope this end-of-year read brings a moment of warmth and lightness as you wrap up the year, and we’re holding extra care for those who this season can be tough. Thanks for being our community 💙 ## Let's keep talking. Be in the know with our free newsletter. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. # 〽️Service Stats & Updates As of **Thursday, December 18, 2025.**.. **18,140** samples analyzed Serving **189** harm reduction programs Reaching **296** counties in **43** states **477** unique substances identified **Note to our service users**: If you’re using an older [version of our card](https://cdr.lib.unc.edu/concern/multimeds/5d86p887m?locale=en) to report test strip results, please specify if “MTS” means *methamphetamine* or *medetomidine*! --- # 📦 Service Updates Our team will be out of the office from **December 22-January 2, 2026.** Meaning we will not be processing any kit requests or analyzing samples during that time. Regular operations will resume on Monday, January 5, 2026\. Thank you for your understanding. We’re excited to bring back new insights to strengthen our work and share our experiences! --- # 🗓️The Year in Drugs 2024/2025 reshaped the U.S. drug landscape and 2026 could define a generation. From shifting drug preferences , a destabilized supply, funding cuts, geopolitics, and rising surveillance, the forces at play will decide who benefits, who’s harmed, and whether recent gains hold or slip away. Click below to read how we break down the four trends that will shape what comes next and why harm reduction has never ***mattered more***. [The Year in Drugs 2025This year was prelude to a pivotal 2026\. Our predictions on drug trends that will shape the coming year. Let’s not squander the opportunity.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-32.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image-21-1.png)](https://www.opioiddata.org/the-year-in-drugs-2025/) --- # 🥳 Celebrating Nab We’re thrilled to share that **Nabarun Dasgupta, t**he mastermind behind our lab,has been named a [**2025 MacArthur Fellow**](https://www.macfound.org/programs/awards/fellows/) — better known as the **“Genius Grant.”** This incredible honor celebrates what we’ve always known**\-** Nab’s unwavering dedication to humanizing drug policy and advocating for people who use drugs. Even amid the excitement, Nab’s focus remains on the future and how this award can help expand our collective impact.Click the link below to learn more about his inspiring work and this well-deserved achievement! [The Real WorkWe celebrate a man who deserves to be celebrated![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-31.png)Opioid Data LabAdams Sibley![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/dasgupta_2025_hi-res-download_6.jpg)](https://www.opioiddata.org/the-real-work/) --- # Drug Policy Alliance 2025 Our team had an amazing time at the Reform Conference engaging in powerful discussions with influential leaders in harm reduction, sharing ideas, and building connections that will last well beyond the weekend. The gathering brought together advocates from across the movement focused on building a future where drug policy centers health, equity, and safety. We left feeling energized, inspired, and more committed than ever to the work ahead. Hopefully we got to chat at the ACDC meeting! We loved tabling, meeting so many passionate folks, and we’re happy to report that our swag was a big hit.😉 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/IMG_3764.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/IMG_3809-1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/IMG_7861-1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/IMG_2624-1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/ACDC-Group-photo-2025.JPG) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/IMG_2609--1--2.jpeg) Our team enjoying our time in Detroit! Pictured: Nab, Shay, Erin, Jalice, Paula, Dmitri, Adams, & Illyana. Not pictured: Our two Davids. --- # 🛍️ Department of Unsafe Supply Were you disappointed in Halloween candy this year? Did it taste a little less chocolatey? [You're right](https://www.nytimes.com/2025/10/30/climate/candy-chocolate-cocoa-prices-climate-change.html)! Prices for cacao raw material have increased due to shortages. Candy companies have reformulated and rebranded to put *less of the active ingredient* into finished product. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/11/image-1.png) Source: [NYT](https://www.nytimes.com/2025/10/30/climate/candy-chocolate-cocoa-prices-climate-change.html) Where have we heard this before recently? 🤔 Oh yeah, the national conversation about whether fentanyl concentrations have declined. One way this gets quantified is in wastewater. Pittsburgh has a nice dashboard for these data: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/11/image-2.png) Source: [Allegheny County](https://tableau.alleghenycounty.us/t/PublicSite/views/SubstanceUseDashboard/WastewaterSurveillanceData?%3Aembed=yes&%3Atoolbar=no&%3AshowAppBanner=false) Just like Mr. Goodbar isn't going away, just being reformulated to be *less potent* (ha!), why would be surprised if similar things are happening in the unregulated drug supply? Taking this candy analogy a step further, *The Atlantic* [points out](https://www.theatlantic.com/health/2025/10/chocolate-shortage-candy-flavors-halloween/684476/) that Gen Z and Millennial consumers "seek out taste mash-ups, unexpected textures, and flavor experiences" – the same trends we see in the accelerating mixing of components of street drugs. Unregulated drugs exist in a free market. (Free-for-all market?) Consumer demand explains a lot of what we see in the adulterated candy and drug supply chains. (Both those articles are behind paywalls, [but ahem](https://archive.ph/).) --- # 📷EmpathyLens **EmpathyLens.org** is a *free online library* of realistic, compassionate, and non-stigmatizing photos related to drug use, harm reduction, treatment, recovery, and prevention that anyone can use in outreach, education, or media. Its goal is to *reduce stigma* by promoting humanizing imagery and offering stigma-education resources alongside the images. All photos are available under a public-domain license so organizations and individuals can freely include them in their work. [Click here to check out their site and learn more!](https://empathylens.org/) --- # 📣 Team Voices Check out monthly blog posts from members of our team! In a drug supply shaped by unpredictability, David highlights how people who use drugs actively protect one another through using together, spotting, and watching out for community. Explore what safer support can look like when someone prefers or needs to use alone, underscoring how connection, even from a distance, can save lives. [Preventing Fatal Overdose for People who Use AloneJudgment free, confidential hotlines (such as SafeSpot) are available 24/7, at no cost, so that people who use drugs alone have someone to act on their behalf in the event of an overdose![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-33.png)Opioid Data LabDavid Colston![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1584786379647-c10852954d2b)](https://www.opioiddata.org/preventing-fatal-overdose-for-people-who-use-alone/) --- # Post OD Toolkit This[ post-overdose toolkit](https://www.hca.wa.gov/assets/program/82-0675-post-overdose-toolkit-friends-family.pdf) is a gentle, compassionate guide for friends and family navigating what comes after a loved one survives an overdose. It reminds readers they are not alone in a scary and emotional moment and offers clear, nonjudgmental guidance on caring for both your loved one *and yourself.* Grounded in empathy, harm reduction, and lived experience. Above all, it centers dignity, love, and hope during a time when support matters most. ❤️‍🩹 --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! [Check out this reel ](https://www.instagram.com/reel/DR2kbiCFWI0/?igsh=MTIwcWRhcHFubjRlcA%3D%3D)from **The Daily Show** *\-* I promise you’ll find it amazing regarding the “war on drugs”. It somehow manages to be both painfully accurate and laugh-out-loud funny. 😄 **American Journal of Preventive Medicine:** [Illicit drug use during pregnancy in states with and without punitive prenatal substance use policies](https://www.ajpmonline.org/article/S0749-3797%2825%2900623-3/abstract) **Health Affairs:** [Empowering A New Kind Of Research Team To Study Substance Use](https://www.healthaffairs.org/doi/10.1377/hlthaff.2025.00960) **JAMA Network:** [Over-the-Counter Retail Naloxone Sales](https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2838725) **Legal Action Center:** [Groundbreaking Settlement in Lawsuit About Right to Nursing Care for Individual with Substance Use Disorder](https://www.lac.org/news/groundbreaking-settlement-in-lawsuit-about-right-to-nursing-care-for-individual-with-substance-use-disorder) **Reynolds Journalism Institute:** [Resisting false binaries when reporting on the complexities of addiction](https://rjionline.org/news/resisting-false-binaries-when-reporting-on-the-complexities-of-addiction/) **Settlement Funds:** [Take a look at how Texas is handling opioid settlement dollars](https://rice1.osn.mghpcc.org/crc-ssl/Opioid%20Settlement%20Funds%20-%20Report/index.html) **Slate:** [How Gen Z Is Rewriting the Rules of Sobriety](https://slate.com/technology/2025/09/gen-z-tiktok-alcoholics-anonymous-sobriety.html?pay=1761600767808&support%5Fjournalism=please) Learn more about SoberTok and what YA in AA have to say! **Talking Drugs:** [Checkout this post about why banning drug checking has heartbreaking outcomes ](https://www.instagram.com/p/DP5yYNCDV%5Fk/?img%5Findex=4&igsh=NWIxamR4eWp0Zm4x) **Washington Post:** [Dancing patients’ aren’t the biggest problem with drug ads](https://www.washingtonpost.com/opinions/2025/10/16/fda-prescription-drug-ads-benefits-harms/) and/or [Unsafe amounts of lead found in some protein powders, report says](https://www.washingtonpost.com/health/2025/10/15/consumer-reports-protein-powder-lead/) **Wiley:**[Refining cause of death attribution among opioid, opioid-stimulant and stimulant acute toxicity deaths](https://onlinelibrary.wiley.com/doi/10.1111/add.70190) --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. **Atrium Health** is looking for a new [Peer Support Specialist](https://careers.atriumhealth.org/jobs/16691425-peer-support-specialist-mobile-integrated-health-port)! Check out how the **City of Chicago's** community worked to [lower overdose death's by 37%](https://www.linkedin.com/posts/big-cities-health-coalition%5Fkudos-to-the-chicago-department-of-public-activity-7387503133205102593-CDG8/?utm%5Fsource=share&utm%5Fmedium=member%5Fios&rcm=ACoAAAQ62DUBufbeTX7YLlr007Uf6f7KIKIf09U) since the national peak! **Missouri Institute of Mental Health’s Addiction Science** Team is hiring a [Senior Research Specialist](https://mimhaddisci.org/join-our-team) to support research and evaluation across overdose prevention, substance use treatment, and recovery services statewide. Huge shoutout to Professor Delesha Carpenter and others who put together [Naloxone Near Me ](https://naloxonenearme.org/?utm%5Fcontent=352653993&utm%5Fmedium=social&utm%5Fsource=linkedin&hss%5Fchannel=lcp-5781622)where people in NC can go for **naloxone resources**! **Legal Action Center** Training [Overcoming Opposition to Substance Use Disorder Treatment Programs: Leveraging Anti-Discrimination Law](https://www.lac.org/resource/overcoming-opposition-to-substance-use-programs-leveraging-anti-discrimination-law-training) **Need Visuals for harm Reduction?** Check out these resources ▶️ [Empathy Lens](https://empathylens.org/), [Zero Stigma](https://www.zerostigma.art/), [Radian Photography ](https://drive.google.com/drive/u/0/folders/1Tn2dyP4Z7HJAOPrjke67BV70iyidl3AA) **NYC Health Department** is hiring [Drug Checking Technician](https://cityjobs.nyc.gov/job/drug-checking-technician-bureau-of-alcohol-and-drug-use-in-queens-jid-38485)! **NYU** Post Doc opportunity focusing on OUD access, treatment, etc.! [Krawczyk\_PostDoc\_2025\_FinalKrawczyk\_PostDoc\_2025\_Final.pdf113 KBdownload-circle](https://www.opioiddata.org/content/files/2025/10/Krawczyk%5FPostDoc%5F2025%5FFinal.pdf "Download") --- # 🎙️Podcasts Check out **On Becoming a Healer's** episode on opioid/pain issues from On Becoming a Healer. [Here's a list on where to listen](https://pod.link/healer/episode/NTI1YmNiNDItZWFmNy00YWY3LWIyOTgtYjg4NWM1ODBjYmNi)! --- ## Thanks for reading and I hope your year ends in the most amazing way possible!!! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/10/Black-And-White-Simple-Personal-Business-Card--1-.png) ### The Year in Drugs 2025 URL: https://www.opioiddata.org/the-year-in-drugs-2025/ Last updated: 2026-05-11T15:48:47.000Z This was a consequential year for drugs and drug policy in the United States. Next year will be pivotal. The kind of opportunity for lasting change that comes along once in a few generations. Here's our top 4 trends and predictions for 2026: 1. **Generational shifts** in drug preference among Gen Z suggest an enduring change away from opioids. Cannabis and psychedelic regulation will be hotly contested. 2. **Sedatives and anesthetics displacing fentanyl** will increase dissatisfaction with the drug supply, reduce opioid exposure and decrease OD risk, but portend even more difficulty getting people into treatment. 3. **Geopolitics of drug production** are poised to reconfigure who profits from the (drug) war, leading to market consolidation and alternate trade routes, as well as new substances and scapegoats. From the chaos, new drug market millionaires will be anointed. 4. **Cratering federal funding for treatment and prevention** will put stress on states and local hospitals. Counties will feel pressure to divert opioid settlement funds. AI powers will forward government surveillance. Housing versus forced treatment will be a central debate. The big picture is that the *really positive gains* from 2024 lent momentum to continued improvements in 2025\. But we also may have missed a bit of an opportunity, distracted and underfunded this year, to turn the whole thing around. Maybe easing our foot off the accelerator, not hitting the brakes. Through this gap we see glimpses ahead of a worsening drug supply. Or maybe that's what the drug market would have done anyway. Years of emphasis on treatment and harm reduction worked! Misguided experiments peeling these back have already showed how easily drug harms can re-emerge. As the drug supply is further destabilized, myopic obsession with just fentanyl, militarism, and short-term fixes drain away our rare opportunity to make lasting generational improvements. While underfunded and traumatized, the harm reduction workforce is remarkably resilient, and will once again be asked to do more than their share to protect our neighbors. Buckle up! Below, we cover the biggest drug stories of 2025, and make the case why 2026 is poised to be a year of major change. --- # Overdose Trends Earlier in the 2025 we learned that overdose mortality rates have been [declining in the United States since 2021](https://www.opioiddata.org/peak-od-phenotypes/), and that [all states](https://www.npr.org/2025/03/07/nx-s1-5295618/fentanyl-overdose-drugs) trended downward by 2024\. [Different parts of the US](https://www.theguardian.com/us-news/ng-interactive/2025/oct/17/overdose-deaths-data-analysis) experienced the neap and ebb tides of fentanyl as haphazard waves over the past half-decade. From the [macro](https://www.thelancet.com/journals/lanam/article/PIIS2667-193X%2825%2900236-4/fulltext) level to [local](https://www.npr.org/2025/11/30/nx-s1-5608090/overdose-deaths-are-down-across-much-of-the-u-s-one-community-offers-clues-as-to-why), explanations for this decline consistently point to changes in drug supply, protective drug user behaviors, and interventions. OD deaths dropped in nearly all states by 20-30% from peak years. Nationally, we are roughly back to where we were pre-COVID, but still 4x higher than at the [start of the century](https://www.opioiddata.org/this-ad-didnt-age-well/). We are still losing too many people we love. According to the revised CDC [provisional-predicted](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) overdose death data, Peak OD in the USA was June 2023: 111,466\. The most recent 12-month period available is April 2025 with 76,516 deaths. This would be a reduction of 31.3%, but we are still not sure how major methods changes in February 2025 affect interpretation. (More on this below.) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-16.png) [Source](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm): CDC NVSS (thru April 2025), all drugs ## 2025 Overdose Spikes Yet, state and city data show that some places saw a transient increase in fatal and non-fatal overdoses in late 2024 and into the first half of 2025\. The good news is that the jumps had largely quelled by late summer, resuming years-long downward trajectories. Expect annual year-over-year fatal OD rates for 2025 to show an overall decline nationally, but compared to previous years they will be attenuated. Curiously, the early 2025 OD spikes didn't follow a clear pattern geographically. [Milwaukee](https://county.milwaukee.gov/EN/Office-of-Emergency-Management/EMS/Data-Analytics/Overdose) and [Seattle](https://kingcounty.gov/en/dept/dph/health-safety/medical-examiner/reports-dashboards/overdose-deaths-dashboard) saw an increase in fatal ODs in November 2024, the same month as [Arizona](https://www.azdhs.gov/opioid/dashboards/index.php#overdose-deaths). In [San Francisco](https://media.api.sf.gov/documents/2025%5F12%5FOCME%5FOverdose%5FReport.pdf) and [statewide California](https://www.cdph.ca.gov/Programs/CCDPHP/sapb/CDPH%20Document%20Library/Prelim%5FMonthly%5FDeath%5FData%5F2025%5F09.pdf) the peak emerged in January 2025\. [Cleveland](https://ccbh.net/overdose-data-dashboard/) saw an increase in 1Q2025, and [Seattle](https://kingcounty.gov/en/dept/dph/health-safety/medical-examiner/reports-dashboards/overdose-deaths-dashboard) saw another peak in March. But over in New England ([Connecticut](https://public.tableau.com/app/profile/heather.clinton/viz/SUDORS%5FDashboard%5Ffinal2/OverdoseDashboard), [Maine](https://mainedrugdata.org/wp-content/uploads/2025/12/2025-10-ME%5FOD%5FReport-Final.pdf)) it was in 2Q2025, peaking in June. Here in the South, [Kentucky](https://kiprc.uky.edu/programs/overdose-data-action/county-profiles) also peaked in June, whereas [North Carolina](https://drive.google.com/drive/folders/1bEuitepfZNV6jFYA9YkYLXQ7fr2%5Fh7ts) saw the bump a couple of months earlier in April. Random?? The fastest reporting locations consistently show a resumption in OD decline into the Fall of 2025\. Some of those deaths are still under investigation, but even accounting for that lag, the overall picture seems to be of a transient surge in overdose deaths in the first half of the year, continued by a resumption of decline. ## International Comparisons 🇨🇦 Lest we think that what we are experiencing in the United States is a unique, let's take a look at similar opioid overdose mortality data from Canada. Fentanyl and its analogues made up the majority of opioid ODs, similar to the US. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-27.png) [Source](https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/): Government of Canada 🏴󠁧󠁢󠁳󠁣󠁴󠁿 But in Scotland, we saw a different picture, with OD deaths rebounding in 2025\. The most common [drugs involved](https://www.bbc.com/news/articles/cgqnx74ld07o) were methadone, heroin, and nitazenes. So, while there were different drugs involved from the US and Canada, the drop in 2024 was similar. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-25.png) [Source](https://www.gov.scot/binaries/content/documents/govscot/publications/statistics/2025/12/suspected-drug-deaths-scotland-july-september-2025/documents/suspected-drug-deaths-scotland-july-september-2025/suspected-drug-deaths-scotland-july-september-2025/govscot%3Adocument/suspected-drug-deaths-scotland-july-september-2025.pdf): Police Scotland, National Records of Scotland, Public Health Scotland --- # Generational Changes In 2025 we also noticed [intergenerational changes](https://www.opioiddata.org/this-ad-didnt-age-well/) in opioid use and overdose, with (most of) Gen Z reducing their OD risk, along with a shift towards cannabis, psilocybin, MDMA, and ketamine. Also [less alcohol](https://www.opioiddata.org/september-2025-newsletter/). **Key to remember: 7-out-of-10 overdose deaths are happening in** [**Gen X and Millennials**](https://www.opioiddata.org/may-2025-newsletter/)**.** This is where resources need to go. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-17.png) [Source](https://www.opioiddata.org/this-ad-didnt-age-well/): UNC Opioid Data Lab A major reason why Gen Z is turning away from opioids has to do with what they have experienced. [1.4 million kids](https://ajph.aphapublications.org/doi/10.2105/AJPH.2024.307847) were there when their aunts, uncles, parents, and grandparents struggled with opioids. Any advertiser will tell you this experience is way more salient than a message campaign. The DEA's ["Fentanyl Free" campaign](https://www.abc15.com/news/state/dea-launches-fentanyl-free-america-campaign) limped into existence in December 2025, right before the holidays. It's a series of [radio spots and a logo](https://www.dea.gov/fentanylfree/promote), but at least it mentions knowing how to access and use naloxone. They seem obsessed with pills, but most OD deaths involve powder. 🤷🏾 This isn't particularly surprising, as DEA has leaned heavily into the one-\[fake\]-pill-can-kill narrative propagated by their grieving parent advisors whose kids had tragically passed in the previous OD era. The overall effect is that the public education campaign is years out of date. Voices of parents are important, but hinging US policy on anecdotes is not wise; better to have parents that have a [broader and more current](https://drugpolicy.org/news/parents-police-and-advocates-condemn-senate-passage-of-halt-fentanyl-act-demand-lifesaving-health-solutions-to-fentanyl-and-overdose/) understanding of drugs and can put their story in context. ## International Comparisons 🏴󠁧󠁢󠁥󠁮󠁧󠁿🏴󠁧󠁢󠁷󠁬󠁳󠁿 Looking over at England and Wales, we see the generational breakdown is nearly identical. To make the chart below look the same as the one above, rotate left (counterclockwise) and take the mirror image. 😵‍💫 Still, the burden of drug overdose deaths is highest in Millennials and Gen X, with Gen Z having markedly less OD deaths. [![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-24.png)](https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2024registrations) [Source](https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/deaths/bulletins/deathsrelatedtodrugpoisoninginenglandandwales/2024registrations): Office of National Statistics 🇪🇺 And looking at Europe as a whole, we see a remarkably similar pattern in that the younger generation of drug using age (approximately Gen Z) makes up a smaller portion of OD deaths. While there is substantial variation by country due to underlying differences in age distribution (ahem, age-adjusted rates would have been better EUDA!) – the majority of OD death burden is shifted to middle age. In generations past, as a general observation, overdose mortality used to increase in young adulthood (age 20s) and then decline in the 30s and 40s. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-26.png) While the emphasis on preventing harms in youth is well-intentioned, the real burden of overdose mortality in the Global North is among the middle aged. --- # Law Enforcement Data Back in the US again. In May, as federal law enforcement were diverted into immigration, [drug seizures dropped](https://www.washingtonpost.com/world/2025/05/31/mexico-united-states-fentanyl-seizure-drop/) at US international borders. By October, border fentanyl seizure events had reached a new low (n=39). In 2025 for the third year in a row, fentanyl seizures dropped, down -28.6% from 2023. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-15.png) [Source](https://www.cbp.gov/newsroom/stats/drug-seizure-statistics): US CBP (thru Nov 2025) DEA continued to [take credit](https://www.justice.gov/opa/pr/justice-department-highlights-dea-drug-seizures-first-half-2025-successful-operations-over) for drops in overdose by touting a decline in the amount of fentanyl per fake pill, attributing success to criminal interdiction. We are left wondering though if border drug seizures themselves an intervention, or are they more of a passive indicator? --- # Synthesis: countries, time, age So, what do we make of where we've been? 2024 seems to have been remarkable. Government policy, funding, and priorities were different across these nations. Border seizures in the US fell while OD rates dropped, pointing to an impact from drug supply. Yet, the drugs causing ODs in Scotland were different than in Canada/USA, and Scotland also saw a decline in 2024\. What was more consistent across countries however, were changes by generation. What's the common experience here? (My *speculation*...) It feels like the restrictions perpetuated by the government response to the COVID pandemic interrupted age-development trajectories and social connectedness. Older generations (Boomers, Gen X, Millennials) turned to opioids to fill some of the longing, because they had had familiarity with those substances from the earlier Rx opioid era. Fentanyl was too strong, but easier to make in the context of a frozen global supply chain. In North America, the timing of the Chineses generic ban on in-country fentanyl manufacturing on the eve of the pandemic (May 2019, see below), and inter-cartel competition in Mexico (partially due to law enforcement-led destabilization of leadership), converged with increased demand to send overdose rates soaring in North America. Gen Z didn't socialize during middle and high school the way their parents had, and did less experimentation with drugs and alcohol. By 2024 it felt like we had moved on from COVID. And some states/provinces had had fentanyl around longer, and/or had better harm reduction and treatment services, and were able to recover (years) faster than nations as a whole. For the first time ever, these services were starting to get meaningful public investment. In Europe, age/generation disruptions of drug use patterns were similar. On the supply side, the Afghan Taliban's [April 2022 ban](https://www.unodc.org/unodc/en/press/releases/2025/November/afghanistan-opium-cultivation-falls-in-2025-shifting-regional-production-and-trafficking-patterns--says-new-unodc-survey.html?fbclid=IwY2xjawOyQxxleHRuA2FlbQIxMABicmlkETFDNmZVMDNLN0U5ZERyWHY5c3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHiDcxu01w6h7p6T5zNGKoay9uhNcy05BO5z3uNfBXgllK28u6fgLAodmQweD%5Faem%5FGe1JH2dHRiMamn6x9O45-g) on opium production created an opening for synthetic opioids, drawing on the North American experience, delivering nitazenes to make up for [plummeting](https://www.unodc.org/unodc/en/press/releases/2025/November/afghanistan-opium-cultivation-falls-in-2025-shifting-regional-production-and-trafficking-patterns--says-new-unodc-survey.html?fbclid=IwY2xjawOyQxxleHRuA2FlbQIxMABicmlkETFDNmZVMDNLN0U5ZERyWHY5c3J0YwZhcHBfaWQQMjIyMDM5MTc4ODIwMDg5MgABHiDcxu01w6h7p6T5zNGKoay9uhNcy05BO5z3uNfBXgllK28u6fgLAodmQweD%5Faem%5FGe1JH2dHRiMamn6x9O45-g) supply of heroin, largely skipping over fentanyl. With further disruption of the two largest Mexican cartels in 2024, we are entering an uncertain era. In the United States, it feels like two drug taste-markets are emerging: 1. one emphasizing synthetic opioids, sedatives, methamphetamine, and alcohol for older generations 2. one emphasizing cannabis, psychedelics, and plant-grown stimulants catering to Gen Z (and those young-at-heart) --- # Wastewater Data We remain skeptical about BioBot corporation's sewer surveillance data because we don't know their sampling frame and methods, but their national data show similar shape to other data sources (as measured by weekly metabolite norfentanyl concentration). They also seem to imply a sudden drop in September 2025, but again we don't really know their methods. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-14.png) [Source](https://tableau.alleghenycounty.us/t/PublicSite/views/SubstanceUseDashboard/WastewaterSurveillanceData?%3Aembed=yes&%3Atoolbar=no&%3AshowAppBanner=false) BioBot via Allegheny County Sanitary Authority (thru Dec 4, 2025) 🍫 At the same time, a drug mixture containing psychoactive substances (theobromine, caffeine, phenethylamine, and anandamide) also decreased in the amount [per unit](https://www.bbc.com/news/articles/cz0n8eygdp7o). We are of course talking about chocolate. Less active substance (cocoa butter), more adulterants ([vegetable oil, sugar, nuts](https://www.today.com/food/news/chocolate-companies-cut-back-on-cocoa-rcna248192)). Listen to [this podcast](https://www.npr.org/2025/08/01/1256575139/hershey-chocolate-prices-cocoa-shortage-climate-change) for causes (hint: drought in West Africa). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-11.png) [Source](https://www.nytimes.com/2025/10/30/climate/candy-chocolate-cocoa-prices-climate-change.html?smid=nytcore-android-share) NY Times What happens in consumer psychoactive substances is mirrored in the illicit drug supply: Less active ingredient means more adulteration. --- # Drug Checking Data Wastewater data cannot tell us if fewer people are *using* fentanyl, if they are *using less*, or if using *less often*. Our [fieldwork](https://www.sciencedirect.com/science/article/pii/S0955395925003135) suggests all three changes in behavior. Another possibility is that people are not actually getting fentanyl even when they buy it and are expecting it. We looked at samples analyzed using GCMS in our lab (n=8,012) and quantified how often expected-fentanyl samples contained fentanyl in primary abundance. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-19.png) [Source](https://opioiddata.org): UNC Street Drug Analysis Lab ([sampling frame](https://deepnote.com/app/opioiddatalab/Coverage-Summary-543893b6-9663-4db0-b010-30911a71eb39?utm%5Fsource=status-bar&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=543893b6-9663-4db0-b010-30911a71eb39)) (thru Dec 16, 2025) **Considered together, across overdose, seizure, wastewater, and drug checking data, the period 2023 to 2025 was notable for the lessening of fentanyl exposure at the population level.** If people aren't getting fentanyl when they expect to have bought fentanyl, then we need to ask what is changing in the drug supply. What is being added instead of fentanyl? --- # Drug Supply Changes In 2025, we saw a rising flood of sedatives and numbing agents in the drug supply. Overall reaction to these changes was [widespread dissatisfaction](https://www.sciencedirect.com/science/article/pii/S0955395925003135). While we are keeping an eye on new classes of synthetic opioids that could replace fentanyl, we are more concerned with medetomidine because it's *already* replacing fentanyl in some cities; abruptly quitting drug use is suddenly more dangerous than enduring opioid withdrawal. ## Sedatives and Numbing Agents Local anesthetics lidocaine, procaine, and tetracaine (purple in graph), exploded in summer 2024, and continued well into 2025\. In fact, we test more samples with local anesthetics than xylazine now! Procaine is also known as Novacain® – the numbing shot you get at the dentist. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-9.png) [Source](https://opioiddata.org): UNC Street Drug Analysis Lab ([sampling frame](https://deepnote.com/app/opioiddatalab/Coverage-Summary-543893b6-9663-4db0-b010-30911a71eb39?utm%5Fsource=status-bar&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=543893b6-9663-4db0-b010-30911a71eb39)) (thru Dec 8, 2025) Why these numbing agents? We don't know. We speculate there might be some molecular interaction between opioid receptors and local anesthetics that has not been characterized. (Hello, does anyone still work at NIDA?) Among the fentanyl analogues, we note that in 2025, *para-*fluorofentanyl (green) was still around but declining, and that this happened before the passage of the HALT Fentanyl Act in July. ## Old and new benzos Bromazolam (a potent benzo, yellow in graph) also decreased in proportion to other fentanyl adulterants, even in the Pacific Northwest where it's been consistent for a few years. In July, Baltimore saw a [cluster of non-fatal overdoses](https://www.medschool.umaryland.edu/media/som/news/news-logos/Fentanyl-mixed-with-new-drug-may-be-linked-to-mass-overdose---The-Baltimore-Banner.pdf) involving N-methylclonazepam, an emerging (but still uncommon) potent benzodiazepine. When considered across bromazolam, xylazine, and medetomidine, the influx of sedatives seems a trend likely to continue. Most people who use drugs do not want to be this heavily sedated. In 2025, the unregulated drug supply got noticeably shittier. ## Unprepared for medetomidine At a syringe service program in Pittsburgh, among samples (n=254) we analyzed in 2025, 40% of expected fentanyl samples contained *no fentanyl*. (Read that again.) Instead, 60% of expected fentanyl samples contained medetomidine as a primary drug. Wild! Our lab saw medetomidine heading west, reaching New Mexico and Washington in 2025. The good news is that unlike its sister molecule xylazine, medetomidine is not a kappa opioid. This means there aren't skin wounds. Medetomidine (also known as dexmedetomidine) is an important [human and animal medicine](https://www.opioiddata.org/not-your-hospitals-precedex-why-street-medetomidine-hits-different/) used in hospital anesthesia. Medetomidine has 3 specific concerns: 1) heavy sedation leaves people vulnerable to theft and assault; 2) strong unpleasant [hallucinations](https://www.opioiddata.org/not-your-hospitals-precedex-why-street-medetomidine-hits-different/); 3) abruptly stopping drug use could lead to high blood pressure requiring a very expensive week-long stay in hospital intensive care. **Medetomidine makes people afraid to stop using drugs because abstinence can be lethal.** Alice Bell from Prevention Point Pittsburgh tells us that word is spreading that abruptly stopping dope-with-medetomidine can lead to heart attacks. Their recommendation is not to go to substance use treatment clinics/doctors, but rather to *hospitals* for detox because the outpatient setting is not equipped to deal with medetomidine withdrawal. Long stays in intensive care are often required in the ICU. And these weeklong stays are *expensive*. (Medicaid folks, are you listening?) Medetomidine started [replacing xylazine](https://www.opioiddata.org/not-your-hospitals-precedex-why-street-medetomidine-hits-different/) in force around June 2024\. By cracking down on (state scheduling) xylazine *without simultaneously* addressing medetomidine put us in a horrible bind. 🙄 #pwned This isn't just a matter of "oh the drug supply just gets worse" but rather this is a wholly predictable sequence. ⚠️ ****Medetomidine makes the advice to quit drugs potentially lethal.** Outpatient buprenorphine in primary care, methadone clinics, and abstinence-oriented residential facilities are not prepared to handle medetomidine withdrawal. The hospital ED is going to become a more critical place to start MAT. ## Nitazenes Nitazenes were another [big story](https://time.com/7317460/nitazenes-fentanyl-opioid-crisis-drugs/), with hyperbolic news coverage overusing the word *potency*. **Among our samples, nitazenes constitute less than 2%.** We are keeping an eye on them, but as of December, we aren't seeing a major influx. (See red line in graph above.) There is a flicker in the line over the summer, corresponding with the [Chinese central government generic ban](https://www.unodc.org/LSS/Announcement/Details/7e29daf9-1d49-45e6-95e7-8ce932bc94e1) on July 1st. But it's unlikely that our samples would be replaced this quickly, and this wavering may be coincidence. What is clear is that it's not displacing non-opioid sedatives and fentanyl (yet). But there is an inkling of a subtle change. Both before and after July, *protonitazene* holds the top spot in terms of frequency within the nitazene class. But *metonitazene* has dropped from its #2 position. We caution strongly that these are small sample sizes, and that expanded nitazene test strip use may alter what samples we get. At the same time, we saw exactly this kind of market consolidation between fentanyl analogues when the Chinese central government implemented a generic ban in 2019\. The variety of fentanyl analogues shrank, and government intervention essentially picked a winner. (We'd love to hear if our community partners and labs are seeing this shift, including our European colleagues: opioiddatalab@unc.edu. We see less *iso* species here than Europe, note the new #2 position post-ban.) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-5-1.png) [Source](https://opioiddata.org): UNC Street Drug Analysis Lab ([sampling frame](https://deepnote.com/app/opioiddatalab/Coverage-Summary-543893b6-9663-4db0-b010-30911a71eb39?utm%5Fsource=status-bar&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=543893b6-9663-4db0-b010-30911a71eb39)) (thru Dec 8, 2025) ## New synthetic opioids Another class of newer synthetic opioids we are watching are the [orphines](https://www.caymanchem.com/literature/nitazenes-and-orphines-the-latest-wave-of-opioid-nps?srsltid=AfmBOorbC6juQwAV6%5FAz%5FzdTZx2Xp5iB6P7-Q7CNq0%5FHLBqQ9Bkbhjne), like [this nightmare sample](https://results.streetsafe.supply/sample/807964) we tested from Michigan containing brorphine. Another in this family is cyclorphine, which showed up in [Ontario, Canada](https://www.cbc.ca/news/canada/thunder-bay/cychlorphine-thunder-bay-9.7012520) and [London, England](https://www.standard.co.uk/news/crime/camden-drug-deaths-cychlorphine-synthetic-opioid-b1262119.html) in December. The other emergent class of synthetic opioids are methadone analogues, like [dipyanone](https://pmc.ncbi.nlm.nih.gov/articles/PMC12185669/) and [methiodone](https://en.wikipedia.org/wiki/IC-26) (IC-26), which we may have had our first detection of from [Missouri](https://results.streetsafe.supply/sample/604361) in October. In 2025, in the US drug supply, nitazenes, orphines, and methadone analogues are relatively rare. But they introduce new competition to replace fentanyl. All the usual interdiction pressures are in place, now the question is how these molecules will duke it out. ## BTMPS on the outs As we [previously noted](https://www.opioiddata.org/september-2025-newsletter/), the plastic additive bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate looks to be generally on the way out of the US fentanyl supply, albeit slowly. About 20-25% of the fentanyl samples we test still have it though, down from the peak of 40% in Fall 2024. ## Why is this happening? Let's be perfectly clear: The overemphasis on fentanyl is making the drug supply even worse. And, while xylazine made buprenorphine inductions more *difficult*, the resulting crackdown may be making medetomidine-dope withdrawal *dangerous*. Sure, at least some of the sedatives may have less overdose risk, but drug policy targeting fentanyl alone is making 2026 poised to be a hellish year in the drug supply. We also note that ending [de minimis shipping](https://www.latimes.com/business/story/2025-05-02/a-big-scam-the-end-of-a-shipping-loophole-and-what-it-means-for-consumers) in August may lead to more scrutiny of packages ordered online. This might hit the psychonaut community hard, with fewer shop options the resulting funnel could well reduce the variety of psychedelic substances. On the other hand, smaller shops may emerge and disappear leading to exit scams, chaos, and more discrepancy between what is ordered vs what is received. Caveat emptor, eh? If you want a better understanding, go to these two must-read articles below. The synthetic cannabinoids are a great example of what happens with classwide "generic" bans. Just like bake-at-home bread, the last time we went through this, we saw semi-finished (ostensibly legal) drug kits in Switzerland to get around the ban, and a shift finished product manufacturing to South Asia. [“Playing Whack-a-Mole”: A History of China’s Drug Bans - TalkingDrugsNews of China’s new nitazene ban prompted a deeper look into how past fentanyl and synthetic cannabinoid drug bans worked out.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-19.ico)TalkingDrugsAndré Gomes, Tori Rudkowsky![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/China-ban-part-1.png)](https://www.talkingdrugs.org/playing-whack-a-mole-a-history-of-chinas-drug-bans/) [Will China’s Nitazenes Ban Work? - TalkingDrugsChina’s nitazenes ban may help stop the illegal production of this synthetic opioid. However, concerns exist about its potential impact.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-18.ico)TalkingDrugsAndré Gomes, Tori Rudkowsky![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/Nitz-part-2-cover-e1756472416219-1.png)](https://www.talkingdrugs.org/will-chinas-nitazenes-ban-work/?utm%5Fsource=chatgpt.com) --- # Bless Their Hearts A pricey "herbal infusion" with slick branding, which turned out to be a kava and kratom blend, [raised moral outrage](https://www.painnewsnetwork.org/stories/2025/8/15/moral-panic-over-kratom-drink-stirs-anti-kratom-hysteria) in July after a pretty boy TikTok influencer caught a habit. Over the summer, "pink cocaine" ([which is not cocaine at all](https://www.vanityfair.com/style/story/tusi-pink-cocaine-drug)) had a moment, fueled by celebrity follies. News sites like [*USA Today*](https://www.usatoday.com/story/news/health/2025/05/08/gas-station-heroin-tianeptine/83520858007/) and CBS provided free advertising to tianeptine manufacturers by featuring their brightly colored packaging as clickbait. Expect interest and demand for tianeptine to flare as irresponsible media coverage boosts this [weak opioid](https://www.nature.com/articles/tp201430) with low OD risk and anti-depressant properties. Meanwhile, the Onion published this: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-8.png) [Full article at The Onion](https://theonion.com/fda-approves-new-drug-that-reverses-effects-of-narcan/) ## Sign up for our newsletter Stay informed in 2026 with our detailed analyses. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. # International Front The WHO's ECDD [rejected](https://www.talkingdrugs.org/experts-and-cultivators-condemn-whos-failure-to-reschedule-coca/) a request to down-schedule coca leaf, which has been used religiously and safely for millennia, citing convertibility to cocaine. (A standard that is not consistently applied globally to regulation of other substances.) Some indigenous groups also pointed out that unchecked production could lead to further [land invasion](https://www.tni.org/en/article/conflicted-over-coca), reminding us that over-commercialization and demand in the Global North has tangible consequences. Former President of the Philippines, Duterte remains in [prison](https://www.talkingdrugs.org/the-icc-must-hold-duterte-accountable-for-his-drug-war-crimes/), because of [extrajudicial killings](https://www.talkingdrugs.org/duterte-rising-how-the-philippines-drug-war-came-to-be/) in the name of the drug war in the early 2000s. Justice takes time. --- # Drug War Geopolitics In 2025, the US federal government continued its decades-long game of picking winners and losers among global drug manufacturers. Congress passed HALT Fentanyl Act [legislation](https://drugpolicy.org/news/parents-police-and-advocates-condemn-senate-passage-of-halt-fentanyl-act-demand-lifesaving-health-solutions-to-fentanyl-and-overdose/) encouraging the off-shoring of synthetic opioid production away from North America (including Mexico) and towards Asia. Meanwhile, the Executive Branch chose to force the rerouting of cocaine shipments in the Caribbean bound for Europe/Africa, [perfectly timed](https://www.washingtonpost.com/world/2024/12/28/cocaine-consumption-soars-europe-asia/) to help cartels raise profits after encountering a [European cocaine glut](https://www.occrp.org/en/feature/faq-why-are-some-european-drug-gangs-burying-cocaine-instead-of-selling-it). This [beautiful story-map](https://features.csis.org/tracking-transatlantic-drug-flows-cocaines-path-from-south-america-across-the-caribbean-to-europe/) tracks outflows from South America. It is hard to see right now how the United States' synthetic supply of methamphetamine and fentanyl will be impacted by strikes in other regions. “Standby Mr. President, the drugs are on their way.” In September, by far the most disturbing development in the Drug War in 2025 was using [drugs as a pretext](https://en.wikipedia.org/wiki/2025%5FUnited%5FStates%5Fmilitary%5Fstrikes%5Fon%5Falleged%5Fdrug%5Ftraffickers) for boat strikes by the United States military. Extrajudicial killings via drone attacks on civilian boats in the Caribbean and Pacific continued through the rest of the year. Strong legal questions have been raised. In December, an Executive Order [laid the groundwork](https://www.politico.com/news/2025/12/15/trump-fentanyl-weapon-mass-destruction-00691742) for starting another war under the pretense of Weapons of Mass Destruction (WMD). The rhetoric offers a shortcut around evidence, proportionality, and accountability—just as it did in Iraq. This is political theatre, in the theatre of war. We should pay attention to how this plays out, but it is also a distraction. There are tangible threats in the drug supply completely unrelated to the pending war. Our work of taking care of our own communities needs to continue. The hard-won gains in reversing the decades-long increase in overdose deaths have largely been through persistent science-driven care. Across the country, I see neighbors taking care of neighbors, removed from the macho national rhetoric spinning on about preventing drug cargo with walls and drones and warships. In rural communities and urban clusters, nobody wise is sitting around waiting for airstrikes on boats in the Caribbean. Instead, *we take care of our own.* --- # State of harm reduction ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/5E1011BA-23FE-4B25-9214-57D8D6035A06.png) Generated [image backstory](https://en.wikipedia.org/wiki/Dewey%5FDefeats%5FTruman) By one measure, harm reduction is flourishing globally: [112 countries](https://hri.global/publications/global-state-of-harm-reduction-2025-update-to-key-data/?link%5Fid=0&can%5Fid=0254f948874eac54e6b6a0b30d212936&source=email-a-critical-moment-for-harm-reduction&email%5Freferrer=email%5F3013963&email%5Fsubject=a-critical-moment-for-harm-reduction) explicitly endorse harm reduction in national policies. On the other hand, 92% of harm reduction advocates say services in their country are under threat, with 62% describing the threat as high or critical. [HRI](https://hri.global/publications/global-state-of-harm-reduction-2025-update-to-key-data/?link%5Fid=0&can%5Fid=0254f948874eac54e6b6a0b30d212936&source=email-a-critical-moment-for-harm-reduction&email%5Freferrer=email%5F3013963&email%5Fsubject=a-critical-moment-for-harm-reduction) puts this beautifully: > Across the world, programmes are shrinking or closing. Outreach teams have been cut. Supplies are running out. Communities that rely on harm reduction to stay alive are facing impossible choices. > > But there is also hope and determination. > > We documented remarkable resilience: > • Countries with domestic funding have protected essential services. > • Peer-led networks have stepped in where formal systems have collapsed. > • Organisations have pooled limited resources to keep people safe, supported, and alive. > > **This update makes one thing clear: harm reduction works. But only if it’s funded.** In the US, harm reduction notched a [smirking victory](https://www.statnews.com/2025/09/30/ny-ag-settlement-indivior-opvee-overdose-drug/) when Indivior stopped marketing (not selling) nalmefene nasal spray, the unnecessary and financially unviable (expensive) competitor to generic naloxone. An [Executive Order](https://www.statnews.com/2025/07/25/trump-executive-order-targets-supervised-consumption-harm-reduction/) in July took aim at safe consumption spaces, or overdose prevention centers. In September, HHS tried to prematurely declare harm reduction dead, through letters issued via CDC and SAMHSA. There is a huge harm reduction workforce that is not going anywhere. Sure, many orgs chose to scrub those two words "harm reduction" from their websites. It erodes our collective identity, but doesn't diminish our resolve to see our communities thrive. But the anti-harm reduction stance is also tone-deaf. There are millions of Americans whose lives have been touched by close relatives struggling with addiction. (Bookmark this [excellent messaging playbook](https://www.bigcitieshealth.org/overdose-prevention-messaging-2025/).) Polling in 2025 revealed that compassion and second chances are supported by wide segments of the population. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/image-20.png) [Source](https://www.bigcitieshealth.org/overdose-prevention-messaging-2025/): Big Cities Health Coalition It is surprising then that the politicians are taking an axe to health insurance funding, paring back eligibility for Medicaid, introducing work requirements and paperwork ([track it here](https://www.kff.org/medicaid/tracking-the-medicaid-provisions-in-the-2025-budget-bill/)). Reducing access to drug treatment is *exactly the wrong direction* from where we need to go. We have a moment, in 2026, to make real and lasting changes. Let's not squander it. What these federal actions do is effectively reduce funding. And this is where opioid settlements come in. --- # Opioid Settlements Nearly three decades after the initial crimes, the settlement against Purdue Pharma's Sackler family was [finally approved](https://www.pbs.org/newshour/nation/judge-formally-approves-opioid-settlement-for-purdue-pharma-and-sackler-family-members-who-own-the-company) in November; let's hope it sticks this time. ## Waste, Fraud, Abuse, Mismanagement Some states are seem to be spending opioid settlements well. But in reality NO state is across the board good, with some states doing better at the county level but not the state level. But county spenders were getting duped by unscrupulous vendors in damn near every state. Y'all need to get it together, and not be scammed. Drones in Arizona. Millions of dollars on disposal pouches (California, Colorado, Connecticut, Indiana, Iowa, and elsewhere). Dog food and vet bills for K9 units. An ice rink in Kentucky. Handheld drug analysis devices that don't work. Body cameras in Michigan. An office move, fiber optic cables, and shelving in Mississippi. (Seriously, $12,000 for an office shelving system!) $7,500 for T-shirts in Missouri. Hundreds of thousands of dollars for concerts in New Jersey. Plenty of non-opioid activity in Pennsylvania. A padded cell in South Dakota. A camera upgrade in Tennessee. Drones in West Virginia. Overpriced "fentanyl proof" gloves in Wisconsin. Stay tuned for a major report on this early next year, and check out the list being tracked in real-time here: [Opioid Settlement Money Accountability Work - OPIOpioid Settlement Money Accountability Work - Opioid Policy Institute![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/android-chrome-192x192_ynl3olcl.png)OPI![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/OPI-and-Opioid-Policy-Institute-500x500-square-full_461nmrgu.png)](https://opioidpolicy.org/osm-accountability) There are things that are less likely to get federal funding now, like syringe service programs, pipes, overdose prevention centers, and housing-first programs. These are things that settlement funds should prioritize over other things. --- # Marijuana: Is this the year? In November, Congress quietly [closed a loophole](https://www.axios.com/2025/11/15/thc-hemp-products-ban-shutdown-bill) that allowed small amounts of quasi-legal delta-9 THC retail sales in states that hadn’t legalized weed. Will it be back to the unpredictable sensations from Delta-8? Will there be have and have-not states? Are dispensaries expected to become pharmacies? Mobilization of small businesses will be worth watching. Wildcard in December: the perennial promise of cannabis legalization was batted around, but this time via [Executive Order](https://abcnews.go.com/Politics/trump-sign-executive-order-reclassifying-marijuana-officials/story?id=128472615) putting it in [Schedule III](https://www.nbcnews.com/politics/trump-administration/trump-signs-executive-order-fast-tracking-reclassification-marijuana-rcna249741). It is supposed to "clear the way for research" and medical purposes. An improvement from Schedule I, but far from effective regulation. Unclear how far this is going to go. Impacts on [patient access](https://www.statnews.com/2025/11/24/hemp-loophole-closure-could-limit-patient-access/) would not be surprising, meaning opportunity for black markets. “[Wellness influencers](https://www.forbes.com/sites/johnsamuels/2025/06/10/is-elon-musks-ketamine-use-encouraging-dangerous-self-medication/)” and ketamine are a cautionary tale, including speculation of what Elon Musk is on. Just gonna say this because it needs repeating: Marijuana in 2025 did not show signs of being contaminated with fentanyl. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/12/IMG_5237-1.JPG) Satire here, but here's the [truth](https://kffhealthnews.org/news/article/fentanyl-opioid-response-exposure-myth-misinformation-overdose/). --- # Housing: Elephant in the Room So much of public sentiment (and therefore policy) about drugs is fueled by what can be seen from a car window. Housing insecurity, chaotic public drug use, even the smell of weed on the sidewalk... these are the things that always come up first when we talk about our work to normies. (And kids mistakenly taking pills "laced" with fentanyl.) Prevention works, but it also renders our efforts invisible. We are on the precipice of undoing years of painstaking good work in reducing drug harms. From an [HIV outbreak](https://www.opioiddata.org/do-people-use-naloxone-on-themselves/) in Maine to [ending the housing-first program](https://www.youtube.com/watch?v=EDX%5FirLFvCQ) in Utah, getting folks into housing is essential to ending long-term drug harms. If you want to get caught up on the science of homelessness and what we can do to truly alleviate the problem, [start following Dr. Margot Kushel](https://www.linkedin.com/in/margotkushel/). --- # Data landscape Our understanding of national overdose numbers took a major hit when the formulae to calculate CDC provisional and predicted overdose deaths were changed in February with no announcement. In addition to updating the baseline model, the reporting lag is supposed to be now 4 months instead of 6\. The gag order on CDC officials from speaking is harmful. We need the deets! The jury is still out on the revised methodology, but we're looking into it. We also saw wild applications of AI to monitor people's drug use, like this example from [Florida](https://www.wesh.com/article/seminole-county-project-overdose-use-ai-to-track-drug-use/69196215). [Sewer surveillance](https://www.theatlantic.com/health/archive/2024/08/wastewater-monitoring-drug-use/679612/) (wastewater testing) for drugs also expanded, driven by for-profit companies and NIDA, with summer partygoers in [Nantucket](https://nypost.com/2025/09/07/us-news/nantucket-cocaine-levels-are-50-higher-higher-than-us-average-sewage-tests-show/) getting called out for using blow. What would it take to harness the ingenuity of the private sector to improve government data collection? Here’s our [shortlist of four things](https://ajph.aphapublications.org/doi/10.2105/AJPH.2025.308328) to keep an eye on as info sources shift. In fact the whole [January issue](https://ajph.aphapublications.org/toc/ajph/116/1) of *American Journal of Public Health* is dedicated to regaining public trust. Finally, it wouldn't be a 2025 retrospective unless we mentioned AI. 🤖🤣 Under the banner of the war on drugs, governments are quietly expanding AI-driven surveillance tools—facial recognition, predictive policing algorithms, social-media monitoring, license-plate readers, and automated report generation—often with minimal public oversight or evidence of effectiveness, raising serious civil liberties concerns about privacy and transparency. The [Brennan Center](https://www.brennancenter.org/topics/government-power/privacy-free-expression/policing-technology?utm%5Fsource=chatgpt.com) is doing excellent work in this area. --- # Here comes 2026 With the successes of 2024 now clear, and our ability to hold steady in 2025, we face a tremendous opportunity in 2026\. There are more people engaged with harm reduction than ever before. And yet the threats from an unregulated drug supply, reduced federal funding, and outdated rhetoric are impediments. We have a once-in-multiple-generations chance, right here, right now. Let's not squander it. ### Preventing Fatal Overdose for People who Use Alone URL: https://www.opioiddata.org/preventing-fatal-overdose-for-people-who-use-alone/ Last updated: 2025-12-19T03:20:55.000Z In an era marked by synthetic opioids and an adulterated drug supply, it is of paramount importance to take additional precautions when deciding to use drugs. This takeaway is not novel to most in people active substance use and/or people who are working to reduce drug-related risks. However, in the midst of the winter-holidays, I find myself especially fortunate to have cherished companions to celebrate wins, mourn losses, and provide support when I need it. For people in active substance use, having hands-on support can save lives. In a recent study of ours, we heard from several people with lived substance use experience who took pride in looking out for others in their community who used drugs. More specifically, participants discussed the strategy of using together and/or spotting for one another so they were able to act if their partner suffered an overdose. 💡 ****About this study** Data for this study are from semi-structured qualitative interviews (n=74) conducted in three US states (California, Michigan, and Pennsylvania) to better understand practices related to naloxone use and preferences for overdose response. While open-coding transcripts, we picked up on themes related to people with lived substance use experience supporting one another - including the preference and perceived importance of co-use and spotting for one another. Hannah (alias to protect identity), who lives in California and predominantly uses meth and weed shared in one of our studies, > “if I see one of my friends who do fetty \[fentanyl\]… if they're by themselves, I'll just hang out with them while they're smoking or whatever. So they don't have to be alone in case they do OD” Cathy from Michigan further exemplified how people may stagger when they use, > “We were in the hotel room, and he just got out of jail. And I always wait till everyone's done using before I do mine, if I'm in a group of people. And so I'm like just waiting and I was specifically watching him, because I knew he just got out.” Cathy understood the added risk for potential overdose because their acquaintance had just been released from prison and likely had a lower tolerance. These strategies are common and effective, but may not always be practical. For example, some people may not have someone to use with (due possibly to the lack of a trusted and willing companion, fear of facing stigma, etc.), or they simply prefer to use alone. Julia, also in Michigan, uses with their boyfriend now, but before they “would rather use alone” due to personality differences and how they preferred to experience their high. Whether or not someone feels comfortable using their drug of choice in someone else’s presence is a highly individual and personal decision. Still**,** using alone carries considerable risk, as Hannah has experienced, > “I have friends that did fetty and shit and died by themselves, cause no one was with them.” As such, it is critical that people who may not have someone they feel comfortable using in the presence of are aware of resources that exist that allow people who use drugs to be supported from afar. ### A Safer Way to Use "Alone" One free hotline option, open 24/7, is “**SafeSpot**” (**1-800-972-0590**). [SafeSpot](https://safe-spot.me/how-it-works/)connects callers with an informed operator that stays on the line until after the caller completes their use. The hotline is judgment free and confidential, and only collects an address in case of emergency (the address is not stored in any database after the call is finished). If an overdose is detected (the caller stops responding after use), the operator on the line will contact their predetermined responder or local emergency medical services. SafeSpot’s 60 Hotline Operators have collectively supervised over 28,000 use events and detected 30 overdoses. [Home Safespot Overdose HotlineSafeSpot Overdose Hotline is a free, 24/7 virtual overdose spotting service for people who are using drugs alone.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-safe_spot_blackAsset-20-270x270.png)Safespot Overdose Hotline![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/FinalLogo_SafeSpot.png)](https://safe-spot.me/) ### What Can I Do? If you know someone that prefers to use on their own, making sure they know about resources like SafeSpot can be lifesaving. If you are a treatment provider or work for a syringe service program and are looking to display SafeSpot information on behalf of your participants,[printable infographics can be located here](https://drive.google.com/drive/u/0/folders/17OqLJT1kyPF8ACPaspQK7M2p%5FYzHXVfC)**.** If you are in charge of your state’s Opioid Settlement Funds and want to have a relationship with SafeSpot, reach out to us at [opioiddatalab@unc.edu](mailto:opioiddatalab@unc.edu) or[**info@massoverdosehelpline.org**](mailto:info@massoverdosehelpline.org) **Acknowledgement:* Data collected and analyzed in this post were made possible byfunding received from the U.S. Food & Drug Administration Center for Drug Evaluation & Research under a broad agency announcement (75F40122C00193, PI Dasgupta). This post does not necessarily reflect the viewpoints of the U.S. Food & Drug Administration. We also thank the people with lived experience that were willing to share their time and stories with us.* ### 17 years of saving lives in Pittsburgh URL: https://www.opioiddata.org/17-years-of-saving-lives-in-pittsburgh/ Last updated: 2026-05-11T15:51:03.000Z [Trends and characteristics during 17 years of naloxone distribution and administration through an overdose prevention program in Pittsburgh, PennsylvaniaObjective Describe time trends during 17.5 years of community-based naloxone distribution Methods Analysis of administrative records from a harm reduction program in Pittsburgh, Pennsylvania, USA, collected during encounters for overdose education, naloxone dispensing and refills. Monthly time trends were analyzed using segmented regression. Programmatic context aided interpretation of quantitative findings. We also evaluated impacts of 2014 state legislation loosening naloxone prescribing requirements and providing Good Samaritan protections. Results From July 2005 to January 2023 there were 16,904 service encounters by 7,582 unique participants, resulting in 70,234 naloxone doses dispensed, with 5,521 overdose response events (OREs), utilizing 8,756 naloxone doses. After legislation, new participants increased from 10.4 to 65.9 per month. New participants tended to be older (46 vs. 37 years), female (58% to 35%), White race, and more likely to be family/friends as opposed to people who use drugs themselves. Consequently, ORE per participant fell from 1.46 to 0.47 in the year after enactment. On average, 1.63 (95% CI: 1.60, 1.65) naloxone doses were administered per ORE, which did not change substantially over 17 years (χ2 = 0.28, 3 df, p = 0.60) during evolution from prescription opioids, to heroin, to illicitly manufactured fentanyl. In 98.0% of OREs the person who experienced overdose “was okay”, i.e., survived. Emergency medical services were called in 16% of OREs overall, but <7% since 2019\. There were 106 more emesis events per 1,000 OREs with 4 mg nasal spray compared to intramuscular injection; and 48 per 1,000 more reports of anger. Titration of intramuscular naloxone was associated with lower rates of adverse events. Conclusions While state legislation created the environment for expansion, reaching previously underserved communities required intentional new programmatic development and outreach. Long-term consistency of <2 doses per ORE, high survival rate, and robust utilization all lend confidence in prioritizing naloxone distribution directly to people who use drugs and their social networks. Trial registration: This investigation was pre-registered https://osf.io/b2f4h![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-13.ico)PLOS OneNabarun Dasgupta ,![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image-2)](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026) At 15,000+ words, this tome is one of the most ambitious projects we have ever undertaken at the Opioid Data Lab. We hope you'll read the whole thing, but in a series of posts, each linked at the bottom of this post, we pull out the most important points in non-technical language. First let's take a look at the *why* and *who* and *how* we did this work. 🏛️ This project was funded by the US Food and Drug Administration. The contents of the article are solely the responsibility of the authors and do not necessarily represent the official views of the US Food and Drug Administration. These blog posts are solely representations of the Opioid Data Lab. --- # Why we needed to learn more We start by acknowledging that overdose reversal record keeping requirements from funders can be a considerable impediment to actual service delivery. Data on how many doses were handed out and how many reversals reported often end up as vanity metrics. We felt the data could have a lot more value if we worked with the program and activists to contextualize. Surprisingly, there is limited published documentation of how harm reduction programs adapt to changing drug supplies, laws, pharmaceutical formulations, and societal norms over an extended time. We know this happens, it's part of the work. And we have limited understanding of how peer reversal behaviors change over time, particularly as the drug supply landscape has evolved. --- # What we learned ## Doses of naloxone needed [Many](https://pmc.ncbi.nlm.nih.gov/articles/PMC8454200/) scientists have pointed out that increasingly high doses of naloxone may not be necessary to reverse fentanyl overdoses in the community setting. We sought to objectively capture if the number of doses needed for survival had changed over 17.5 years. 💡 On average, 1.63 (95% CI: 1.60, 1.65) naloxone doses were administered per overdose response event, which did not change substantially over 17.5 years (**χ* *2* \= 0.28, 3 df, **p* \= 0.60) during evolution (2005 to 2023) from prescription opioids, to heroin, to illicitly manufactured fentanyl. We observed a 98.0% survival rate with community administered naloxone. [Read more](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone-0315026-g009) ## Impact of state legislation We were interested in seeing how state legislation changed naloxone provision and overdose response. Pennsylvania Act 139 was enacted on November 30, 2014, and went into affect the immediately following January. 💡 After legislation, new participants increased from 10.4 to 65.9 per month. New participants tended to be older (46 vs. 37 years), female (58% to 35%), White race, and more likely to be family/friends as opposed to people who use drugs themselves. Consequently, ORE per participant fell from 1.46 to 0.47 in the year after enactment. While state legislation created the environment for expansion, reaching previously underserved communities required intentional new programmatic development and outreach. [Read more](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#sec088) ## Titration to avoid adverse events We also wanted to bring attention to the practice of naloxone titration with injectable naloxone. People who use drugs will often use partial doses of naloxone, monitor for return to breathing, and administer doses more slowly to avoid putting people into withdrawal. This is the first paper to document the positive benefits of titrating naloxone doses by people who use drugs to prevent withdrawal. 💡 There were 106 more cases of vomiting per 1,000 overdose response events with 4 mg nasal spray compared to intramuscular injection; and 48 per 1,000 more reports of anger. Titration of intramuscular naloxone was associated with lower rates of adverse events. Titration was associated with: less ****vomiting** IRR = 0.26 (95% CI: 0.084, 0.80), less ****anger** IRR = 0.081 (0.011, 0.57), and less ****“feeling sick”** IRR = 0.44 (0.186, 1.051). [Read more](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#sec027) Here are a few of our other blog posts from the paper. Please let us know if you want to see other pieces as posts (opioiddatalab@unc.edu). 1. [About naloxone](https://www.opioiddata.org/about-naloxone/) 2. [Brief history of community naloxone distribution](https://www.opioiddata.org/brief-history-of-community-naloxone-distribution/) 3. [Evidence making interventions](https://www.opioiddata.org/evidence-making-interventions/) 4. [Programs have powerful underutilized data](https://www.opioiddata.org/programs-have-powerful-underutilized-data/) 5. [Long-term changes in types of naloxone distributed](https://www.opioiddata.org/long-term-changes-in-types-of-naloxone-distributed/) 6. [Have naloxone doses gone up with fentanyl?](https://www.opioiddata.org/have-fentanyl-doses-gone-up-with-fentanyl/) 7. [Do people use naloxone on themselves?](https://www.opioiddata.org/do-people-use-naloxone-on-themselves/) --- # The Setting Prevention Point Pittsburgh is one of the longest continuously operating overdose prevention programs in the world. The overdose prevention program is helmed by the redoubtable **Alice Bell**. She created the overdose prevention program, conducted thousands of the interviews, and still runs the service two decades later. **Malcom Visnich** handles a sizable portion of the day to day operations on the mobile van, and would often call in to our meetings from on-site. [Prevention Point PittsburghPrevention Point Pittsburgh (PPP) is a nonprofit organization dedicated to providing health empowerment services to people who use drugs. The mission of Prevention Point Pittsburgh is to promote and advocate for the reduction of harms associated with injection and other forms of drug use, and to reduce the risk of HIV/AIDS, Hepatitis C, other blood-borne infections, and overdose.‍![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/6437f5ca005d98e1cbcab173_PPPGH.png)![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/5eec3abc2c3c8c80d8074b73_prevention-20point-20logo-201in-20blue-20on-20light.png)](https://www.pppgh.org/) Prevention Point Pittsburgh has published other important papers using their data [here](https://link.springer.com/article/10.1007/s11524-011-9600-7), [here](https://www.tandfonline.com/doi/abs/10.1080/02791072.2018.1430409), [here](https://kilthub.cmu.edu/ndownloader/files/12212123), and [here](https://journals.sagepub.com/doi/full/10.1080/08897077.2018.1449053). They have been using a consistent data collection form to record overdose response events (OREs) when their participants came back for naloxone refills. They were an ideal research-ready partner. # A letter of love It was Louise Vincent who said "Love is a research value." The way in which we did the science was also infused with respect, an emphatic THANK YOU to all the Prevention Point staff and volunteers over 2 decades who have spent their weekends doing life giving work, the compassionate care, providing basic human needs, when nobody else would. They do this work out of love for their community, and it was incumbent upon us to honor the thousands of hours of work that gave rise to the data, and do so out of love. # National Perspective The authors come from three professional domains: harm reduction program staff, government and academic scientists, and public health advocates. Our approach to generalizability wasn't to extrapolate one program's experience to all of harm reduction. Instead, our approach was to position the experience in Pittsburgh within a national perspective. We relied on 💜 **Eliza Wheeler** and 💜 **Maya Doe-Simkins** from [Remedy Alliance/For The People](https://remedyallianceftp.org/), two naloxone pioneers and living heroes, who each have decades of experiences doing direct service, advocacy, technical assistance, and bulk naloxone distribution. Their longview and broadview was instrumental in deducing how what we observed in Pittsburgh connected with what was happening at the hundreds of programs that Remedy serves. # Government Scientists Finally, we have deep respect for our colleagues at the US Food and Drug Administration. Led by **Jana McAninch**, the co-authors came from 4 different departments within the Agency, bringing depth of regulatory, clinical, and scientific perspectives. The rest of the co-author team were **Amy Seitz**, **Dorothy Chang**, **Summer Barlow**, and **Zach Dezman**. In addition, the working group included a dozen other FDA officials. We've had a longstanding collaboration with Jana and her team(s), and have always found them to be scientifically rigorous and open-minded partners. Thank you for helping us uncover and document the real story behind community naloxone distribution! # Dream Team Combing all these folks together was **Adams Sibley** and **Maryalice Nocera** at UNC. We also want to thank the reviewers who read the manuscript with an incredible eye to detail, despite the incredible length. We don't know who you are, but your contributions were immensely helpful! --- # Conceptual Framework 🙈 Did your eyes just glaze over? Bring 'em back! This is important. A powerful aspect of this work was applying the [Evidence Making Intervention (EMI)](https://www.sciencedirect.com/science/article/abs/pii/S0277953619304812) framework, by Kari Lancaster and Tim Rhodes. The EMI framework shifts the locus of evidence production away from universally generalizable knowledge, which is common in traditional biomedical research. (And what narrowly defines NIH's funding mission.) Instead, EMI prioritizes a more contextualized scientific process in which data and conclusions are generated through localized public health interventions serving immediate, applied needs. Therefore, the purpose of this analysis is not to present the hypothetically universal experience of naloxone distribution, but rather to examine one location in-depth to understand the forces that directly impacted service delivery and naloxone utilization. We unpack the jargon at the start of the [Methods section](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#sec009), but in summary these were the main core values: - The most important thing was that PPPGH was providing life-saving prevention services; data were useful but secondary to the mission. - We each have different ways of knowing that are equally valid, whether we are formally trained scientists, program staff, government regulators, or activists. - It's critical to understand how programs and participants adapt to local circumstances. We relied on EMI because we were faced with two difficult questions: **How can we analyze 17.5 years of data with fidelity, knowing that drugs and circumstances were constantly evolving?** Here's our answer: By listening to the people who were there and did the hard work of caregiving. **How do we create equality between programmatic experience and quantitative data?** Here's our answer: In the final paper, after *each* quantitative variable reported, we present a dedicated section called "Programmatic Context," which reflects co-authors AB’s and MV’s lived experience from years of direct service delivery, program coordination, and employee supervision. During full team meetings, relevant programmatic context for each variable in the dataset was discussed, and recorded in meeting notes. Following the EMI principles of Equality of Knowledge and Practice Implementation, these conversations often took the shape of program staff and advocates (MDS and EW) informing scientists and government officials about the nuance of service delivery. 💞 Honoring programmatic context and lived experience transformed a nerdy exercise into mutual learning. In addition to a better scientific end product, we emphasize that the **process* induced by the EMI framework was genuinely enjoyable. The back-and-forth between people of different backgrounds revealed much more than any one party could have contributed by themselves. Put another way, honoring programmatic context and lived experience turned away from a nerdy exercise, and instead it became a space for mutual learning. In addition to a better scientific end product, we emphasize that the *process* induced by the EMI framework was genuinely enjoyable. The back-and-forth between people of different backgrounds revealed much more than any one party could have contributed by themselves. 👉🏾 [Read out blog post on EMI here](https://www.opioiddata.org/evidence-making-interventions/). --- # Methods We encourage you to [look at the Methods](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#sec009) in detail. In brief: ## **Data Collection & Analysis** We analyzed naloxone distribution records spanning nearly 18 years (2005-2023), tracking when people received naloxone kits and later reported using them during overdoses. Data were collected on standardized forms by trained interviewers, with ongoing quality assessments. We combined quantitative data with programmatic insights from staff who directly delivered services, ensuring our analysis reflected real-world harm reduction practice. ## **Key Measurements** We measured how many doses were needed per overdose and tracked side effects like withdrawal symptoms ("felt sick"). We created novel surveillance metrics to understand naloxone usage patterns, predict future needs, and detect overdose surges in the community. These metrics showed strong agreement with hospital emergency department overdose trends, validating their utility for public health monitoring. We also examined how participant demographics changed over the study period. ## **Statistical Analysis** We examined trends across three drug epidemic phases: prescription opioids/heroin (2005-2011), heroin dominance (2012-2015), and fentanyl era (2016-2023). We used segmented regression, a statistical technique that identifies sudden changes in trends over time, particularly useful for evaluating the impact of the 2014 Pennsylvania law enabling broader naloxone distribution, including effectiveness and usage patterns. Time series visualizations with smoothed trend lines helped illustrate changes over the 210-month study period. ## **Death Case Review** We compared effectiveness between different naloxone formulations and conducted detailed reviews of 23 cases where people died despite naloxone administration, examining circumstances and timing. --- # Open Science Principles Because this was a federally funded study, and because we wanted anybody to be able to use the results, we followed [Open Science](https://www.cos.io/open-science) best practices. While we've adhered to parts of the Open Science framework in other studies, it's taken a lot of trail-and-error to learn how to implement. It's so worth it! 1. We [pre-registered](https://osf.io/b2f4h) the study, announcing our intent and planned analyses before we started. This makes us accountable to our original plan. In the final paper we also noted ways in which we deviated from what we had said we would do. 2. We made our [methods and code](https://osf.io/sq5d6/) publicly available, using Stata and Jupyter notebooks. 3. We [posted the data](https://osf.io/e8bqa/) with permission of Prevention Point Pittsburgh. 4. We paid Prevention Point for their data and time on the project. And they are co-authors. 5. We posted [versions of our paper](https://www.medrxiv.org/content/10.1101/2024.11.21.24317731v1) so people could see how our how the science evolved, and to inform a broader audience during peer review, but we consciously didn't publicize the pre-print. 6. We presented the results at the [Compassionate Overdose Response Summit](https://www.healthmanagement.com/insights/briefs-reports/compassionate-overdose-response-summit-highlights-and-key-takeaways/) ([video](https://www.healthmanagement.com/insights/webinars/compassionate-overdose-response-summit-and-naloxone-dosing-meeting/), [slides](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/6395wj71s?locale=en)) while the paper was going through a year-long review process because we felt the information couldn't wait. 7. We published the paper in an [open access journal](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026) "free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose." Slides for each figure are pre-made for your at the link. Doing *all the things* took intentional effort. And time. We hope we can live up to this standard in all our work, but we know that not all projects can make all this happen. --- # Research Questions Five research questions were specified in the [public pre-registration](https://osf.io/b2f4h/overview). If you're looking for the answers, [this section of the published paper](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#sec088) evaluates each question. 1. Did the utilization rate of naloxone and demographics of participants change after enabling state legislation was enacted? 2. After enactment of state legislation, what actions did the program take to focus uptake of naloxone directly to networks of people who use drugs? 3. Were program adaptations (e.g., site expansion) effective in improving naloxone uptake among communities of color in Pittsburgh? 4. Has the average number of doses of naloxone administered during an overdose response event changed over time as the drug supply has changed? Specifically, was more naloxone needed for reversing overdoses during the era of illicitly manufactured fentanyl, compared to previous periods where overdoses were due to heroin? 5. Is the number of doses administered per overdose response event impacted by type of naloxone formulation? Three additional questions were developed by the co-authors during the iterative analysis process and evaluated in accordance with the [Evidence-Making Intervention (EMI) framework](https://www.opioiddata.org/evidence-making-interventions/). 1. Did enactment of the Pennsylvania “Good Samaritan” law impact the proportion of overdoses response events in which 911 was called? 2. What were the circumstances of deaths reported after administration of naloxone? 3. Did adverse events differ by formulation of naloxone? And did titration of naloxone have an impact on adverse event rates? The answers to all 8 questions are clearly stated in the Discussion section that you can go to directly from this link: [Trends and characteristics during 17 years of naloxone distribution and administration through an overdose prevention program in Pittsburgh, PennsylvaniaObjective Describe time trends during 17.5 years of community-based naloxone distribution Methods Analysis of administrative records from a harm reduction program in Pittsburgh, Pennsylvania, USA, collected during encounters for overdose education, naloxone dispensing and refills. Monthly time trends were analyzed using segmented regression. Programmatic context aided interpretation of quantitative findings. We also evaluated impacts of 2014 state legislation loosening naloxone prescribing requirements and providing Good Samaritan protections. Results From July 2005 to January 2023 there were 16,904 service encounters by 7,582 unique participants, resulting in 70,234 naloxone doses dispensed, with 5,521 overdose response events (OREs), utilizing 8,756 naloxone doses. After legislation, new participants increased from 10.4 to 65.9 per month. New participants tended to be older (46 vs. 37 years), female (58% to 35%), White race, and more likely to be family/friends as opposed to people who use drugs themselves. Consequently, ORE per participant fell from 1.46 to 0.47 in the year after enactment. On average, 1.63 (95% CI: 1.60, 1.65) naloxone doses were administered per ORE, which did not change substantially over 17 years (χ2 = 0.28, 3 df, p = 0.60) during evolution from prescription opioids, to heroin, to illicitly manufactured fentanyl. In 98.0% of OREs the person who experienced overdose “was okay”, i.e., survived. Emergency medical services were called in 16% of OREs overall, but <7% since 2019\. There were 106 more emesis events per 1,000 OREs with 4 mg nasal spray compared to intramuscular injection; and 48 per 1,000 more reports of anger. Titration of intramuscular naloxone was associated with lower rates of adverse events. Conclusions While state legislation created the environment for expansion, reaching previously underserved communities required intentional new programmatic development and outreach. Long-term consistency of <2 doses per ORE, high survival rate, and robust utilization all lend confidence in prioritizing naloxone distribution directly to people who use drugs and their social networks. Trial registration: This investigation was pre-registered https://osf.io/b2f4h![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-14.ico)PLOS OneNabarun Dasgupta ,![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image-3)](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#sec088) Link to Discussion section ## Sign up for Opioid Data Lab The Street Drug Analysis Lab is a public service of the University of North Carolina at Chapel Hill. We provide analytical chemistry services and information for public health. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### Do people use naloxone on themselves? URL: https://www.opioiddata.org/do-people-use-naloxone-on-themselves/ Last updated: 2025-12-03T19:10:29.000Z Most conversations about overdose reversals focus on someone stepping in to save another person’s life. But buried in our newly published analysis of 5,521 overdose reversal events (OREs) is a phenomenon that rarely receives attention: people giving naloxone to ***themselves***. This seems unlikely, right? If some is in a true "overdose" situation, they are by definition unresponsive. This is also technically off-label, because these naloxone formulations are supposed to be used in opioid-induced respiratory depression. *Why would someone use naloxone right after using heroin or fentanyl, when it would just be wasting money, and possibly put them into withdrawal?* Sometimes there may be a short window when people realize they took something that feels stronger than they expected. Injectable naloxone can be given in less than a full dose, meaning people may choose a small amount of antidote to prevent themselves from going into a full overdose. This likely happens when people use drugs alone. We recommend our friends at [Safe Spot](https://safe-spot.me/) (call 1-800-972-0590) if you need someone to spot you over the phone. Look, we aren't endorsing that folks should give themselves naloxone. It would be easy to make yourself really sick. But, it's something that happens, albeit very rarely, and we figured we should look into it. In our study on 17.5 years of naloxone administration in Pittsburgh, we found some n=44 cases where people reported self-administering naloxone. [Trends and characteristics during 17 years of naloxone distribution and administration through an overdose prevention program in Pittsburgh, PennsylvaniaObjective Describe time trends during 17.5 years of community-based naloxone distribution Methods Analysis of administrative records from a harm reduction program in Pittsburgh, Pennsylvania, USA, collected during encounters for overdose education, naloxone dispensing and refills. Monthly time trends were analyzed using segmented regression. Programmatic context aided interpretation of quantitative findings. We also evaluated impacts of 2014 state legislation loosening naloxone prescribing requirements and providing Good Samaritan protections. Results From July 2005 to January 2023 there were 16,904 service encounters by 7,582 unique participants, resulting in 70,234 naloxone doses dispensed, with 5,521 overdose response events (OREs), utilizing 8,756 naloxone doses. After legislation, new participants increased from 10.4 to 65.9 per month. New participants tended to be older (46 vs. 37 years), female (58% to 35%), White race, and more likely to be family/friends as opposed to people who use drugs themselves. Consequently, ORE per participant fell from 1.46 to 0.47 in the year after enactment. On average, 1.63 (95% CI: 1.60, 1.65) naloxone doses were administered per ORE, which did not change substantially over 17 years (χ2 = 0.28, 3 df, p = 0.60) during evolution from prescription opioids, to heroin, to illicitly manufactured fentanyl. In 98.0% of OREs the person who experienced overdose “was okay”, i.e., survived. Emergency medical services were called in 16% of OREs overall, but <7% since 2019\. There were 106 more emesis events per 1,000 OREs with 4 mg nasal spray compared to intramuscular injection; and 48 per 1,000 more reports of anger. Titration of intramuscular naloxone was associated with lower rates of adverse events. Conclusions While state legislation created the environment for expansion, reaching previously underserved communities required intentional new programmatic development and outreach. Long-term consistency of <2 doses per ORE, high survival rate, and robust utilization all lend confidence in prioritizing naloxone distribution directly to people who use drugs and their social networks. Trial registration: This investigation was pre-registered https://osf.io/b2f4h![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-15.ico)PLOS OneNabarun Dasgupta ,![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image-4)](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026) ## **How common is self-administration?** In our dataset, **0.8%** of all overdose reversals involved self-administration of naloxone (**44 out of 5,521** overdose response events). That may seem small, but every one of these instances represents a moment when someone recognized quickly enough—and had naloxone close enough—to act before losing consciousness. Most of the time, people who reversed their own overdoses used injectable naloxone (77.3%, or 34 of 44 instances). And in the majority of cases, they gave themselves one (or less) or two doses: - **1 (or less) dose:** 50% (22 events) - **2 doses:** 36.4% (16 events) ## **A chain of events** Here's approximately what happens in the sequence that leads to self-administration: 1. **Immediate perception of potency** – Feeling the strength of the opioid agonist more quickly or more intensely than expected. 2. **Naloxone within reach** – Having naloxone on hand and knowing how to use it. We've heard of folks pre-filling syringes with naloxone. 3. **Conscious recognition of overdose risk** – People knew they consumed more than intended, or the drug was stronger than expected. 4. **Intervention before severe symptoms** – They administered naloxone *before* respiratory depression or loss of consciousness. ## **Why did self-administration decline in the fentanyl era?** One of the striking findings is thatself-administration used to be more common during the heroin and Rx opioid era. - During the **heroin and prescription opioid era** (2005–2016): **14.4 self-administrations per 1,000 overdose response events** - During the **illicit fentanyl era** (2016–2023): **5.5 self-administrations per 1,000 overdose response events** That’s a **three-fold drop**. Why the change? Likely because fentanyl’s onset is simply too fast. With heroin or prescription opioids, people had enough time to realize, *“This is too strong—I took too much.”* With fentanyl, the window between “something feels wrong” and “I can no longer act” is dramatically shorter. Fewer opportunities for self-administration doesn’t mean less awareness; it means less time. This highlights a cruel reality of the unregulated fentanyl supply: it compresses the timeline for life-saving action, even among people who know their bodies, who have naloxone ready, and who fully intend to use it. ## **Why this matters** Self-administration is a reminder that people who use drugs are not passive recipients of risk. They constantly make assessments, take precautions, and try to keep themselves—and others—alive. ## What we don't know Since this is such a rare phenomenon, there is a lot we don't know about it. How did people decide to use naloxone that particular time? Did people use less than a full dose? Did they inject it intramuscularly or intravenously? How did they decide on how much naloxone to give themselves? Was this something they did more than once? What happened once they had the naloxone? Why did they think they needed a second dose? Would they have used SafeSpot? Did they seek someone out to keep an eye on them in case they slipped back? Did they feel like using again because of the naloxone? These are somewhat difficult questions, but things that are worth considering. ## **A final thought** You don’t hear much about self-administration of naloxone, but it represents a kind of self-defense—people doing everything they can in a rapidly changing risk environment. As fentanyl reshapes the timeline of overdose, these moments of quick thinking become harder to achieve. --- *We used generative AI tools to help generate some of the text for this post. We reviewed every word and edited substantially as we thought appropriate.* ### Have naloxone doses gone up with fentanyl? URL: https://www.opioiddata.org/have-fentanyl-doses-gone-up-with-fentanyl/ Last updated: 2026-05-11T14:48:13.000Z 📈 Naloxone doses have not appreciably increased from ****1.57** to ****1.60** doses per reversal, comparing the heroin/prescription opioid era 2012-2015 against 2016-2023, when fentanyl was involved in 77% of overdose deaths. On a purely molecular level, fentanyl is more potent than heroin so pharma keeps cajoling health departments to buy more expensive higher dose naloxone and new reversal drugs (like nalmefene), see details by [Hill et al](https://pmc.ncbi.nlm.nih.gov/articles/PMC8454200/). **It would be *really* helpful to know if the average dose per reversal has changed during the fentanyl era.** Let's look at the overdose [data from Allegheny County Health Department](https://tableau.alleghenycounty.us/t/PublicSite/views/OverdoseDashboard%5F16179787053040/OverdoseDashboard?iframeSizedToWindow=true&:embed=y&:display%5Fcount=n&:showAppBanner=false&:origin=viz%5Fshare%5Flink&:showVizHome=n). And let's combine it with 17.5 years of data from our friends at [Prevention Point Pittsburgh](https://www.pppgh.org/), a harm reduction program in Pittsburgh, Pennsylvania, USA. 📝 This is a modified excerpt from a [published paper](https://www.opioiddata.org/17-years-of-saving-lives-in-pittsburgh/) on naloxone distribution in Pittsburgh, with additional analyses. \[Numbered Citations\] link to the original open access publication. This content can be redistributed however you'd like. We expanded the scope beyond Prevention Point's [2019 published paper](https://journals.sagepub.com/doi/abs/10.1080/08897077.2018.1449053) which found: > Despite increases in fentanyl-contributed deaths, there were no statistically significant differences between any of the 4 years (2013–2016) on average number of naloxone doses used by participants to reverse an overdose (F = 0.88; P = .449). *Conclusion*: Even though IMF is more potent than heroin and is a rapidly increasing contributor to drug overdose deaths in Allegheny County, the average dose of naloxone administered has not changed. We [worked together](https://www.opioiddata.org/evidence-making-interventions/) to refresh the analysis. From July 2005 to January 2023 there were 16,904 service encounters by 7,582 unique participants, resulting in 70,234 naloxone doses dispensed, with 5,521 overdose response events (OREs), utilizing 8,756 doses of naloxone. **The person who had overdosed was judged to be “okay” 98.0% of the time after receiving naloxone.** We [presented these data](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/6395wj71s?locale=en) at the [Compassionate Overdose Response Summit](https://www.healthmanagement.com/insights/briefs-reports/compassionate-overdose-response-summit-highlights-and-key-takeaways/). [Watch a video](https://vimeo.com/928039968#t=1h22m25s) of us talking through this analysis (1:22:25 timestamp), and what this program looks like IRL. --- # Eras of Overdose We can define each era by the most prominent substance involved in (at least half of) overdose deaths. There was a lot of overlap from 2005 to 2015 so these labels could be quibbled with, or you can just treat 2008-15 as the Rx opioid + heroin era. The next 3 graphs show substances involved in overdose deaths, per year, in Allegheny County (where Pittsburgh is located). The yellow line up top is any/all opioids, and the colored lines are specific types of substances. **Rx opioids Era.** Let's call this 2008 to 2011\. Prescription opioid were involved in 53.5% of overdose deaths during these years, after which less than half involved Rx opioids. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image.png) Grey line = Rx opioids **Heroin Era.** About 2012 to 2015\. Heroin was involved in 52.5% of overdose deaths. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-1.png) Blue line = heroin **Fentanyl Era.** Starting in 2016 and continuing to end of study in January 2023 (and beyond). Fentanyl was involved in 77% of overdose deaths. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-5.png) Red line = fentanyl # Naloxone Dose **The average dose per reversal from 2005 to 2023 was 1.63, with 98.0% survival rate.** To be clear, that is LESS THAN TWO DOSES of 4 mg nasal spray. It is LESS THAN TWO DOSES of 0.4 mg/mL intramuscular naloxone. The graph below shows the monthly average number of doses per overdose response event, over 17.5 years. The short graph below is number of total doses administered by Prevention Point Pittsburgh participants. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-4-1.png) The vertical axis corresponds to average monthly dose per overdose response event, with dots representing the raw monthly average, and the trend lines depicting the Gaussian-smoothed rolling three-month rolling average. Shaded fill areas represent the 95% confidence interval of the smoothed mean doses per overdose response event per month. Let's break this down into the eras above, using the arithmetic average. | Era | Years | % OD Deaths | Naloxone per Reversal | | ------------------- | ------- | ----------- | --------------------- | | Rx opioids | 2008-11 | 53% | 1.92 doses | | Heroin | 2012-15 | 52% | 1.57 doses | | Fentanyl | 2016-23 | 77% | 1.60 doses | | | | | | | Rx opioids + heroin | 2008-15 | | 1.70 doses | From 2008 to 2011, prescription opioids were involved in 53% of overdose deaths, with the balance predominantly heroin. During these years, average naloxone per ORE (overdose reversal event) was 1.92 doses (95% CI: 2.05, 1.79). Heroin started replacing prescription opioids, becoming more dominant starting in 2012, involved in 52% of overdose deaths from 2012-15\. During these years, average naloxone per ORE was 1.57 doses (95% CI: 1.64, 1.50). Fentanyl emerged in 2016 and remained dominant into 2023, on average in 77% of annual overdose deaths. During these years, average naloxone per ORE was 1.60 doses (95% CI: 1.63, 1.57). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-6.png) And for all y'all stats nerds, the difference between heroin and fentanyl eras is not statistically significant. You can use whatever test you'd like (overlapping confidence intervals is fine), we really cannot say that 1.57 vs. 1.60 are statistically different. 💡 ****Looking at 17 years of data, the average naloxone dose has not gone up during the fentanyl era, compared to earlier times.** And hey, if you don't like these eras, that's fine. Take a look at the 17 timeline and cut it up however you'd like. **Even in a year where fentanyl was involved in 86% of overdose deaths (2020), the average doses per reversal was 1.54.** ### Caveats We caveat that during this time, people who use drugs were learning how to adapt to the influx of fentanyl, and naloxone availability was greatly increased. We don't have data on concentration of fentanyl per bag/pill. [Carfentanil](https://www.opioiddata.org/programs-have-powerful-underutilized-data/) was also a factor during this time period. --- # Formulation Effect But why would doses per reversal be highest during the Rx opioid era? It's not because of methadone, but good thought Data Detective. There's a more direct explanation, that would be obvious to anyone who packed a kit or volunteered at Prevention Point Pittsburgh. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_6681.jpeg) Right. So let's see which formulations were dispensed at Prevention Point Pittsburgh. The 10 mL vial was the only thing available until 2012\. So the "Prescription Opioid Era" had the 10 mL multi-dose vial, which may have led people to administer more doses than needed just based on the form factor. (This is why using 2005-2012 for the combined prescription opioid + heroin era was a little confounding.) Here's the volume of what was dispensed: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-8.png) Figure 5 from [Dasgupta et al](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026). And here's the average number of doses of which naloxone was utilized in reversals, by formulation: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-7-1.png) Figure 9 from [Dasgupta et al.](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026) Program staff described that with the 10 mL vial it was easy for people to administer additional doses, and that unit dosing with the 1 mL vial and nasal spray reduced this behavior. In instances where many doses and/or multiple forms had been administered, program staff described that it was common for people to receive additional doses of naloxone after police or paramedics arrived, even if the person was already revived and was breathing. Therefore, extreme numbers of reported doses administered may reflect circumstances beyond the reporter’s control, and doses not dispensed by Prevention Point Pittsburgh. Let's take this a step further and see if the number of naloxone doses differed by formulation type. Now the horizontal axis is number of doses administered per ORE. The vertical axis is standardized count frequency (called kernel density in histogram jargon). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/11/journal.pone.0315026.g008.PNG) **Fig 8 from** [**Dasgupta et al.**](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026) **Number of naloxone doses administered per overdose response event.** > **Figure legend.** Average number of naloxone doses administered per overdose response event are presented with the vertical axis, smoothed using Gaussian kernel density estimators. For 1 mL and 10 mL vials, fractional dosing was observed, with less than a single full dose (1 mL of 0.4 mg/mL) being administered; this was not possible for the nasal spray, resulting in the visible left-truncation of the kernel density plot. Box plots below each graph show median and interquartile range are presented horizontally; circles represent outlier observations. Study dates: August 2005 to January 2023. Over 17.5 years, the cumulative arithmetic average number of naloxone doses per overdose response event was 1.63 (95% CI: 1.60, 1.65), and the geometric mean was 1.44 (95% CI: 1.42, 1.46). Time trends presented in [Fig 8](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone-0315026-g008) show two distinct patterns. The 1 mL vial and 4 mg nasal spray were used mostly as one or two doses (roughly bimodal), whereas the 10 mL vial and multiple forms represent more continuous distributions, including titrated fractional doses and administration of less than one full labeled dose to achieve reversal. When multiple forms of naloxone were administered, the number of total doses was greater (median of two versus median of one) than single formulation administrations. The average doses per overdose response event was lowest for 1 mL vial with 1.51 doses (95% CI: 1.48, 1.54), [Table 3](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone-0315026-t003). Using 1 mL vials as a reference group, the average number of doses per ORE was 7.5% higher (95% CI: 3.7%, 11.5% higher, *χ*2 \= 3.9, Wald p < 0.001) for the nasal spray with 1.63 doses per ORE (95% CI: 1.58, 1.68). For the 10 mL vial, doses were 22.1% (95% CI: 15.6%, 28.9% higher doses, *χ* 2 \= 7.1, p < 0.001) higher than the 1 mL vial with 1.85 doses per ORE (95% CI: 1.75, 1.94). When multiple forms were used, the average doses were 2.76 doses per ORE (95% CI: 2.58, 2.94). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/11/journal.pone.0315026.t003.PNG) Table 3 from [Dasgupta et al](https://journals.plos.org/plosone/article/figure?id=10.1371/journal.pone.0315026.t003). The overall rate of naloxone doses per overdose response event in Pittsburgh remained stable over a 17.5-year period ([Fig 9](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone-0315026-g009)). Segmented regression did not yield any statistically verifiable change points (*χ* 2 \= 0.28, 3 df, p = 0.60; [Table 2](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone-0315026-t002)) during the 17.5-year observation period of the number of doses per overdose response event (Fig S13 in [S1 File](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.s001)). --- # Linear Relationship So, we wondered, does dose of naloxone go up with increasing penetration of fentanyl? Let's look at percent of OD deaths involving fentanyl during each year of the fentanyl era, plottong average dose per year. Note that ALL values are below 2.0 doses per reversal (dashed line). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-9.png) Wanna see the linear regression fit? Meh. It's nothing notable. Some little increase but still well under 2.0 doses per reversal. Interpreting the slope, **for every 5% increase in fentanyl among OD deaths, we expect 0.03 higher dose to be needed on average: Nothing burger.** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-10.png) # Conclusion The average dose of naloxone went up 2% during the fentanyl era. In real-world situations, more fentanyl does not mean higher doses of naloxone are needed. In real-world data, cheap, generic intramuscular and lower-dose sprays work just fine. --- # 📈 Data Notes ## Definitions *Dose* was defined as the lowest single dose in approved labeling for overdose reversal. For 1 mL and 10 mL vials, a single dose was defined as 0.4 mg delivered intramuscularly, and 4 mg intranasally (in one nare) for the nasal spray. *Overdose response events* (ORE) include any report of an attempted overdose reversal regardless of the outcome of the event (successful resuscitation, death, or unknown outcome) where naloxone was administered. While the term “reversals” is commonly used in the literature, “ORE” was considered a more accurate term in the context of these data. ## Overdose data To see these data in full on the County government website, [click here](https://tableau.alleghenycounty.us/t/PublicSite/views/OverdoseDashboard%5F16179787053040/OverdoseDashboard?iframeSizedToWindow=true&%3Aembed=y&%3Adisplay%5Fcount=n&%3AshowAppBanner=false&%3Aorigin=viz%5Fshare%5Flink&%3AshowVizHome=n), and go to "Fatal Trends." Scroll down to the bottom. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-3.png) Here are the numbers from the County Tableau site. % Rx opioids = 53.5% 2008: 51 2009: 58 2010: 57 2011: 48 Crossover in 2012, near equal parts heroin (48%) and Rx opioids (41%) % Heroin = 52.5% 2012: 48% 2013: 53% 2014: 51% 2015: 58% Fentanyl emerged in 2014, increasing from 3% the previous year to 19%. % Fentanyl = 77% 2016: 62% 2017: 73% 2018: 71% 2019: 77% 2020: 86% 2021: 80% 2022: 85% 2023: 82% --- # Funding This research was funded by the US Food and Drug Administration via UNC (BAA #167, Contract 75F40122C00193). The views presented do not necessarily reflect the views of the Funder, and should not be construed as Guidance or policy. ### Long-term changes in types of naloxone distributed URL: https://www.opioiddata.org/long-term-changes-in-types-of-naloxone-distributed/ Last updated: 2025-11-05T21:02:10.000Z 📝 This is a modified excerpt from a [published paper](https://www.opioiddata.org/17-years-of-saving-lives-in-pittsburgh/) on naloxone distribution in Pittsburgh. Citations link to the original open access publication. This content can be redistributed however you'd like. During the 17.5-year period, half of all naloxone doses dispensed by Prevention Point Pittsburgh were: - 1 mL (0.4 mg/mL) vials (n = 35,715; 50.8%) - 10 mL (0.4 mg/mL) vials (n = 18,420; 26.2%) - 4 mg nasal spray (n = 16,063; 22.9%) - Only 36 doses of the autoinjector were dispensed during a one-month period in 2016 with donated product During the first decade of operation ([Fig 5](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone-0315026-g005)), Prevention Point Pittsburgh distributed the 10 mL vial exclusively. Yellow sparkline below the main time trends panel are provided to visualize fluctuations in monthly counts of naloxone doses distributed. ## Programmatic context Program staff provided context for the two points where lines crossed. Initially the 10 mL vial was the only formulation available, but the 10 mL vial was replaced by 1 mL vials starting in October 2012 due to a new contract with the manufacturer. With this transition, by August 2013 all IM distribution was of 1 mL vials, packaged by the program as kits containing two 1 mL vials. The other line crossing occurred in Spring 2021 when a manufacturing problem disrupted 1 mL vial production. From [May 2021 to September 2022](https://www.washingtonpost.com/health/2021/08/11/naloxone-demand/), a manufacturing shortage of affordable naloxone led to a shortage of the 1 mL vials. The State of Pennsylvania was able to increase bulk nasal naloxone to Prevention Point, but the organization had to hire a part-time staff person to help other community-based programs with accessing the state ordering portal. After the shortage was resolved, 1 mL vial purchases resumed in late 2022. ### Programs have powerful, underutilized data URL: https://www.opioiddata.org/programs-have-powerful-underutilized-data/ Last updated: 2025-11-05T20:35:59.000Z 📝 This is a modified excerpt from a [published paper](https://www.opioiddata.org/17-years-of-saving-lives-in-pittsburgh/) on naloxone distribution in Pittsburgh. Citations link to the original open access publication. This content can be redistributed however you'd like. Many harm reduction programs collect overdose reversal data from participants, usually through a short paper or digital questionnaire when participants come back for naloxone refills. Basic stats from these "surveys" often make their way into progress reports and academic papers. It may seem intuitive, but reversal reports can also complement official OD reporting systems. If reversal reports can be a speedy source of knowledge, they provide harm reduction programs with an opportunity to leverage their data to educate their participants, as well as open new avenues for funding. This may seem obvious, but we didn't find other examples in the published literature. So we created a basic (and easy to calculate) monthly metric: ![Reversal Rate Formula](https://latex.codecogs.com/png.image?%5Cdpi%7B150%7D%5Cbg_white%5Ctext%7BMonthly%20Reversal%20Rate%7D=%5Cfrac%7B%5Ctext%7BNumber%20of%20Reversals%20(ORE)%7D%7D%7B%5Ctext%7BNaloxone%20Doses%20Dispensed%7D%7D%5Ctimes100) (ORE = overdose response event, often called a "reversal report") In high volume, high utilization programs, you could *approximately* interpret this as the percentage of doses used within a month. This could be a helpful metric for purchasing and service planning. (Many caveats here, since average time to use can be months, naloxone can be obtained elsewhere, etc.) So at Prevention Point Pittsburgh, you can see that 2013-15 were high naloxone utilization years marking when illicitly manufactured fentanyl first emerged to replace heroin. And 2016-17 was when carfentanil made it's appearance. This also provides a granular look at how long it takes for participants to adjust to newly emerging drugs, though there is so much else going on that is unobserved (e.g., fluctuations in concentration) that it would be unwise to extrapolate broadly. However, we do get an empirical benchmark of how long (about 2 years) it would be expected for OD rates to drop after the initial full-bore emergence of fentanyl, a fundamental question in explaining the east-to-west pattern of overdose death declines nationally. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/11/Screenshot-2025-11-05-at-2.58.45---PM-1-1.png) Back to using this metric for data intelligence. The official Allegheny County rates for opioid-related hospital emergency admissions looks very similar to the Prevention Point reversals data! (the red dotted line above is the left axis of the graph below). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/11/image.png) Supporting Information from [paper](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026) The PPPGH data are monthly, and the ED data are quarterly, but you can see a strikingly similar pattern. Programs that can look at their data monthly can stay ahead of health authority data that takes months (or years) to go public. Again, we acknowledge that record keeping of OREs has been contentious among harm reduction programs because it can place substantial administrative burden on staff that detracts from their ability to distribute naloxone and provide other direct services. We hope the [EMI framework](https://www.opioiddata.org/evidence-making-interventions/) will be a way to do this better. ### About naloxone URL: https://www.opioiddata.org/about-naloxone/ Last updated: 2025-10-31T19:37:27.000Z 📝 This is an excerpt from a [published paper](https://www.opioiddata.org/17-years-of-saving-lives-in-pittsburgh/) on naloxone distribution in Pittsburgh. Citations link to the original open access publication. This content can be redistributed however you'd like. **By: Colleagues at the US Food and Drug Administration** Naloxone was first synthesized in 1961 by Jack Fishman and Harold Blumberg and was approved by the US Food and Drug Administration (FDA) in 1971 as a human prescription medication for the reversal of opioid depression, including respiratory depression, induced by natural and synthetic opioids (“overdose”) \[[22](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref022)\]. Naloxone is approved to be administered intravenously (IV), intranasally (IN), or by intramuscular or subcutaneous injection (IM/SC). Naloxone for injection is currently available in the US under many approved generic versions. Additionally, many naloxone-containing drug-device products delivering a range of doses have been approved by the FDA since 2014 (Table S1 of Supplemental Material in [S1 File](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.s001)) and are available by prescription or nonprescription. These product approvals have relied upon data derived from healthy subjects, in accordance with the 505(b)(2) pathway outlined in the Federal Food, Drug, and Cosmetic Act of 1938 \[[23](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref023)\]. The pharmacological action of naloxone \[[24](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref024)\] is primarily via antagonism at the mu-opioid receptor, with additional antagonist ability at the kappa- and sigma-opioid receptors. Naloxone’s strong attraction to opioid receptors displaces and prevents the binding of opioid agonists such as heroin, fentanyl, and morphine in the central nervous system. Intravenous administration of naloxone leads to rapid redistribution in the body, including crossing the placenta (teratogenicity category C). Naloxone administered intramuscularly and intranasally reach a maximum concentration at 10–30 min and 5–30 min, respectively \[[25](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref025)\]. The nasal and oral bioavailabilities of naloxone are approximately 50% and 1%, respectively. The serum half-life of naloxone ranges from 30–81 min in adults. Naloxone is primarily excreted via the kidneys after glucuronide conjugation in the liver. Adolescents (those ≥12 years of age) through adults experiencing opioid overdose can receive an initial dose of 0.4 mg to 2 mg IV, which can be repeated at 2-to-3-minute intervals as needed to reverse respiratory depression; intranasal and IM/SC products follow a similar frequency of dosing. Additional doses may need to be administered every one to two hours or given as an infusion for extended-release opioids or opioids with long durations of action (e.g., methadone, buprenorphine). Caregivers are encouraged to keep patients under surveillance to guard against the chance of renarcotization and return of respiratory depression. There is no maximum dose of naloxone, and very high exposures have been reported in the literature \[[26](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref026)\]. However, the FDA Prescribing Information cautions clinicians to consider an alternative cause of the patient’s presentation if 10 mg of naloxone has been given IV without an improvement in the patient’s condition \[[24](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref024)\]. Adults with opioid dependence who receive naloxone can develop an opioid withdrawal syndrome, characterized by body aches, abdominal cramping, nausea, vomiting, diarrhea, rhinorrhea, sneezing, diaphoresis, tremulousness or shivering, anxiety or agitation, piloerection, and yawning. The severity and duration of the precipitated withdrawal is related to the dose of naloxone and to the degree of opioid dependence. Other adverse reactions include tachycardia, increased blood pressure, and rarely, seizures. A rare but serious adverse reaction to naloxone is noncardiogenic pulmonary edema. The risk of naloxone-induced pulmonary edema also appears to be dose-dependent \[[27](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref027)\]. Naloxone is on the World Health Organization’s List of Essential Medicines \[[28](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref028)\]. It reverses opioid-induced respiratory depression rapidly but may also precipitate withdrawal in people who have opioid tolerance. Community-based naloxone distribution has become widely accepted in the US as a means of secondary prevention of overdose deaths, albeit with heterogeneity in enabling state governmental laws and policies \[[29](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref029)\]. ### Evidence Making Interventions URL: https://www.opioiddata.org/evidence-making-interventions/ Last updated: 2025-10-31T19:32:16.000Z 📝 This is an excerpt from a [published paper](https://www.opioiddata.org/17-years-of-saving-lives-in-pittsburgh/) on naloxone distribution in Pittsburgh. Citations link to the original open access publication. This content can be redistributed however you'd like. ### Conceptual framework This study was based on the [EMI framework](https://www.sciencedirect.com/science/article/abs/pii/S0277953619304812) \[[17](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref017),[53](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref053)\]. This framework shifts the locus of evidence production away from universally generalizable knowledge, which is common in traditional biomedical research. Instead, EMI prioritizes a more contextualized scientific process in which data and conclusions are generated through localized public health interventions serving immediate, applied needs. Therefore, the purpose of this analysis is not to present the hypothetically universal experience of naloxone distribution, but rather to examine one location in-depth to understand the forces that directly impacted service delivery and naloxone utilization. The application of the framework to the current investigation can be summarized using the six central tenets of EMI. In applying these principles in the Results section, “Programmatic Context” follows “Quantitative Results” for each set of variables analyzed. 1. *Material-discursive Process*: Naloxone distribution in Pittsburgh is not expected to be the same as anywhere else, yet there is value in understanding the local context. State policies and local drug supply considerations are made when interpreting quantitative data. 2. *Emergent, Contingent, Multiple effects:* Applied to this study, participant behaviors were expected to change over time. Overdose response practices naturally evolved over a 17-year period, instead of assumed to be static, as in shorter studies. 3. *Practice-based Matter-of-concern:* Of central relevance is how the concept of naloxone distribution was interpreted by program staff and locally adapted. For example, the program adapted to the COVID pandemic, and as new naloxone products and street drugs shifted. Therefore, contemporaneous contextual details are provided allow quantitative data to be interpreted with fidelity. 4. *Practice of Implementation:* How the intervention was delivered is of equal importance to other outcomes (e.g., biomedical or pharmacological). Therefore, logistical considerations and site expansion rationales are provided in detail, especially in ways that impacted participant recruitment and training of participants, and ultimately, the quantitative data. 5. *Performative Work of Science:* Administrative data were collected first and foremost for service delivery, and the scientific knowledge generated from their review is an added benefit. While data were collected with the intention of analysis, the questions asked of participants were also designed to gather information on reversals that would reveal opportunities for counselling and behavior change at the point of care. 6. *Equality of Knowledge:* Program staff’s experience of service delivery is of equal explanatory value as quantification of administrative records. Program staff were included in each step of the analysis process, and their experiences are recorded in the Results section, and they are co-authors of this manuscript. The Equality of Knowledge principle, a recursive process for knowledge generation was applied, starting with whole-team generation of the research questions. The data analyst (ND) generated tabular and graphical representations of time trends for batches of variables. The team then assembled to discuss patterns, aberrations, policy impacts, public health implications, and topics for further investigation, including new research questions based on discussions of programmatic context. After the initial discussion, the analyst would prepare follow-up tables, developing statistical methods as the inquiry warranted, and refine time trend graphs, which were then presented at the following meeting. This recursive process was applied to each set of variables in the dataset until all variables had been analyzed and discussed. In addition to the five research questions elaborated in the pre-registration, the recursive process resulted in three additional research questions described above. ### Brief history of community naloxone distribution URL: https://www.opioiddata.org/brief-history-of-community-naloxone-distribution/ Last updated: 2025-10-31T19:25:06.000Z 📝 This is an excerpt from a [published paper](https://www.opioiddata.org/17-years-of-saving-lives-in-pittsburgh/) on naloxone distribution in Pittsburgh. Citations link to the original open access publication. This content can be redistributed however you'd like. **By: Maya Doe-Simkins and Eliza Wheeler of** [**Remedy Alliance**](https://remedyallianceftp.org/) Prevention Point Pittsburgh started distributing naloxone in 2005, after being inspired by formative work by the Chicago Recovery Alliance. Previously naloxone had been used exclusively in hospitals for managing anesthesia and by pre-hospital emergency medical service providers to reverse opioid overdose. In 1996, fueled by rising fatal heroin overdose among participants and staff, the Chicago Recovery Alliance \[[30](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref030)\] began distributing naloxone via their syringe services program to people who use drugs and their immediate social networks, an innovation marking the first known formal overdose education and naloxone distribution program in the world \[[31](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref031),[32](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref032)\]. For the first decade of operations, the naloxone distribution program at Prevention Point Pittsburgh operated within a broader national context, which evolved from an environment of little support to codified scientific and legal protections. Given limited funding during the first 18 years (1996–2014) of broader intervention evolution, the development and implementation of new naloxone distribution initiatives within syringe services programs nationally was primarily through peer-based mentoring and technical assistance between programs. This was the case with Prevention Point Pittsburgh. Naloxone was purchased using smaller value unrestricted funds from sources such as t-shirt sales and donations to memorial funds from families who had lost a loved one to overdose. The staff time and cost to implement and deliver the services was absorbed by syringe service programs, viewed as an ethical imperative regardless of funding. Using this unfunded interorganizational mentoring model, there were 48 programs in the US by 2010 \[[18](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref018)\], and 140 by 2014 \[[33](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref033)\]. Because naloxone was a prescription medication, these initiatives existed in a medico-legal gray area that generated onerous requirements on harm reduction programs. For example, from 2005 to 2014, a documented in-person medical encounter and individual prescription from a physician was required for Prevention Point Pittsburgh to dispense naloxone to a participant. After coordinated national advocacy by public health organizations, state level legislation, and accumulating scientific evidence, policies supporting naloxone distribution were established starting around 2014 nationally, and directly contributed to the expansion of the naloxone distribution initiative in Pittsburgh. The advent of federal support for naloxone distribution also had an impact on Prevention Point Pittsburgh by creating an expanded community of harm reduction practice for innovation, diffusion, and communication. In 2014, a memo from the Substance Abuse and Mental Health Services Administration (SAMHSA) to the National Association of State and Territorial AIDS Directors (NASTAD) clarified that using federal funds for naloxone was an acceptable expenditure for state block grants \[[34](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref034)\]. The first new federal funding that explicitly allowed for naloxone distribution was the Health Resources and Services Administration (HRSA) 2015 Rural Opioid Overdose Reversal grant program \[[35](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref035)\]. Prior to federal funding, local governments and harm reduction programs used local and philanthropic funds to support naloxone distribution in Massachusetts \[[20](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref020)\], New York \[[14](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref014)\], New Mexico \[[36](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref036)\], San Francisco \[[37](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref037)\], Rhode Island \[[38](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref038)\], North Carolina \[[21](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref021)\], Baltimore \[[39](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref039)\], and Pittsburgh \[[19](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref019)\]. Prevention Point Pittsburgh operated within this community of practice, the activity of which centered around the listserv and monthly meetings of the Opioid Safety and Naloxone Network, facilitated for over a decade by co-author AB \[[40](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref040),[41](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref041)\]. By the end of 2015, several key events paved the way for further development of Prevention Point Pittsburgh’s naloxone distribution program. Research emerged confirming that naloxone distribution via syringe services programs was effective at reducing overdose mortality \[[42](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref042)\] and was cost-effective \[[43](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref043),[44](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref044)\]. Laws were passed in 43 states to support expansion \[[45](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref045),[46](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref046)\]. Two new branded naloxone products (nasal spray and auto-injector) were approved for prescription use among lay persons \[[47](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref047)\] and heavily promoted by pharmaceutical manufacturers \[[48](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref048)\]. Harm reduction programs also created a Buyers Club to obtain low cost injectable naloxone directly from a different manufacturer \[[40](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref040)\]. The FDA supported development of nonprescription naloxone formulations by conducting studies of labeling instructions \[[49](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref049)\] and expediting review of new products \[[50](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0315026#pone.0315026.ref050)\]. Of direct relevance to Prevention Point Pittsburgh, Pennsylvania Act 139 was enacted on November 30, 2014, allowing standing orders and third-party naloxone prescriptions. Prevention Point Pittsburgh’s Medical Director issued a standing order for the organization, enabling naloxone distribution without requiring individual prescriptions. ### The Real Work URL: https://www.opioiddata.org/the-real-work/ Last updated: 2026-05-20T16:22:02.000Z > **The Real Work** > Wendell Berry > > It may be that when we no longer know what to do > we have come to our real work, > > and that when we no longer know which way to go > we have come to our real journey. > > The mind that is not baffled is not employed. > > The impeded stream is the one that sings. This brief post is written without the consultation or consideration of the leader of this meager scientific endeavor. Because his humility would run up against it. Sorry, Nab. Earlier today, [Nabarun Dasgupta](https://www.macfound.org/fellows/class-of-2025/nabarun-dasgupta) was one of [22 thought leaders](https://www.macfound.org/programs/awards/fellows/) named as a 2025 MacArthur Fellow. The fellowship comes with plenty of funding and prestige. More importantly for us, as colleagues, it comes with validation of what we already knew: That Nab is a human worth celebrating. We hope that if this is your first visit to the page, you'll spend some time learning about his two-plus decades of tireless advocacy for people who use drugs, and in shaping policies and practices that humanize them. A MacArthur Fellowship is a career-defining moment. And while today might be an opportunity for reflection and appreciation, it is telling that in the chaotic aftermath of the announcement, in e-mails and texts and calls, Nab's immediate focus is not on the past nor present but on the future: How this award will help us expand our work. 80,000 Americans died from overdose last year. That's tens of thousands fewer than what we've come to expect. But it's still tens of thousands too many. The work continues. To bookend with a statement that Nab likely *would* approve of: Every human being, no matter what they consume or why they consume it, deserves dignity, autonomy, and safety. Harm reduction – the not-so-radical notion that uplifting is a more practical response to the overdose epidemic than condemning – is the way we choose to support this ideal. There are thousands of grassroots organizations across this country working to guarantee access to basic materials like naloxone, drug checking equipment, and safe use supplies. As importantly, these organizations offer the rare spaces where people stigmatized for their drug use are met with humanity and compassion. We hope you will consider donating, volunteering, and advocating for these efforts. Sincerely, The Opioid Data Lab --- *Header image courtesy of the John D. and Catherine T. MacArthur Foundation* ### September 2025 Newsletter URL: https://www.opioiddata.org/september-2025-newsletter/ Last updated: 2026-05-11T15:44:21.000Z ****2,000 newsletter subscribers & counting!!** 🎉 Thanks for being part of this growing crew that’s all about curiosity, science, harm reduction, and keeping each other safer. Couldn’t have done it without you and here’s to also analyzing over ****15,000 samples**! We are on a roll and thanks to the awesome community on the journey with us 😃 ## Let's keep talking. Be in the know with our free newsletter. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. # 〽️Service Stats & Updates As of Monday September 7, 2025... **15,760** samples analyzed Serving **180** harm reduction programs Reaching **260** counties in **43** states **451** unique substances identified Note to our service users: If you’re using an older [version of our card](https://cdr.lib.unc.edu/concern/multimeds/5d86p887m?locale=en) to report test strip results, please specify if “MTS” means methamphetamine or medetomidine! --- # 😩 One Year of BTMPS This [handy review](https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2836265) from David Zhu of the spread of [BTMPS](https://www.opioiddata.org/mystery-substance-summer-2024/) had us taking a closer look at the 1,600+ samples with it that we've analyzed at UNC from 19 states. Overall its prevalence seems to be trending down since it's emergence in Summer 2024, and peak in October. A year later, in August 2025 BTMPS was in about a quarter of fentanyl samples, and lower into September. ✌🏾 Buh bye, we hope. [Follow our live data](https://deepnote.com/app/opioiddatalab/bis2266-tetramethyl-4-piperidyl-sebacate-57aada26-47f7-4095-a52e-f6f334b086e8?%5F%5Fembedded=true) updated daily. [](https://storage.3.basecamp.com/5250175/blobs/f1c9e326-8365-11f0-bc12-0242ac120005/download/image.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/image-6.png) --- ***"If substance use no longer interferes with your ability to live a productive and loving life, then recovery has been achieved, with or without abstinence."*** Maia Szalavitz getting real in her essay [*I’m in Addiction Recovery and I Still Drink Wine*](https://www.nytimes.com/2025/08/14/opinion/non-sober-addiction-recovery.html)*.* --- # 📉 Department of Data Are overdose deaths back to pre-COVID levels? Who's left behind? Our colleagues in Kentucky [weighed in on this](https://injepijournal.biomedcentral.com/articles/10.1186/s40621-025-00608-7). While the overall numbers trended down in 2024, they found that OD deaths among Black residents were +56%, and +41% among ages 55-64\. Stimulant involved ODs were up 45%. \[Open Access\] ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/image-2.png) [Source](https://doi.org/10.1186/s40621-025-00608-7) --- # 🍄 Psychedelics Our friends over at Rocky Mountain Poison & Drug Safety have a [new report](https://www.rmpds.org/sites/default/files/2025-08/NSIHT%20DATA%20REPORT%202024%5F0.pdf) on the use of psychedelics in the United States. > **Psychedelic substance use was highest among younger adults.** > Psychedelic use was highest among adults aged 18-25 (7.9%) in 2024, followed by adults aged 26-49 (7.0%). Adults aged 50 and older had the lowest prevalence (1.4%). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/image-5.png) Source: RMPDS --- # 🍻 Bye Bye Booze? This [article in *Vox*](https://www.vox.com/future-perfect/458272/alcohol-drinking-decline-health-teen-drinking-alcoholism) caught our attention because the decline in alcohol consumption corresponds with other drug use indicators among youth above. > In 2024, [according to one long-running youth survey](https://isr.umich.edu/news-events/news-releases/missing-rebound-youth-drug-use-defies-expectations-continues-historic-decline/), 42% of 12th graders reported drinking alcohol, down significantly from 75% in 1997\. For 10th graders it was 26 percent (down from 65%) and for eighth graders it was 13% (down from 46% in 1997, which *yikes*). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/image-4.png) Source: Vox **Taken together, we strongly believe that shifting drug use preferences among Gen Z are a major factor in the decline in deaths from overdose.** --- # 💵 Federal Funds for Naloxone In late July, [SAMHSA released a letter](https://www.samhsa.gov/sites/default/files/dear-colleague-letter-executive-order-ending-crime-disorder-americas-streets-07302025.pdf) clarifying that ***yes*** federal funds can continue to be used for purchasing wound care supplies, test strips, and naloxone. Corey Davis at the Network for Public Health Law has an [excellent lawyerly take](https://www.networkforphl.org/news-insights/the-july-2025-executive-order-and-the-state-of-harm-reduction-in-the-us/) on this and the Executive Order. Specifically, the letter notes "Opioid overdose reversal supplies, including the purchase of naloxone" -- which means all supplies needed to administer naloxone **including IM syringes**. [Intramuscular naloxone is really critical](https://remedyallianceftp.org/pages/all-about-naloxone) right now: It is the most cost effective and has the least side effects. Speaking of naloxone side effects, you'll want to read [this excellent qual paper](https://doi.org/10.1016/j.drugpo.2025.104948) led by Ranjani Paradise. Key takeaway is that giving too much naloxone has real consequences: "Many participants described intense physical pain and/or emotional distress immediately following overdose reversal, which reduced their desire and ability to engage with service providers." *You’re so sick after that, \[treatment\] is the last thing on your mind, like, just don’t ask me anything, you know? … Maybe the next day, you’d be up for thinking about \[treatment\] a little more, but usually not right after \[the overdose\].* As always, start with the minimum dose of naloxone, do rescue breathing, count breaths, and wait before doing a second dose. Titration using IM naloxone has long been used to reduce side effects, and is a skill participants should be comfortable with. --- # 🕵️ Research Update Lots of new data and scientific pubs on the drug supply: The brief upturn in overdose deaths we saw in late March and April 2025 in North Carolina had an [unexpectedly high level of cocaine](https://drive.google.com/drive/folders/1bEuitepfZNV6jFYA9YkYLXQ7fr2%5Fh7ts) involvement (42%) than usual (20-31%). Fentanyl in marijuana is a myth: Fent rarely shows up unexpectedly in other drugs, [only 2%](https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-025-01189-w). From Canada, [side effect](https://link.springer.com/article/10.17269/s41997-024-00990-7) analysis on novel drug supply adulterants. Consistent drug supplier [doesn't translate](https://www.sciencedirect.com/science/article/abs/pii/S0376871625002042?via%3Dihub) to consistent drug supply in terms of quality. Two-out-of-three people [share drug checking results](https://pubmed.ncbi.nlm.nih.gov/40561713/) with family and friends. UPenn has a good webinar recording on [managing medetomidine withdrawal](https://penncamp.org/medetomidine/). Xylazine's emergence led to a [doubling of amputations](https://www.sciencedirect.com/science/article/pii/S0376871625002790) in Philly. People who use drugs in Philadelphia [don't like xylazine](https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-025-01275-z) and try to find ways to mitigate harm. In New Haven, they found about 1 in 5 people using xylazine to actually be [seeking xylazine](https://www.tandfonline.com/doi/full/10.1080/10826084.2025.2549499) and having reasons for doing so; they tended to be White women. In the general population, [only 3.6% had purchased OTC naloxone](https://pmc.ncbi.nlm.nih.gov/articles/PMC12202286/). --- # 😵‍💫 Hallucinations with medetomidine Adams just published [this open access paper](https://onlinelibrary.wiley.com/doi/10.1111/dar.70024) on a medical paradox: In hospitals, medetomidine is used to quell delirium. On the street, a community partner asked us to see if it could be causing hallucinations. Working with anesthesiologists, we found the same molecule(s) causing opposite effects in pharmaceutical versus unregulated forms. Since it was published, we have heard from paramedics, doctors, and harm reduction providers from the East Coast confirming that they too were seeing this. We want to emphasize that medetomidine remains predominantly a East Coast and Ohio River Valley contaminant. We are only seeing sporadic samples from the Southwest and West Coast. [Not Your Hospital’s Precedex: Why Street Medetomidine Hits DifferentThe sedative is considered remarkably safe in clinical settings, but on the street – at unknown doses mixed with fentanyl and xylazine – medetomidine tells a different story.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-29.png)Opioid Data LabAdams Sibley![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/shannon-vandenheuvel-4R20-qlgmP4-unsplash-1.jpg)](https://www.opioiddata.org/not-your-hospitals-precedex-why-street-medetomidine-hits-different/) --- # 📣 Team Voices **Mabeki**, our summer practicum student reflects on what he has learned about the complexity of the drug supply and how **systemic racism** and **stigma** shape drug policy and harm reduction. From the dangers of criminalization to the racialized history of cocaine, their perspective sheds light on why evidence-based, compassionate approaches are essential. Read more by clicking below! [Mabeki’s ReflectionsOur summer practicum student reflects on what he learned about the complexity of the drug supply and how systemic racism and stigma shape drug policy and harm reduction.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-30.png)Opioid Data LabMabeki Mvuendy![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/UNC_portraits_June2025_02__Mabeki-1.jpg)](https://www.opioiddata.org/mabekis-reflections/) [](https://3.basecamp.com/5250175/buckets/42795723/boosts/new?boost%5Bboostable%5Fgid%5D=Z2lkOi8vYmMzL1JlY29yZGluZy85MDM2OTYyNDA2) --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! ## 💰Rich people use drugs A great reminder of the political minefield that comes from revealing who buys and uses drugs the most: **Rich people!** As wastewater testing expands, we’ll see more headlines like this: *Cocaine levels are 50% above the US average in rich and famous hotspot Nantucket, sewage tests show \[*[*NY Post*](https://nypost.com/2025/09/07/us-news/nantucket-cocaine-levels-are-50-higher-higher-than-us-average-sewage-tests-show/)*\]* We should be asking **1)** how cocaine was quantified *exactly*, **2)** how is an island’s wastewater different from the mainland, **3)** where the national comparison came from, and **4)** what corporate influence led to this testing. We heard of the same type of result from wastewater testing in Wake County NC in 2018\. ## Mother of Methadone *Filter* had [nice coverage](https://filtermag.org/mother-of-methadone/) of Dr. Melody Glenn’s new book [*Mother of Methadone: A Doctor’s Quest, A Forgotten History, And A Modern-Day Crisis*](https://www.penguinrandomhouse.ca/books/781015/mother-of-methadone-by-melody-glenn-md/9780807017760)*.* "Dr. Marie Nyswander is finally getting her flowers. Along with Drs. Vincent Dole and Mary Jean Kreek, Nyswander (1919-1986) was one of the pioneers of methadone maintenance, which has helped millions of people around the world stay alive. In the male-dominated world of science and medicine, her contributions have often been overlooked or downplayed." ## First Mobile MAT Clinic A mobile clinic launched by Dr. Eric Morse, in partnership with NC First Lady Anna Stein’s [**Unshame NC** initiative](https://www.unshamenc.org/), is rolling across the Triangle to deliver free, stigma-free opioid treatment including methadone and buprenorphine to those who need it most. Watch the report here to see how this on-wheels lifeline is changing lives by removing transportation barriers and building recovery with compassion and dignity. [](https://3.basecamp.com/5250175/buckets/42795723/boosts/new?boost%5Bboostable%5Fgid%5D=Z2lkOi8vYmMzL1JlY29yZGluZy85MDE2MDUzNTQ1) **Suboxone:** Another good book is Shoshana Walter's [*Rehab*](https://www.simonandschuster.com/books/Rehab/Shoshana-Walter/9781982149826)which "exposes the country’s failed response to the opioid crisis, and the malfeasance, corruption, and snake oil which blight the drug rehabilitation industry." She'll be at the [LitQuake Festival](https://www.litquake.org/) in San Francisco on October 12 to discuss. **KFF Health News.** For this monthly installment of big companies doing shady things check out this rage bait: [Optum Rx Invokes Open Meetings Law To Fight Kentucky Counties on Opioid Suits](https://kffhealthnews-org.cdn.ampproject.org/c/s/kffhealthnews.org/news/article/optum-rx-unitedhealth-group-kentucky-counties-lawsuits-opioids-open-meetings-law/amp/) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/IMG_15E87E4FE406-1-1-1.jpeg) ## ❤️‍🩹 We are deeply saddened by the passing of Louise Vincent, a true boots-on-the-ground harm reduction trailblazer. Her impact as a leader, advocate, and fierce voice for people who use drugs will be felt for generations. Our condolences go out to all who knew and loved her—may she rest in her power and peace. [Here is a link to her memorial post by Nab.](https://www.opioiddata.org/rip-louise-vincent/) # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. Join **North Carolina Harm Reduction Coalition** as their next Chief Operating Officer and help shape the future of harm reduction in NC while leading a mission-driven, *fully remote* team dedicated to saving lives. [NCHRC COO Job postingNCHRC COO Job posting.pdf139 KBdownload-circle](https://www.opioiddata.org/content/files/2025/09/NCHRC-COO-Job-posting.pdf "Download") **Orange County, NC** has multiple openings for [Outreach Specialist position!](https://www.governmentjobs.com/careers/orangecountync/jobs/5050248/street-outreach-specialist) **NC Institute of Medicine** 2025 Annual Meeting is November 13th. [Find out more here!](https://www.eventbrite.com/e/2025-nciom-annual-meeting-tickets-1492456239789?aff=oddtdtcreator) **Mississippi Today** will have a 30-minute webinar where they break down how they reported on opioid settlement spending in a state facing major health challenges on September 17th! [Register here!](https://zoom.us/meeting/register/OTL720ODS7asCZ5%5FAjZjTg?ref=news.reportingonaddiction.org#/registration) Don’t miss the **Breaking Barriers: Compassionate Care and Community Engagement in the Opioid Crisis Conference** on September 15th in Charlotte, NC. [Register here!](https://www.southpiedmontahec.org/event/75020) --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. Send us more doodles and notes! They sustain us. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/IMG_2047-1.jpg) ## Thanks for reading!!! ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ### RIP Louise Vincent URL: https://www.opioiddata.org/rip-louise-vincent/ Last updated: 2026-05-11T15:44:33.000Z **Above all, Louise Vincent advocated for dignity**. And therefore it is with the highest esteem, and the saddest of hearts, that the National Survivors Union and the North Carolina Survivors Union announced the passing of Executive Director, Louise Beale Vincent. She is survived by a whole huge community that fucking loves her. And will never forget. And we send our love to her partner Don Jackson who was always by her side. --- **Donations in her memory can be made here:** **Read the** [**National Survivors Union**](https://www.facebook.com/search/top?q=urban%20survivors%20union) **announcement and see** [**NC Survivors Union Facebook page**](https://www.facebook.com/NCSurvivorsUnion) **for updates.** --- An [internationally recognized](https://www.facebook.com/watch/?v=463318282246993) advocate for people who use drugs, Louise was feisty and brilliant. She was the friend you always wanted in your corner. But when you invited her in, you best be ready to hear the hard truths that nobody else would utter. She started her formal work in harm reduction under the wing of [Thelma Wright](https://pubmed.ncbi.nlm.nih.gov/35817454/), another North Carolina legend. Sterile syringes prevent HIV infection, and Louise’s organization has stopped untold thousands of transmission events through distribution of sterile injecting and smoking equipment. She created services to help people who use drugs or are engaged in sex work to get free hepatitis testing and treatment. But most of all, she gave them a place where they were treated as equals, without judgement, no matter what. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/IMG_4597-2.jpeg) Louise with Thelma at a rally on Halifax Mall in Raleigh. Source: Roxanne Saucier After the loss of her daughter Selena, she redoubled her efforts to distribute naloxone. The stockpiles that she and Don procured went freely out the door to other programs in North Carolina, during a time when distributing the life-saving antidote to people who use drugs was still heavily stigmatized. During the coronavirus pandemic, not only did she and Don keep the [exchange on Grove Street](https://www.ncsurvivorsunion.org/supplies) open, they expanded capacity to provide services meeting the moment of demand. During this frightening and isolating time, Louise summoned the leaders of drug user activism from around country to North Carolina to rekindle camaraderie and hear the stories that could not be told via computer. Damn, she told a good story. And she helped others find their voice. Through her [narcofeminisim storytelling circles](https://journals.sagepub.com/doi/abs/10.1177/00914509241296518), she created a space for women to share intimate, harrowing tales of their experiences in the War on Drugs, stories that would never have otherwise been heard. Yet, these were circles of support and healing, in a manner that had never been done before. In this way, and others, Louise was a relentless innovator. She pioneered the use of canned oxygen to assist in rescue breathing for overdose reversal, and to calm people who had taken more stimulants than they could handle. She was willing to try anything to give people who use drugs an inch more autonomy, a mile more dignity. About a decade ago, she [found her passion](https://filtermag.org/its-time-for-people-with-privilege-to-come-out-about-their-drug-use/) by going beyond direct services. In the face of an increasingly institutionalized harm reduction movement, Louise was incensed that the rights and dignity of people who use drugs were being ignored. When she joined the [National Survivors Union](https://www.nationalsurvivorsunion.com/) (then known as USU - Urban Survivors Union), she brought a whole new level of energy to the nascent movement. Through nurturing by Robert Suarez, Becky Brooks, Isaac Jackson, Shilo Jama, and Mark Kinzly, drug user organizing became a reality in the United States. Her influence was felt beyond Greensboro. A national action on drug user organizing came in the form of the [Reframe the Blame](https://static1.squarespace.com/static/5b1004d99772ae3d0c175e3b/t/5e43010fb50d3507e775cd3e/1581449500259/final+reframe+the+blame+toolkit+.pdf) campaign, a searingly convincing toolkit to push back against drug-induced homicide laws. She was honored as the recipient of the inaugural Dan Bigg Award for ground breaking activists at the 2018 National Harm Reduction Conference. Afterwards, she didn’t rest. She could never sit still when so much work was left to be done, so many people to reach, and while she was facing yet another institution that trampled the dignity of drug users. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/IMG_AF691BDF8BFE-1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/IMG_301E76F0D3B3-1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/IMG_5F6DFC0EFC6B-1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/IMG_15E87E4FE406-1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/IMG_80B9BBC5CA50-1.jpeg) Receiving the Dan Bigg Award in 2018 with Mark Kinzly, Karen Stanczykiewicz-Bigg, and Greg Scott. Source: Nigel Brunsdon Deeply unsettled by her experiences getting treatment, she advocated tirelessly for methadone reform, rattling the cage until the system finally started to recognize patient agency. She co-authored the hugely influential [Methadone Manifesto](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2021.306665), that actually led to tangible national policy changes. She was an advocate for the dignity and rights of people with disabilities and chronic pain, even before she lost her leg in a motor vehicle accident. In recent years her health suffered from exposure to xylazine. She [bravely and publicly](https://filtermag.org/hospital-drug-wounds-stigma/) told her near-death story to show others they needed to be careful. She was responsible for catalyzing the first drug checking service in the South, the first run by a drug user union. Throughout these life changes, Don has been a constant companion who always put Louise’s needs first. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/09/image-1.png) Hand drawn by Brittain Peck Along the way, Louise earned a [Masters in Public Health degree](https://phe.uncg.edu/louise-vincent-making-an-impact/). “Love is a research value,” Louise was fond of saying. She stood up to researchers, making them treat her and her staff with dignity, and equal pay. This stance, picked up by others in the drug user advocacy movement, led to a sea change in how people who use drugs are included and compensated in NIH research studies. But any measure of Louise’s impact cannot convey the personal impact she had on those of us whose lives she touched. Yes, she was an inspiration. But she also showed up when she wanted to, always demanded we do more, and never hid her feelings. Through the fallings-out and reconciliations, somehow our respect for her only grew. And in this moment of her passing, we ask you to remember her with dignity. Please help her work continue with a donation, or any other support of NSU or the North Carolina Survivors Union. Above all, STAND UP for the values she showed us. And show Don some love! Donations to keep Louise’s work going: ### Mabeki's Reflections URL: https://www.opioiddata.org/mabekis-reflections/ Last updated: 2025-10-28T20:18:03.000Z Hi again! While learning more about harm reduction, the drug supply, and drug policy, I have identified two key points that I would like to emphasize. The first is that the drug supply is *very* complex and sensitive to change. The volume of a certain substance and its concentration can impact the trends in distribution and/or consumption. For example, while it might seem that a drastic increase in law enforcement should improve overdose trends, the opposite can occur. A situation in which law enforcement spikes can negatively impact these trends by halting the distribution of a certain substance, which can create an opening for another substance that the community – and its health professionals – may not be prepared for. Additionally, if the “original” substance that consumers were previously familiar with returns, but with a higher concentration, a consumer might purchase it at the same volume as before, which could prove fatal. Once again, this demonstrates how ineffective criminalizing drug usage is at preserving health. The second point is that on a systemic level, socioeconomic status and racial identity are undeniably linked to how drug usage is perceived and how harm reduction might be considered. People who are unhoused are particularly susceptible to harsh consequences that can arise from drug usage, and this is only compounded by inaccessibility to essential healthcare. One striking example of this is the prolonged and unanticipated impact of using Xylazine, an adulterant that causes severe skin wounds. While developing such symptoms would be very unpleasant for anyone, those who are unhoused often face more profound challenges, such as having their wounds constantly exposed to the elements, and yet, due to severe economic strife, are unable to access any relief. Additionally, on the off chance that they gain access to healthcare, the added stigma of being unhoused often results in being disrespected and dismissed by professionals within the system. With regards to racial identity, the way society continues to approach drugs is highly racialized, and such racialization informs the way any given drug is perceived at a systemic level. For example, cocaine, which was seen as less addictive than opioids, was used widely by white Americans but became racialized in the media *after* the substance made its way to Black communities. Regardless of how rare cocaine use was among Black Americans, the media was intentional about manufacturing a narrative that would paint Black people in the most violent, criminal way possible. Soon after, laws were passed to tax cocaine usage, and eventually, more laws were passed to completely criminalize nonmedical use of cocaine. This is just one example that demonstrates how systemic racialization leads to criminalization. Even now, the stigmatization of drug usage still undermines efforts to pass policies that promote accessible, inclusive, and evidence-based harm reduction practices. In addition to impeding progress on a policy level, society’s views on drug usage and the racist ‘War on Drugs’ demonize people who use drugs to such a degree that they can find themselves imprisoned, seriously ill, or dead for using a substance. A future in which humane, evidence-based harm reduction practices, such as drug checking, become standard is a future that has dismantled the terrible remnants of the War on Drugs and centralizes care and justice in public health. We should all strive for this! **\-Mabeki** **Mvuendy** ### Not Your Hospital's Precedex: Why Street Medetomidine Hits Different URL: https://www.opioiddata.org/not-your-hospitals-precedex-why-street-medetomidine-hits-different/ Last updated: 2026-05-11T15:44:52.000Z If you follow our [watchlist](https://www.opioiddata.org/unc-watchlist/), you know about a veterinary tranquilizer that's recently entered the unregulated drug supply in multiple states. No, not xylazine, though we're still keeping an eye on that. Think even *more* recently. The substance is [medetomidine](https://www.thelancet.com/journals/lanam/article/PIIS2667-193X%2825%2900063-8/fulltext), xylazine's mysterious and nefarious cousin. A potent sedative and alpha-2 agonist, medetomidine first showed up as a blip in our data in late 2022 and really started trending up last summer. Unlike xylazine, medetomidine (in a form called *dex*medetomidine, brand name Precedex) is FDA-approved in humans. In fact, it's commonly used in hospital settings as a sedative and analgesic. Babies on ventilators. Adverse clinical reactions won't surprise you: lowered pulse and blood pressure. Sure, that comes with the territory of depressants. Overall, the drug has been hailed for its margin of safety – [as safe as safe can be](https://doi.org/10.1053/j.sane.2006.02.003), according to some scientists. But that's with known doses, in controlled environments. On the street, medetomidine tells a completely different story. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/08/image.png) [See daily updated version here](https://deepnote.com/app/opioiddatalab/dexmedetomidine-Tracker-a401c37e-5255-4d15-87a1-252ee09f360d) Our new research study reveals that medetomidine – which we've identified in 14 states – is causing intense, unexpected hallucinations. Among 11,000+ samples analyzed, **samples containing medetomidine were 12 times more likely to be associated with hallucinations** than other samples. [Read the full open-access report in Drug & Alcohol Review]( https://doi.org/10.1111/dar.70024) People described these hallucinations as "intense," "trippy like DMT," and "psychedelic." Some reported visual and auditory hallucinations followed by passing out. Others experienced vivid nightmares lasting 8 hours or dissociative effects. The rub? Precedex is actually used to [*prevent* delirium in clinical settings](https://link.springer.com/article/10.1186/s13613-018-0437-z). This stark contrast highlights how context transforms a drug's effects. Street exposure differs fundamentally from medical use: doses are unknown and potentially massive, there's no titration to effect, consumption is chronic rather than acute, and the drug appears in chaotic, unpredictable mixtures – in this case, **averaging 8 substances per sample** (commonly including fentanyl and/or xylazine). For harm reduction workers and people who use drugs, unexpected hallucinations might serve as an early warning – similar to how persistent wounds signaled xylazine's arrival. (In contrast, [opioids don't](https://pmc.ncbi.nlm.nih.gov/articles/PMC6482381/) cause hallucinations.) Our drug checking partners found medetomidine commonly appears with fentanyl (59%) and/or xylazine (56%), usually in white powders. --- ### **About Our Investigation** [*We first saw medetomidine*](https://results.streetsafe.supply/sample/300461) *in our service in October 2022 in a sample from Raleigh. We mostly see it in East Coast samples, some from the Midwest. Here are* [*all our medetomidine samples*](https://results.streetsafe.supply/?query=medetomidine)*. More recently, we were asked by community members in Pittsburgh what could be causing a sudden uptick in hallucinations. Even though our drug checking is a service, not a research study, we thought our data could help. So we* [*pre-registered*](https://osf.io/4agfx) *the investigation and let y'all know about it in our* [*newsletter*](https://www.opioiddata.org/april-newsletter/)*. In addition to community partners (Alice Bell), we also tapped the expertise of anesthesiologists who uses the medication in the hospital (Irina Philips and Brooke Chidgey), a lab scientist (Madigan Bedard) who uses it in animal studies, and a drug checking stats expert (Sam Tobias). Dream team! For the drug checking data nerds, we were careful in our use of statistical models, and would love your feedback.* --- The mechanism behind these hallucinations remains unclear. Street medetomidine might contain both active and "inactive" forms of the drug (unlike pharmaceutical versions). People tolerant to opioids might be desensitized to sedation while remaining vulnerable to other effects. Or the sheer dose could be orders of magnitude beyond therapeutic levels. **What's certain is that medetomidine adds another layer of complexity to an already hazardous drug supply.** Like xylazine, it likely doesn't respond to naloxone in the same way, though naloxone should still be administered for suspected opioid overdoses. And rescue breathing becomes especially critical when veterinary tranquilizers are involved. Dexmedetomidine also plays an import role in biomedical research and pharmaceutical drug discovery, as it's the go-to anesthetic of choice in animal model lab science. We learn more about medetomidine every day. Our harm reduction [partners](https://www.pppgh.org) in Pennsylvania – now corroborated by [CDC](https://www.cdc.gov/mmwr/volumes/74/wr/mm7415a3.htm) [data](https://www.cdc.gov/mmwr/volumes/74/wr/mm7415a2.htm) – warn that medetomidine is causing severe and potentially life-threatening high blood pressure if you stop taking them abruptly. Other withdrawal symptoms reported describe tachycardia, hypertension, extreme agitation, tremors, and vomiting that can last for days. **Unlike opioid withdrawal which is rarely fatal, withdrawal from alpha-2 agonists like medetomidine can cause dangerous cardiovascular instability requiring medical management.** Healthcare providers may not recognize these symptoms as distinct from opioid withdrawal, potentially missing critical intervention windows. If you work with people who use drugs, especially fentanyl, we encourage you to ask about recent changes or concerns, especially new and unexpected sensations. The word on xylazine was [20 years too late](https://doi.org/10.1016/j.drugalcdep.2008.03.005). We can do better this time. Same substance, radically different outcomes. This is what happens when pharmaceuticals enter the unregulated drug supply – precise medicines become chaotic adulterants, and safety profiles written in controlled settings become less meaningful on the street. --- ### Acknowledgements We thank the Department of Chemistry Mass Spectrometry Core Laboratory for mass spectral analysis of drug samples. Chemical analysis was conducted by Erin Tracy and Jalice Manso. Thank you to additional program staff involved in operations: Shay Louis, Natalie Sutton, Illyana Massey, Colin Miller, David Marshall, Dmitri Fisher, LaMonda Sykes and Bridgette Mountain. ### Summer 2025 Newsletter URL: https://www.opioiddata.org/summer-2025-newsletter/ Last updated: 2026-05-11T15:45:21.000Z ☀️****Summer’s heating up and so are we!** From tracking the drug supply to sharing harm reduction wins, fresh resources, and stories from the field, we’ve got plenty to keep you informed (and maybe even inspired). So grab your sunglasses, sunscreen, and favorite snack — and while you're soaking up the sunshine, let’s dive into this month’s highlights! ☀️😎 # 〽️Service Stats & Updates As of Monday July 21, 2025... **14,484** samples analyzed Serving **175** harm reduction programs Reaching **263** counties in **43** states **442** unique substances identified # 📦 Service Updates Important announcements for orgs using our drug checking service. 1. If you are dumping **test strip water** into our vials, we need to know because we need to adjust lab methods methods to remove the water before loading it on the GCMS. New card version will have a yes/no question for added water. 2. Starting in late August we will be shipping [**Version 10**](https://cdr.lib.unc.edu/concern/parent/5d86p887m/file%5Fsets/1j92gp813)of our **card**. We added medetomidine as an expected drug and test strip results. Even though differentiating between stimulant and opioid overdose was a community-requested feature in Version 9, we find that the box on overdose detail is much less likely to filled out when stimulant/opioid is included as options. Many time people just don't know what was ingested and would rather not guess. So we reverted back to the way we asked it in Version 8. 3. We will be moving to a faster, more reliable, and secure method for delivering drug checking datasets result soon. **If you are using GitHub to pull data CSVs – we need to hear from you now.** Email us: opioiddatalab@unc.edu. Also, unless we hear from y'all otherwise, we will likely discontinue Stata, SAS, and Excel versions of results files, instead CSV is the universal format that can be imported into any stats software or data viz platform. 4. We know most of you expect to receive a **monthly invoice or statement**. Please bare with us. Next month everyone will start receiving combined invoices for the months of May-July.If your program requires them to be separated please email us at opioiddatalab@unc.edu as well! **NOW ONTO THE FUN STUFF!!!** --- # ⛓️ Overdose Chain of Survival ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/1-s2.0-S2666520425001638-gr1_lrg.jpg) On the research front, Dr. Nab and Dr. Adams worked with colleague Arne Skulberg and others to publish a commentary in Resuscitation Plus proposing a novel[ **"Overdose Chain of Survival"** framework](https://www.sciencedirect.com/science/article/pii/S2666520425001638). This six-link model addresses critical gaps in overdose care by integrating immediate emergency response with long-term recovery and prevention strategies. The framework encompasses prevention, recognition and emergency activation, basic first aid, emergency treatment, post-overdose care, and recovery with secondary prevention. The Chain of Survival framework recognizes that overdose response involves more than just naloxone and emphasizes the importance of continuity between acute care and sustained support when people who experience overdose return to their communities. --- # 😣 Algorithms That Suck If you don't like the idea of having algorithms dictate your medical care, here is a [patient advocacy group](https://www.thedoctorpatientforum.com/) pushing back via a brave and blistering [Citizens Petition](https://www.regulations.gov/document/FDA-2025-P-0701-0001) to FDA about super-secretive NarxCare. ([Medscape summary](https://www.medscape.com/viewarticle/hidden-formulas-high-stakes-fight-regulate-clinical-decision-2025a1000cw3).) Public comments blew this up with over 1,200 individuals in support of oversight and regulation of this algorithm as medical software. Pain patients, people on Suboxone or ADHD meds, pay attention. This [excellent new article](https://link.springer.com/article/10.1007/s11606-025-09600-9) \[open access\] by friend-of-our-program Dr. Kelly Knight is a damning exposé. FDA hasn't public made a decision on the petition, and time for comments has been extended. Here's where [you can comment directly](https://www.regulations.gov/commenton/FDA-2025-P-0701-0001). --- # ⚖️ Paradox of Prohibition Graphics DPA worked with the talented graphic designer Rio Holiday to help explain these two concepts that comes up in in our harm reduction work. You can find more info about this [amazing designer here](https://www.rioholaday.com). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/1-Iron-Law-Of-Prohibition-FINAL.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/2-Paradox-Of-Prohibition-FINAL-Updated-V2.png) --- ### **Did someone forward you this email newsletter?** [**Sign up**](https://www.opioiddata.org/signup/) **to get it in your inbox free.** --- # 📉 Department of Data To keep the newsletter short and sweet, we’re moving full data breakdown to a separate post — perfect for all you data lovers who want to dive deeper. You can always click the link to explore the full details, and we’ll continue sharing a quick summary right here. As always, we welcome your feedback as we work to keep things informative, engaging, and easy to read! Four data stories below. **What’s actually in the new HALT Fentanyl Act — and how will it impact the street drug supply?** The legislation introduces a confusing new category of “fentanyl-related substances,” many of which may not even be dangerous. We dug into our drug checking data to see what’s really showing up — and what might come next. [📉 HALT Fentanyl ActSummer 2025![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-26.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image001-1-2.png)](https://www.opioiddata.org/halt-fentanyl-act/) Second, we want to flag a potential major change in the opioid markets that took effect on July 1, 2025\. (We've been [tracking nitazenes](https://deepnote.com/app/opioiddatalab/Nitazene-tracker-bf05bd9a-a8e1-448f-9e56-87615fd02bde) for awhile.) The Chinese national government finally enacted new enforcement against *all* nitazenes, based on agreements reached last year. Despite the problematic language in [this news notice](https://global.chinadaily.com.cn/a/202506/20/WS6854b386a310a04af22c7610.html), it’s worth understanding the implications. This a [good background read](https://www.brookings.edu/articles/the-fentanyl-pipeline-and-chinas-role-in-the-us-opioid-crisis/) from the Brookings Institute on the international supply chain. Nitazenes have emerged in the [United Kingdom](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2824%2900001-X/fulltext), and in places like [Tenneessee](https://www.cdc.gov/mmwr/volumes/71/wr/mm7137a5.htm). Combined with the HALT Fentanyl Act, the synthetic opioid supply is poised to undergo major changes in the coming 6 months. We've set up this [prospective tracker](https://deepnote.com/app/opioiddatalab/Nitazene-Changes-20f45a1a-1b66-401e-b458-ce623313b578) to automatically monitor changes in nitazenes in our data. If you have other metrics we should consider, please reach out. (HT: [Ben Westhoff’s Substack](https://benwesthoff.substack.com/p/trump-just-won-a-major-drug-war-victory) for reminding us this was going into effect.) Next, the spate of non-fatal [overdoses in Baltimore](https://www.washingtonpost.com/dc-md-va/2025/07/19/new-drug-found-baltimore-overdose/) earlier this month caught headlines. One of the new substances involved is [*N*\-methylclonazepam](https://pubchem.ncbi.nlm.nih.gov/compound/528222). Not much is known about its effects on humans. We haven't seen it in our samples yet, but this is not entirely surprising given how firmly entrenched bromazolam and other benzodiazepines are in some parts of the country. Like the graphic above correctly points out, the current "wave" of street drugs is one where non-opioid sedatives are becoming increasingly dominant. Finally, a [reminder](https://www.opioiddata.org/this-ad-didnt-age-well/) that CDC NVSS national predicted overdose numbers are expected to be artificially high for January and February 2025\. Beyond March, the equations used in prediction will show a steeper decline. Because of this untimely change to the prediction algorithm, we are not updating our overdose numbers until at least March data are released and the predictions can be properly vetted. --- # 👋 Meet our Team Members Each month will feature different team members 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/mabeki-1.jpg) ## Mabeki Mvuendy First-year MPH student at UNC Gillings and doing his practicum with the lab! Read more about his work below! Hi everyone! The main deliverable for my practicum is to create an accessible educational communications package that presents information regarding harm reduction services (particularly drug checking) to people who use drugs. A key aspect of advancing public health is to bridge any knowledge gap between public health professionals and the community we intend to serve, so I’m glad I can apply and improve on such a valuable skill.Additionally, I have had the opportunity to learn more about harm reduction through the resources that the team at the lab have provided and through interviews I’ve conducted with some community organizations. Gaining insight about those who are most vulnerable to fluctuations in the drug supply, unexpected adulterants, and the racialization of drugs reminds me that accessibility, equity, and compassion are necessary to achieving successful outcomes as it relates to the drug crisis. \-Mabeki ⭐ ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/Adams1-1.png) ## Congratulations to our very own Adams Sibley! Adams received the 2025 Graduate School Dean's Distinguished Dissertation Award for Social Sciences! [Read more about his dissertation and work here!](https://sph.unc.edu/sph-news/sibley-receives-2025-graduate-school-deans-distinguished-dissertation-award-for-social-sciences/?utm%5Fsource=newsletter&utm%5Fmedium=email&utm%5Fterm=2025-07-23&utm%5Fcampaign=Medicaid+work+requirement+could+strip+coverage+from+thousands+in+NC) # 👋🏾 Team Departures This summer, we said goodbye to two wonderful team members, **Natalie Sutton** and **Colin Miller**, as they moved on to other opportunities. We’re incredibly grateful for their dedication, hard work, and the heart they brought to our program. Their impact will be felt for a long time, and we wish them all the best in what’s ahead. *Thank you, Natalie and Colin!* 🫶🏽 --- # 🥼 Lab Visits! In June we had the pleasure of hosting harm reduction workers and advocates from the Triad! Individuals came from Guilford, Forsyth, and Surry! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/20250627_123301.jpg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/IMG_0232.jpg) Thanks to Amanda Clark, Gloria Brown, Guilford County Drug and Injury Prevention, Mark Yarnall, Guilford Overdose Prevention & Education Collective, Jim Albright, Guilford County EMS, Oliver Sugiyama, GCSTOP, Mary Houser, Greensboro Law Enforcement Assisted Diversion, Melissa Goyen, Foundations Health High Point, Wendy Odum, Birches Foundation (Surry County), Annie Vasquez, and Hannah Phillips, Forsyth County Behavioral Health 😄 --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. NC First Lady's Campaign: **Unshame NC!** [See more about it here.](https://www.instagram.com/unshamenc/?igsh=MWxtbTBxZWZ1YnB1dA%3D%3D) [**NCCU and NCCHCA Medication for Opioid Use Disorder Conference**](https://www.ncchca.org/event/medication-for-opioid-use-disorder-conference-presented-by-nccu-and-ncchca/)**\-**September 4, 2025 **SMART's newest handbook has been released!** It's now fully supportive of harm reduction goals, without condition. You can read a longer description of the [4th edition here](https://shop.smartrecovery.org/products/4-point-program-handbook-4th-ed-english ). They have also updated a self-paced [online training for facilitators](https://learn.smartrecovery.org/ ) to help them be more inclusive. [**Trillium Re-entry Simulation - Warren County NC.** ](https://www.trilliumhealthresources.org/event/trillium-re-entry-simulation-warren-county)Fun, free, engaging, and eye opening. Join them August 5th. **National Black Harm Reduction Network** is [hosting a discussion](https://www.eventbrite.com/e/know-your-supply-a-black-harm-reduction-dialogue-tickets-1489655031299) on drug checking, a harm reduction strategy gaining momentum nationwide. Black communities continue to face the highest overdose rates, yet drug-checking remains largely unavailable in our neighborhoods. It’s time to change that. Join them to explore what it could look like to bring this lifesaving service to your community, learn about funding options, and discover where to turn for support. Let’s build harm reduction programs that truly meet our needs. This dialogue is part of a broader movement to ensure Black people have access to life-saving tools and culturally grounded public health solutions. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/NBHRN_Drug_Checking_WF_01-1-1.png) --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! **50 Years of The War on (Some) Drugs** In this moment, the major changes in the drug supply, treatment landscape, and overdose rates can leave our heads spinning. This essay by Brendan Saloner, Sachini Bandara, and Alene Kennedy-Hendricks at Johns Hopkins can help. They lay out an excellent framework for understanding why US drug policy seems stuck.\[open access\] [**Stable, But Weak: Fifty Years of U.S. Illicit Drug Policy from Nixon to Trump and Beyond**](https://read.dukeupress.edu/jhppl/article/doi/10.1215/03616878-11995184/401243/Stable-But-Weak-Fifty-Years-of-U-S-Illicit-Drug) **JAMA Network:** [The Rapid Spread of a Novel Adulterant in the US Illicit Drug Supply—BTMPS](https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2836265?utm%5Fsource=email&utm%5Fcampaign=content-shareicons&utm%5Fcontent=article%5Fengagement&utm%5Fmedium=social&utm%5Fterm=070725)**,** David T. Zhu, et. al. 2025 **KFF News:** [Who’s Policing Opioid Settlement Spending? A Crowdsourced Database Might Help.](https://kffhealthnews.org/news/article/opioid-settlements-crowdsourced-database-monitor-spending-state-attorneys-general-oversight/) **Science Direct:** [Another carfentanil fatal outbreak in Florida?](https://www.sciencedirect.com/science/article/abs/pii/S0376871625002376?dgcid=rss%5Fsd%5Fall) Chris Delcher, et. al, 2025 **National Library of Medicine:** [Early estimates of awareness and uptake of over-the-counter naloxone](https://pmc.ncbi.nlm.nih.gov/articles/PMC12202286/#:~:text=The%20introduction%20of%20OTC%20naloxone,access%20and%20encourage%20wider%20adoption), Mireille Jacobson, David Powell, 2025. **Manhattan Institute:** A new Manhattan Institute [report](https://manhattan.institute/article/fentanyl-at-the-gates-comparing-large-seizures-at-the-u-s-mexican-and-u-s-canadian-borders) by Jonathan P. Caulkins and Bishu Giri of Carnegie Mellon University finds that nearly all large federal fentanyl seizures occur along the southernwestern US border with Mexico. From 2013 to 2024, 99% of pills and 97% of powder-form fentanyl in those large seizures near land borders came from the south. In total, 32 times more powder and 78 times more pills were seized at the border with Mexico compared to the border with Canada. **The Guardian:** [Ayahuasca tourism’ is a blight on Indigenous peoples and our environment.](https://www.theguardian.com/commentisfree/2025/jun/17/ayahuasca-tourism-indigenous-peoples-environment-pyschedelics-biodiversity-ecuador) **WWAY3 News:**[ Overdose deaths down sharply in the US. local advocates say work remains.](https://www.wwaytv3.com/overdose-deaths-down-sharply-in-us-local-advocates-say-work-remains/) --- # ✈️ Out and About ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/IMG_0324.jpeg) Nab with with the Connecticut drug checkers from around the state!! What an awesome group! --- ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ## Like what you're reading? Get this newsletter in you inbox. Subscribe Email sent! Check your inbox to complete your signup. No spam. Always free. Unsubscribe anytime. ### 📉 HALT Fentanyl Act URL: https://www.opioiddata.org/halt-fentanyl-act/ Last updated: 2026-05-11T15:45:39.000Z The [HALT Fentanyl Act](https://apnews.com/article/fentanyl-opioid-trafficking-drug-cartels-accc52b76dbdfc569928423de174fb5f) passed the US Senate in March and the House in June. It is expected to be signed into law by the President. Confusingly, the legislation creates a new grouping of “fentanyl-related substances” (FRS) which could include non-psychoactive drugs that are not involved in overdose. The list of these substances are poorly defined in the legislation; what comes next is a months-long process for the forensic chemistry community to decipher the chemical descriptions clumsily spelled out by DEA. [For example](https://www.congress.gov/bill/119th-congress/senate-bill/331/text):“The term ‘fentanyl-related substance’ means any substance that is structurally related to fentanyl… By replacement of the aniline ring with any aromatic monocycle whether or not further substituted in or on the aromatic monocycle. Or, By substitution in or on the piperidine ring with alkyl, alkenyl, alkoxyl, ester, ether, hydroxyl, halo, haloalkyl, amino, or nitro groups.” Got it? Riiiiiiight. The FRS designation comes on top of the already established “fentanyl analogues” classification. Confusing!! And it creates higher penalties even for FRS that have no overdose risk. So, we looked at our drug checking data to see [which FRS actually show up in the drug supply](https://deepnote.com/app/opioiddatalab/Fentanyl-Related-Substances-Tracker-682659e2-84cb-4763-90b8-fef13780c786). We’ve analyzed 7,012 samples with fentanyl or FRS. We’ve detected 21 unique FRS. The two most common non-fentanyl FRS are para-fluorofentanyl and despropionyl p-fluorofentanyl. The third most common, norfentanyl, is much *less* potent than fentanyl. In the context of overdose prevention, less potent alternatives to fentanyl could have been intriguing. Carfentanil (and related) are the only FRS [we encountered](https://deepnote.com/app/opioiddatalab/carfentanil-0e647c95-ec05-4dd9-8ec8-3f2d1b1765b9) to be found in the absence of fentanyl. On a sample-by-sample basis, 99.7% of samples already contained fentanyl. Meaning, the legislation is more about theoretical future chemistry than actually impacting current street production. Notably, it appears that the legislation does not cover [nitazenes](https://www.oas.org/ext/DesktopModules/MVC/OASDnnModules/Views/Item/Download.aspx?type=1&id=1045&lang=1). Therefore, we anticipate the impact of the HALT Fentanyl Act will be to push the street opioid supply towards nitazenes, which we are [tracking here](https://deepnote.com/app/opioiddatalab/Nitazene-tracker-bf05bd9a-a8e1-448f-9e56-87615fd02bde). Nitazenes are reported to be *stronger and more sedating* than usual street opioids in the 148 samples we have tested. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/07/image001.png) # Geopolitics of Drugs We want to flag a potential major change in the opioid markets that took effect on July 1, 2025\. (We've been [tracking nitazenes](https://deepnote.com/app/opioiddatalab/Nitazene-tracker-bf05bd9a-a8e1-448f-9e56-87615fd02bde) for awhile.) The Chinese national government enacted new enforcement against *all* nitazenes. Despite the problematic language in [this news notice](https://global.chinadaily.com.cn/a/202506/20/WS6854b386a310a04af22c7610.html), it’s worth understanding the implications. This a [good background read](https://www.brookings.edu/articles/the-fentanyl-pipeline-and-chinas-role-in-the-us-opioid-crisis/) from the Brookings Institute on the international supply chain. Nitazenes have emerged in the [United Kingdom](https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667%2824%2900001-X/fulltext), and in places like [Tenneessee](https://www.cdc.gov/mmwr/volumes/71/wr/mm7137a5.htm). Combined with the HALT Fentanyl Act, the synthetic opioid supply is poised to undergo major changes in the coming 6 months. HT: [Ben Westhoff’s Substack](https://benwesthoff.substack.com/p/trump-just-won-a-major-drug-war-victory) for reminding us this was going into effect. ### 🍳 This ad didn't AGE well URL: https://www.opioiddata.org/this-ad-didnt-age-well/ Last updated: 2026-05-11T15:45:52.000Z *By: Nabarun Dasgupta, Adams Sibley, Colin Miller* **Do you remember this ad?** ![](https://media.tenor.com/RmrVXyFFROsAAAAC/egg-fried-egg.gif) If you, like some on our team, recall seeing [this ad](https://en.wikipedia.org/wiki/This%5FIs%5FYour%5FBrain%5Fon%5FDrugs) while watching Saturday morning cartoons or after-school specials as a kid, you are currently in the highest risk group for overdose death by age. Since those seemingly more innocent times, more than a *million* Americans have died of drug overdose after seeing this ad as a kid. Causation? More likely, "Just Say No" public education campaigns were ineffective. [McGruff](https://www.youtube.com/shorts/asnCKr0nuh8?feature=share) rapping with the ops as backup dancers just isn't, and never will be, *it*. As policy returns towards education as a pillar of response to overdose, let's be smarter this time around. Like faddish sentencing enhancements for drug crimes, yesteryear's anti-drug campaigns never fulfilled their promise. Nevermind that these strategies have little to no supportive evidence - our society's approach to issues around drugs have been based more often on what the general population is comfortable with rather than what leads to people who use drugs to live longer, happier, and healthier lives. Education is key, just not in a, "this is your brain on drugs," kind of way. --- In this post we follow up on [our last newsletter](https://www.opioiddata.org/may-2025-newsletter/) where we noted that middle-aged Americans were making up an increasing share of overdose deaths. We'll go deep into what changed age-wise between 2022 and 2024, and tie it back to education. **TL;DR: There are clear generational trajectories, with Gen X and Millennials making up the bulk of OD deaths, and a marked lowering of overdose among Gen Z.** This is the fourth in our series on overdose declines ([one](https://www.opioiddata.org/are-overdoses-down-and-why/), [two](https://www.opioiddata.org/the-model-that-predicted-od-drop/), [three](https://www.opioiddata.org/peak-od-phenotypes/)). *But first, an urgent data caveat.* --- # The Math ain't Mathing ## Be careful with national OD data this month **Strong caution against knee-jerk reactions to CDC national provisional-predicted overdose death data for January and February 2025.** We are flagging something we have been hearing from independent data-watchers in June: We have strong reason to believe that the recent CDC NVSS national overdose mortality [predictions](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) are **overestimated**. Specifically, we can see data aberrations due to an algorithm revision in February. NVSS historical data going back to 2018 have been quietly revised. The new version of the prediction algorithm overaggressively corrects for pending autopsy investigations *in some months* because it is built on years when overdoses were increasing. This causes an artificial bump in January and February. This algorithmic bump is so big that it appears to (incorrectly!!) even change the nation's overdose trajectory. It is also is visible in both 2024 and 2025 data. In even earlier years, the increasing trend obscured the artificial up-bump. Confirmation bias abounds. The January faux increase was not due to Trump taking office or immediate funding cuts. It was just poor math. Likewise (unless the algorithm is fixed pronto), there will be an artificial forthcoming drop in ODs in March. The algo is tuned to less aggressively correct for pending investigations starting in the third month of each year onwards, and therefore it will make any January vs. March 2025 comparison look like a massive decline *artificially*. And charlatans will queue and clamor to take credit. ✅ CDC WONDER and SUDORS data do not have this problem and continue to be their usual level of reliable. 🙏🏽 Thanks to Lori Post at Northwestern University and David Holtgrave at the New York State Health Department for bringing this to our attention. We'll provide more details as we get clarity, but for the time being, we feel that the purported increase in January 2025 and that which be will reported for February 2025 are **unreliable**. And yes, thank you for continuing to make us aware of local increases in (non-fatal) overdoses in Spring 2025\. We noted it in [last month's newsletter](https://www.opioiddata.org/may-2025-newsletter/) too. The unregulated drug supply remains highly variable. There will be spikes. But, we still believe the *overall* trend is downwards. We believe the algorithm change is a genuine flub. It does not bear the fingerprints of being intentionally nefarious. Rather it is 🤦🏾 supremely ill-timed, and operates largely independent of *real* localized increases in overdose in early 2025\. Stay tuned as we unravel this mess. ## Follow the data developments If you are just joining us, we'd love to keep in touch. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. --- # The Long View We hear you: Drug overdose deaths may be down from their peak, but there are still *a lot* of people dying, and we've lost **so many**. How many? About **1.4 million** people we love since [1979](https://www.youtube.com/watch?v=4aeETEoNfOg). So pardon us if we aren't exactly exuberant, but cautiously hopeful. [It didn't have to be this way](https://www.npr.org/2023/11/09/1211217460/fentanyl-drug-education-dare#:~:text=it%20didn't%20have%20to%20be%20that%20way). The War on Drugs [started](https://www.vera.org/news/fifty-years-ago-today-president-nixon-declared-the-war-on-drugs) in the early 1970s. Here are the receipts: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-23.png) Source: CDC WONDER, processed by UNC Opioid Data Lab Here's another way to look at the 2023-4 decline. We are down about 29% from peak in 2022, but we are still about 4 times higher than we were in 1999\. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-25-1-1.png) On the graphs above, the [migration](https://www.cdc.gov/nchs/nvss/mortality/comparability%5Ficd.htm) from ICD-9 to ICD-10 in 1999 for *all* deaths generally led to more accurate reporting of overdose mortality specifically. And yes, the US population increased 20% over the last 25 years, from 279 million in 1999 to 335 million in 2024\. In 1999 there were 16,825 overdose deaths, or about 6 per 100,000 population. In 2024, we estimate 74,787, so a rate of 22 per 100,000, for a population-adjusted 3.7-fold increase. Without taking the population change into account, on an absolute level it's a 4.4x increase in the OD death count. ## Three Data Challenges Before going on to generational findings, our analysis of national overdose mortality data had to address three significant data limitations that could obscure true trends: 1. **Demographic Granularity**: [CDC NVSS predicted data](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm), often used for policymaking, lacks demographic detail for age-specific analysis, and is also heavily smoothed. Therefore, to get at underlying demographics, we rely on another CDC data product, [CDC WONDER](https://wonder.cdc.gov/). We combined that with a third data product, [CDC SUDORS](https://www.cdc.gov/overdose-prevention/data-research/facts-stats/sudors-dashboard-fatal-overdose-data.html). SUDORS is about 40 states/jurisdictions that do a manual review of overdose deaths, filling in the blanks with additional contextual data not reported in the other sources. 2. **Data Suppression Rules**: CDC WONDER [suppresses](https://wonder.cdc.gov/wonder/help/faq.html#5) cell counts between 1-9 cases to protect privacy, meaning that deaths among youngest and oldest age groups may not appear in public datasets. Put another way, if there were between 1-9 deaths per year within an age group, we won't know the exact number. To address this, we used the number "5" to backfill suppressed values. (You won't see integers 2,3,4,6,7,8,9 in our tables.) So in our tables and code anytime you see "5" you can tell the number was imputed. The impact is minimal: A few dozen cases amidst 70,000. 3. **Incomplete 2024 Data**: Death investigations for overdoses in the final months of 2024 were still pending at the time of analysis, leading to artificially low provisional counts. Historical data shows that 12-month provisional counts are typically 95-97% complete after a 5-month lag. Using the [2023 historical completion rate](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) from major states with longer lags like California, Texas, and New York for May, we adjusted 2024 totals upward by 4.2% to account for pending investigations. Technically speaking: In making inference, we assume the percent distribution of missingness-due-to-pending within strata of a category is random/uniform. In other words, it would be out of the ordinary if our results varied by more than 5% from the eventual final data within each level of a given category. We used these [standard definitions](https://www.pewresearch.org/short-reads/2019/01/17/where-millennials-end-and-generation-z-begins/) of generations. A final methodological caveat – we extrapolate year of birth using the simple equation: (year of death) - (age at death). This isn't perfect because people aren't born uniformly throughout the year, and also because this method could misclassify exact years. Anytime you see a year-of-birth, it's fine to think of it as ±1 year. Just for kicks, there were more live births in the United States in 2023 during summer months, peaking in August. So the calculation we are doing is tenable. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-17-1.png) CDC WONDER, processed by UNC Opioid Data Lab As always, overdose death data have [known limitations](https://www.opioiddata.org/deep-dive-overdose-death-data-process/). --- # Talking About My Generation (obviously, [The Who](https://www.youtube.com/watch?v=qN5zw04WxCc)) We'll come back to the "Who?" in a bit, but first let's finish up the methods. Scientists studying population trends in health (like changes in overdose mortality) often use an **age-period-cohort** (APC) approach. **Age effects** are changes that happen to individuals of a *certain age* regardless of the point in history. **Period effects** are changes that happen to *everyone* at a certain point in history – because of major events, like policies shift, etc. **Cohort effects** are changes that happen to a group *born around the same time* because of shared experiences in their development. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/age.jpg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/cohort.jpg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/period.jpg) ****Image 1 (AGE)**: People in their 70s have higher rates of heart disease: Cardiovascular risk naturally increases with age. ****Image 2 (COHORT)**: People born in the 1940s have higher rates of mesothelioma: They were of working age when asbestos in construction was at its peak. ****Image 3 (PERIOD)**: People who lived through the 1980s (regardless of age) had a higher risk of skin cancer than those who lived before: Ozone depletion accelerated during this time. **Images courtesy of @neonbrand, @strangehappenings, and @perlamutrs via Unsplash.* Our task is to disentangle these effects in the context of overdose declines. **#example #tiktok #insta**: If we observe that 20-year-olds use social media more than 60-year-olds, is this because younger people naturally adopt new technologies more readily (age effect), because social media platforms have become more popular recently (period effect), or because digital natives born in the 2000s grew up during the rise of smart phones (cohort effect)? Here are a few key papers on overdose trends using APC with generations: [Hall 1999](https://onlinelibrary.wiley.com/doi/abs/10.5694/j.1326-5377.1999.tb123495.x), [Huang 2018](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304142), [Jalal 2020](https://www.nature.com/articles/s41591-020-0855-y), [Fujita-Imazu 2023](https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370%2823%2900256-0/fulltext), and also related is [Post 2025](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2835230). Our approach uses the same APC framework but differs in an important way: While the authors above use statistical methods to *disentangle* the effects of age vs. period vs. cohort over long periods of time, we are isolating our analysis to a three-year window (2022 vs. 2024), effectively *freezing out age and period effects.* With such a narrow observation window, cohorts will have aged minimally (just 2-3 years), and all birth cohorts experience the same period effects (the same policy changes, drug market conditions, etc.). This design isolates what we're most interested in: birth cohort-specific responses to recent events - essentially measuring **whether different generations responded differently to whatever factors drove the 2022 vs. 2024 overdose decline**. --- # Generation Data After addressing underreporting and other sources of known systematic data bias, overall overdose deaths in the United States declined around 30% from 2022 to 2024\. The declines were experienced across the board in terms of age, place of death, urbanicity, and race, with one notable exception (scroll down) in Gen Z. 🤓 Our data, code, modeling, graphics, and assumptions are [detailed here](https://deepnote.com/app/opioiddatalab/Ages-2022-vs-2024-2acf7a87-261e-46ac-9394-219287830f6f). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/Artboard-1@3x.png) US Overdose Deaths 2022-24 Source: CDC WONDER, processed by UNC Opioid Data Lab **The biggest takeaway is that overdose deaths in 2024 were highest among Millennials and Gen X, with these generations comprising 71% of overdose deaths.** ([detailed table](https://embed.deepnote.com/2acf7a87-261e-46ac-9394-219287830f6f/68fb0a8a1412424c842290aa7e38234b/4c6707248ffc4594a583a6cd163e7028?height=283.09942626953125)) *Another* remarkable thing is how uniform the gains (i.e., reductions in overdose 2024 vs. 2022) have been across the lifespan, with 25% to 35% declines by birth year. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-27.png) Percent reduction in OD death count, by year of birth, comparing 2024 vs. 2022\. Data source: CDC WONDER, processed by UNC Opioid Data Lab How can we independently verify the generational pattern? [This study](https://ajph.aphapublications.org/doi/10.2105/AJPH.2024.307847) from Verdery et al. at Penn State looked at intergenerational relations of kids who had lost a family member to overdose. Grandparents come in second to aunts and uncles, substantially more than cousins and siblings in the same generation. And yes, parents too, but more grandparents. This was in 2019 and these numbers would likely be higher now. But, it provides an independent reality check on the generational patterns we observe in national overdose death data. (For the sake of completeness, here's [another study](https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2818228) that calculated the burden differently.) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-26.png) [Source](https://ajph.aphapublications.org/doi/10.2105/AJPH.2024.307847): Verdery et al. **Am J of Public Health 2024* Okay, so that generational spacing checks out with the mortality data. But *grandparents*, really? Starting in the 1990s, the [carceral devastation](https://www.jpanafrican.org/docs/vol7no6/7.6-4-Ruitz-Oct26.pdf) inflicted on Black parents led grandparents to step in to raise another generation, [reconfiguring](https://academic.oup.com/socpro/article/72/1/74/7205696) kinship and community ties. What happens to families when that generation of carers are also wiped out? Profound changes. And lengthening existing penalties for drug charges? The *length* of a prison sentence has minimal additional deterrent effect, but it magnifies and extends the familial damage caused by separation. 👪 This 5-part [teach-in from Movement for Family Power](https://www.movementforfamilypower.org/library/abolishing-the-family-policing-system-a-reproductive-justice-imperative) gives all you need to know about how family separation perpetuates trauma and leads to intergenerational cycles of drug problems. Okay, let's look at one more data source to triangulate. [SUDORS](https://www.cdc.gov/overdose-prevention/data-research/facts-stats/sudors-dashboard-fatal-overdose-data.html) can provide detail, such as the age distribution we observed above holds for both men and women, even though the former make up 71% of all overdose deaths. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-22.png) --- # An old idea that no longer holds With drug cycles in the United States, generational effects are well-documented. [This brilliant paper](https://journals.sagepub.com/doi/abs/10.1177/1557085112444899) by Judith Ryder et al. describes the complex generational impacts of crack cocaine on women and girls in the 1990s. Check out [this hilarious paper](https://www.tandfonline.com/doi/pdf/10.3109/10826087209026775) from 1972 talking about "the Beat Generation" that cites Jefferson Airplane lyrics. Amphetamine use disorders were [documented](https://www.opioiddata.org/may-2025-newsletter/) to be specific among those born between 1954 and 1962\. You get the picture. There's a trope in American addiction research, that drug cycles alternate between uppers and downers, and that each cycle takes about a decade. This concept can be [traced back to the late David Musto](https://www.latimes.com/archives/la-xpm-1986-07-31-mn-20288-story.html), historian at Yale. (In the linked article from 1986, he also weighs in on Nancy Reagan, who we'll get to in a moment.) What's different in the last 40 years is that cycle lengths have changed to the point that they overlap. Increasing interdiction pressure, rapid chemical innovation, and efficiencies in global trade have shortened the cycles involving any single substance. Over the last 30 years, what is called the "opioid crisis" is really a series of smaller cycles that overlap. And in our desire to make sense of the macro pattern, age-cohorts are a hidden driver that we don't often think about. In 2012, peak opioid analgesic prescribing, it was the Baby Boomers that were [most likely](https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-age-group/?activeTab=graph¤tTimeframe=11&startTimeframe=24&selectedDistributions=0-24--25-34--35-44--45-54--55&selectedRows=%7B%22wrapups%22:%7B%22united-states%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D) to die of overdose, a majority from Rx opioids. Around 2013, however, we documented a decline in overdose deaths among Baby Boomers, with an influx of heroin overdoses among Gen X, a shift rightward: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-21.png) [Source](https://pubmed.ncbi.nlm.nih.gov/25456574/): Dasgupta et al. **Drug and Alcohol Dependence* 2014 Gen X still seems to be now be dying from heroin and unregulated fentanyl, and also Millennials. What has changed is that Gen Z seems to be *decreasing* overdose deaths at the **same age** when their parents’ OD risk was *increasing*. This is a very big change that challenges the brain and animal models that rely on just **drugs x age**. Instead, we make the case that it is **drugs x age x time**. It may seem obvious but let's be explicit: The type of people dying from overdose during the last 3 decades has evolved. The overly simple narrative of \[Rx opioids ➡️ heroin ➡️ unregulated fentanyl\] fails to take into account that these things were happening across 4 successive generations. Drug availability has something to do with it, but markets also respond to consumer demand. Gen X had access to Rx opioids, heroin, and fentanyl. Millennials it was more heroin and fentanyl. For Gen Z, prescription opioids are not the drug of choice, neither is fentanyl. Possibly, witnessing their parents' and grandparents' generations dying from overdose may be a strong deterrent. (Stronger than any educational campaign.) At same the time, bearing witness may have induced intergenerational trauma and substance use, as Ryder points out with crack. In short – both things can be true, on an *individual level* parental substance use and incarceration can lead to trauma and generational cycles of problematic use (hello, epigenetics?). At the same time, on a *population level*, there seems to be a kind of deterrence-through-example effect. 💬 ****At the current time, overdose prevention resources should be targeted at reducing deaths among Gen X and Millennials who made up 71% of deaths in 2024.** --- # Population Dynamics The [model that predicted overdose declines](https://www.opioiddata.org/the-model-that-predicted-od-drop/) had a strong component of reducing new initiates. This seems to jibe with the data we are seeing above, but there is more to it. Building off of our graphic above, we believe 3 dynamics are happening at the same time: 1. Gen X and Baby Boomers are ageing out of opioid use. For those surviving, substance use treatment is critical, but not all feel comfortable accessing it. Others are dying of "competing risks" like cancer, car accidents, strokes. 2. Gen X and Millennials are engaging in less risky use, including having naloxone on hand, not using alone, etc. and face less (self-)stigma in seeking out treatment. 3. Gen Z's tastes have shifted, and they've learned from the experience of heartache to avoid the unregulated drug supply. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-28-1.png) OD Deaths, USA, 2024 vs. 2022, annotated Please stop saying "there is nobody left to die." It is horribly disrespectful to all those families who will lose loved ones this year. At the same time, it discredits the choices being made by younger generations to interrupt 4-generational grief. --- # Are the kids okay? Something unexpected also shows up in the data, something subtle. There's one group in which OD deaths increased from 2022 to 2024: Younger Gen Z. Before we even start, let's preemptively get this out of the way: [Fentanyl-in-weed is not a concern in the United States at this time](https://filtermag.org/fentanyl-marijuana-myth/). (Burning fentanyl in a joint or pipe likely destroys most of the molecule; commercial vapes don't typically get hot enough to vaporize fentanyl.) Taking the historical context into account, Gen Z has different drug tastes than their older relatives. Older Gen Z has the highest rates of marijuana use compared to all other ages. [NSDUH](https://www.samhsa.gov/data/sites/default/files/reports/rpt47095/National%20Report/National%20Report/2023-nsduh-annual-national.pdf) (Page A-4, Table A5B) pegged past month cannabis use at 36.5% among 18-25, compared to 20.8% of 26+ years-old. Albeit lower prevalence, MDMA also shows a similar age preference. [Stories](https://time.com/7203140/gen-z-drinking-less-alcohol/) about declining alcohol use among Gen Z tend to come out every Dry January. And over in the [United Kingdom](https://www.bbc.com/news/articles/c5y0g2gnjrqo) we see strong generational preference for ketamine. Again lessons come from the consumer goods space. [Coffee consumption](https://www.statista.com/statistics/1450385/coffee-consumption-frequency-in-the-us-by-generation) is lower among Gen Z (but they do love their [cold brew](https://www.forbes.com/sites/jefffromm/2023/12/06/the-gen-z-mindset-is-changing-coffee/)), while [hard seltzer](https://business.yougov.com/content/50951-whos-drinking-hard-seltzer-in-the-us) is a slightly older crowd. Millennial dads used to drink the most [orange juice](https://edis.ifas.ufl.edu/publication/FE1089), but there's been a [sustained drop](https://www.ers.usda.gov/sites/default/files/%5Flaserfiche/publications/110658/ERR-341.pdf?v=31794). So it should come as no surprise that opioids also could have generational and evolving tastes. What happens in the regulated market for psychoactive drugs has parallels in the unregulated market, duh. And the molecule itself doesn't explain everything. But wait, are overdose deaths increasing or decreasing in Gen Z? Turns out there's a stark divide *within* Gen Z. --- # A Disturbing Exception What you are about to read applies to **less than 2%** of OD deaths: The only age group where ODs *increased* between 2022 and 2024 were **15-to-19 year-olds**. It's also the age group where prevention messaging and education would likely be targeted. We need to get this right before we hire [Madison Avenue](https://www.forbes.com/sites/avidan/2019/08/12/a-time-machine-journey-through-madison-avenue-the-greatest-agencies-ever/) to make slick fentanyl scare ads for the kids. We've been here before. It didn't work out well. # 🍳 Did you even know D.A.R.E. has an [drug emoji](https://www.dea.gov/sites/default/files/2021-12/Emoji%20Decoded.pdf)? Ha. --- Below are two behind-the-scenes plots of the same data in the graphic before, but different visual emphasis. In the top graph, the vertical bars are number of deaths in a given age-year, and horizontal is **age-at-death**. In the bottom graph the horizontal axis is **birth year** (i.e., cohort). The red line is the same as the blue bars in the graphic at the top of the page, the count difference between 2022 and 2024\. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-3.png) Reduction in ODs 2024 vs. 2022, by ****YEAR OF BIRTH** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-4.png) Reduction in ODs 2024 vs. 2022, by ****AGE AT DEATH** Except, zooming in, there's a spot where the red lines are different: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/image-9-1.png) Source: CDC WONDER, processed by UNC Opioid Data Lab **From 2022 to 2024 this is the only cohort where overdoses *increased*.** The increases are among those **born 2005 to 2011**. Literally, anyone born any other year in the last 100 years would have been in an "improving" category in 2024\. This mini age cohort comprises only 1.4% of all overdose deaths in 2024\. But these estimated thousand young lives weigh extra heavy. Kids born 2005-to-2011 would be 15-to-19 years of age in 2024 when they died of an overdose. For the data nerds, here's the full table: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-19.png) Source: CDC WONDER, processed by UNC Opioid Data Lab The ages and years in the table above belie a specific artifact arising from [categorizing a continuous variable](https://royalsocietypublishing.org/doi/10.1098/rspb.2024.1640). This is what is causing the difference between the two graphs above, plotted by age-group versus birth cohort. (As a reminder, 5 in table cells means there were less than 10 ODs per year for that age but we don't know precisely how many.) In the overdose data, categorizing continuous age in 5-year increments obscures a birth-year effect. Between 2024 and 2022, OD deaths increased for those born from 2005 to 2011 (pink & red cells in Deaths Difference column). The category jump works like this on cells colored dark red: Kids born in 2008-09 (red cells) aged 13/14 in 2022, would go on to be 15/16 in 2024 at time of death, pulling them out of 10-14 category, and landing in age group 15-to-19 (yellow cells). Looking at the Deaths Difference column we can see the impact of the age-group boundary: An increase (+16) among those born in 2009 is swamped out by a large decrease (-175) among those born in 2003, as the yellow age-group boxes in the table shift downwards. Hence, older Gen Z seems to have adopted strongly protective behaviors against overdose, whereas we cannot say the same for all of younger Gen Z where ODs increased. Stated another way, putting people into 5-year bins while doing a 2 year comparison, what we are actually saying is "What would be the difference in ODs if everyone stayed the same age between 2022 and 2024?" This is like measuring the depth of a river from a fixed dock (okay), versus measuring from the deck of a boat moving down the river (better). So those kids would have been in high school or just beyond when they died, 15-to-19 years-old. Looking back, they would have been in middle school when COVID emerged in the United States in April 2020\. And by "school" we mean Zoom classroom. And before y'all jump to conclusions, this isn't just a byproduct of COVID-mandate lockdowns. The highest burden is in the Sun Belt where lockdown and school-from-home policies were more relaxed. So maybe this isn't a COVID/school effect? Or maybe it is a sign of broader COVID-related social disturbances? Or cannabis legalization having a protective effect in other states? The numbers are small and squishy (albeit heartbreaking) so let's not hallucinate a narrative based on thin data. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/image-5.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/WonderMap-2.png) Source: CDC WONDER. Percent of OD Deaths by HHS Region among those born 2005-11. --- # Where do we go from here? > *Juventud, divino tesoro,* > *¡ya te vas para no volver!* > Youth, divine treasure, > You leave, never to return! > \- Rubén Darío Many of us grew up attending D.A.R.E. presentations in the school cafeteria, Nancy Reagan's "Just Say No" campaign still ringing in our ears. Maybe you remember police officers warning about tattooed gang members lurking just outside of school grounds eager to offer you free pills. Maybe you remember signing an abstinence pledge. Or maybe you remember singing these catchy lyrics with your whole class: > D! I won't do drugs! > A! Won't have an attitude! > R! I will respect myself! > E! I will educate me! Years later, researchers would demonstrate that the D.A.R.E. program was [largely](https://www.mdpi.com/1660-4601/6/1/267) [ineffective](https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.84.9.1394) in changing ***behavior***. Perhaps the only positive outcome was getting a t-shirt (inexplicably an adult large?). We can laugh at the absurdity of growing up in the D.A.R.E. generation (as kids, we joked that DARE stood for "Drugs Are Really Exciting"), or we can bemoan that politicians on [both sides of the aisle](https://www.presidency.ucsb.edu/documents/proclamation-8648-national-dare-day-2011) poured untold resources into an ineffective public health program. But neither solves the challenge we face now: Keeping young people safe from drug-related harms. Although the "Just Say No" experiment may have been a failure, Nancy got it right when she said "If you even save one life, it's worth it." But if saving one life is truly the goal, then good intentions need to be coupled with good evidence. Even – especially – if that evidence may be uncomfortable. --- We need a divider here because we are *decidedly not* childhood substance use specialists. Amongst our team are scientists and parents. And while we are not experts, you better believe we will use our understanding of science to protect our kids in any way possible. And we have a duty to point out what doesn't work. A couple of weeks ago, one of our kids came home from 5th grade with this certificate. Sorry WCPSS, this is not enough. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/06/IMG_0381.jpeg) Half our team has schoolage kids, elementary to high school, whom we cherish. This is serious and deeply relevant to us personally. Here are our learnings from the scientific literature: 1. [**Substance use**](https://onlinelibrary.wiley.com/doi/full/10.1002/hec.4589) **and** [**trauma**](https://journals.sagepub.com/doi/10.1177/0033294118764918) **are intergenerational phenomena**. If we're serious about keeping kids safe, we [need](https://doi.org/10.1016/j.jsat.2021.108402) to [engage](https://link.springer.com/article/10.1007/s11121-021-01299-4) [families](https://doi.org/10.1371/journal.pone.0252815). 2. **Delay regular use of drugs and alcohol into adulthood**. The [evidence](https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2013.00053/full) is very clear that the the longer kids delay from regularly using substances, the less chance of later problematic use. This is especially pronounced for kids with other mental health things going on, [adverse childhood experiences](https://www.frontiersin.org/journals/sociology/articles/10.3389/fsoc.2021.620395/full), family histories of substance use issues, and difficult family situations. 3. **Teenagers are risk-takers.** This has been true for all of human history – it's not a fact we can wish away. For youth who do experiment with opioids and other drugs, early intervention and treatment (including [medications](https://www.primarycare.theclinics.com/article/S0095-4543%2824%2900045-9/abstract)) should be easy to access, supplemented with [*age-appropriate* and realistic education](https://www.tandfonline.com/doi/full/10.1080/07853890.2022.2104922). Look, exactly nobody is saying to teach injection in middle school. Nobody. Age-appropriate curriculum can start early to dissuade sharing of *any* medications. But let's not kid ourselves that a one hour 5th grade scare lesson, no matter how well-intentioned, is going to lead to "success throughout your life." 4. **Stigma is unhelpful.** [Mental health](https://link.springer.com/article/10.1186/s12888-020-02659-0) and [substance use](https://www.tandfonline.com/doi/abs/10.1080/13575279.2018.1448258) stigma keep adolescents from [seeking help](https://doi.org/10.1016/j.adolescence.2018.05.003) for difficult thoughts and behaviors they're only beginning to understand. Rather than relying on scare tactics that failed the D.A.R.E. generation(s), parents and teachers should [empower the resilience and decision-making capacity](https://www.nejm.org/doi/abs/10.1056/NEJMp2312084) of youth. Peer-pressure is real, and complicated. It extends way beyond drugs. And yes, sometimes coercive approaches can help. But they should not be the default. A former member of the UNC Opioid Data Lab team, Chris Ringwalt, studied prevention in elementary schools for decades. Retired now, his [evaluation of D.A.R.E.](https://academic.oup.com/her/article-abstract/6/3/327/680562) from 1991 remains the paper of record. More recently, the [Safety First](https://med.stanford.edu/halpern-felsher-reach-lab/preventions-interventions/Safety-First.html) curriculum from Stanford University pediatricians is one of the only we are aware of that has a [proven](https://link.springer.com/article/10.1186/s13011-022-00502-1) track record. Materials available in [English](https://drive.google.com/file/d/14sFWxoW2W9c%5FYSGIa45cAPhXqEtV8tmA/view?usp=share%5Flink), [Spanish](https://drive.google.com/file/d/1dlT16jtD6UVAjPFVk3C1C7L6-bwLIOVi/view?usp=share%5Flink) and [Chinese](https://drive.google.com/file/d/1aH3xwlc39Z3JFyAwm-L5R9lh6l%5FoWVLs/view?usp=share%5Flink). > **What Safety First Does** > \+ See abstinence as an important, and primary, strategy in reducing drug harms. > \+ Empower teens to make healthier choices through accurate information. > \+ Recognize that some teens will try drugs. > \+ Encourage teens to take steps to reduce the potential harms of drug use. > **What Safety First Does Not** > \- Encourage or condone teen drug use. > \- Teach teens how to use drugs > \- Judge teens who use drugs. Overdose education in schools may make some squeamish, but in the spirit of Nancy, isn't one life worth the effort? --- # Conclusions In this current moment, we are seeing generational shifts in drug use and harm patterns. At the same time, we have heard from many in law enforcement who feel strongly that border interdiction, longer prison sentences, and education are the three primary pillars for reducing overdose deaths. Politicians have floated mass education campaigns against fentanyl; 🧟‍♂️ D.A.R.E. attempting to reinvent itself with fresh government funding and cringe acronyms like "keepin' it R.E.A.L." ("Refuse, Explain, Avoid and Leave"). Tastes change. The “addictive” nature of a molecule doesn’t explain everything. Social and demographic factors matter. Education is important, but naïvely overreliant on the past. If we are to keep things going in the right direction, we need to go about it smarter than generations before. We owe it to our kids to get this right. ### May 2025 Newsletter URL: https://www.opioiddata.org/may-2025-newsletter/ Last updated: 2026-05-11T15:46:03.000Z Harm Reduction Heroes! 🌼 May is in full bloom, and so is our mission to keep the streets safer-one sample at a time. Dive into this month’s mix of science, solidarity, and seriously cool data, plus real-world harm reduction wins, job ops, events, and ways **you* can make an impact! # 〽️Service Stats & Updates As of Monday May 26, 2025... **13,108** samples analyzed Serving **163** harm reduction programs Reaching **255** counties in **43** states **430** unique substances identified No changes to our Watchlist, but click below to see Live Reports on cafentanil, (dex)medetomidine, nitazenes, BTMPS and more. [UNC Watchlist](https://www.opioiddata.org/unc-watchlist/) --- # 📉 Department of Data ## Fatal ODs Getting Older? We recently noticed that two of the best and quickest state OD reports were showing a previously unknown pattern that may illuminate the demographics behind recent OD mortality drops. And we also saw something similar in a major city. ### Maine Marci Sorg and team puts out an excellent monthly report on overdoses over on [MaineDrugData.org](https://mainedrugdata.org). In the most recent report, we noticed that overdoses were down overall (nearly -30%), and that the age group with the highest burden of OD deaths was 35-44 year-olds. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/image-2-1.png) [Source](https://mainedrugdata.org/wp-content/uploads/2025/04/2025-02-ME%5FOD%5FReport-Final.pdf) ### Kentucky Our friends over at the Kentucky Injury Prevention Research Center have already put out their final [2024 Drug Overdose Fatality Report](https://odcp.ky.gov/Reports/2024%20Drug%20Overdose%20Fatality%20Report.pdf). We made this annotated graph from Table 7 and noticed here too older age groups are making up a larger share of deaths, most pronounced in 45-54 year-olds and 55-64 year-olds. Also note that this trend has existed for 3 years running; it’s not just a 2024 thing. Maybe a coincidence (or artifact of categorizing a continuous variable, or underlying population structure) that it's an older age band than in Maine? ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/image-4.png) So what do these trends mean? Well, it suggests that Millennials (and younger generations?) may be the ones leading the decline in OD rates. If this bears out in other data, it will be critical: The recent drop in ODs is *not* driven primarily by depletion of susceptibles (“nobody else left to die”) and is also *not* primarily coming from fewer initiates to substance use in Gen Z/Alpha. The data above are not consistent with these two common hypothesized explanations for why ODs dropped. **We wanna hear from you on why the generational shift?** Leave your comments below the post on our website!!! ### San Francisco Similarly, San Francisco saw a spike in presumptive overdose fatalities in January-February 2025 among 45-54 year-olds after a whole year of encouraging decline. You can see this in the graph we made below, from the [medical examiner report here](https://media.api.sf.gov/documents/2025%5F05%5FOCME%5FOverdose%5FReport%5FVM9NmMD.pdf). (We've simplified the lines so you can see the pattern.) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/image-3-1.png) [Source](https://media.api.sf.gov/documents/2025%5F05%5FOCME%5FOverdose%5FReport%5FVM9NmMD.pdf) This is a very important reminder that we are not out of the woods yet. There will continue to be spikes in overdose deaths with an unregulated drug supply. KEEP GOING. What you're doing is working. We need more of the services that keep our people alive. And we should also be targeting resources to help groups experiencing the bulk of mortality, and the greatest disparities (highest counts and highest rates, respectively). Stay tuned! We're digging into this. Also, what does your data say? If you have OD mortality data for 2024 (or even better 2025) and you're willing to share demographic tables with us, we'd love to include you in our next analysis. Email **nab@unc.edu** if you wanna collab! --- # 🥽 BTMPS Insights CFSRE just put out this [intriguing alert on BTMPS](https://www.cfsre.org/images/content/reports/public%5Falerts/Public%5FAlert%5FBTMPS%5Fand%5FTMF%5FRelated%5FSubstances%5F052025.pdf). What's new is that they posit that [BTMPS](https://www.opioiddata.org/mystery-substance-summer-2024/) could be an experiment in making fentanyl precursors via a molecule called TM-4-AP. It's a hypothesis based on the piperidyl ring structure of both BTMPS and 4-ANPP. It's clearly one hypothesis that plays well in Drug War antecedents. But we don't see TM-4-AP derivatives in all BTMPS samples, so it's definitely not yet a common thing that's happening. --- # ☠️ OD Numbers Watch this short video as Ethan Chupp, a UNC Gillings Communication Fellow, explores why drug overdose deaths are finally declining after decades of increases. He speaks with street drug scientist Dr. Nab Dasgupta (our very own) about key factors like naloxone saturation, shifts in the drug supply, and what challenges remain. --- # 🕸️ From the Archives Looking back, there were certain pieces of science and writing that were prescient. Led by Svetla Slavova at the University of Kentucky, this presentation contains the results of a survey of medical examiners in 2015, on the cusp of illicit fentanyl emerging nationwide. It is relevant again now 10 years later because there is a lot of discussion about when fentanyl actually emerged in each state, *versus* when it was tested for in overdose autopsies. The results give pause for consideration: Even if fentanyl was “tested for” sometimes the testing was as an add-on based on suspicion of fentanyl. Here’s the takeaway: **When a new class of drugs emerge, like** [**nitazenes are poised to**](https://www.opioiddata.org/unc-watchlist/#nitazenes) **in 2025-6, detection practices in OD fatalities will vary**. Knowing the extent of this variation is the start to standardizing detection methods. The same thing [happened recently](https://www.sciencedirect.com/science/article/abs/pii/S037687162200117X) with xylazine. Here are some of the questions that were asked in the CSTE survey, and form a good starting point for the work we should be doing right now to get prepared for the next round of drugs emerging. - Is fentanyl included in the basic screening panel in your jurisdiction? - If “Yes”: Which of the following years was fentanyl included in the basic screening panel for the entire year - If “No”: If fentanyl is not included in the basic screening panel, is it available as an “add on” test or in an ‘add on’ panel? - If the initial basic screen is fentanyl positive, is confirmatory testing routinely performed? - If yes: Which of the following years was confirmatory testing for fentanyl routinely performed for the entire year - If yes to routine confirmatory testing: What is currently included in confirmatory panel? - Which level capacity is your state/jurisdiction for reporting fentanyl involved overdose deaths? [CSTE presentation fentanyl detectionCSTE presentation fentanyl detection.pdf2 MBdownload-circle](https://www.opioiddata.org/content/files/2025/05/CSTE-presentation-fentanyl-detection-1.pdf "Download") --- # ✈️ Out and About Nab attended the **International Harm Reduction Conference** in Bogotá and ran into Michelle McElroy and Amanda Serrano from ACR Health in New York (left). They provide great drug checking (and other services) to their people! \[And sorry y'all- we couldn't find the picture with all the NYS techs from last fall.\] ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/9189AF87-E0B8-4F7C-AC93-629094F7B0C3_1_105_c.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/EA503C7C-EF4D-462A-A737-E70139104442_1_105_c.jpeg) Then he decided to take a break from the conference and check out Monserrate in Bogotá with the Remedy Alliance crew (right). From the looks of it, they all had a blast! Find out more about the [conference here.](https://hr25.hri.global/) In May, Erin traveled to Portland, OR for the annual **Association of Public Health Laboratories (APHL) Conference**. She presented on a panel titled “More Moves Than a Dance Floor: Chasing Drug Overdose Trends with New Partners” with Alex Krotulski (CFSRE) and Cullen Cunningham (MDH). ![Picture](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/data-src-image-ac72a100-3e5b-4095-84b4-e21624559f45-1.png) --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. **Remedy Alliance:** One of the coolest jobs in harm reduction is overseeing millions of doses of naloxone out the door! Remedy is looking for an [Operations Manager for the Bay area](https://remedyallianceftp.org/pages/join-our-team)! This is an [exciting opportunity for academic harm reductionists](https://montclair.wd1.myworkdayjobs.com/JobOpportunities/job/Montclair-NJ/Associate-or-Full-Professor--Harm-Reduction%5FR1004370) to start a new **Harm Reduction Center at Montclair State University in New Jersey**. Look carefully at salary and application requirements, but someone might just find this to be a perfect fit! **Adolescent Info:** Free registration is now open for the [2025 North Carolina Virtual Adolescent Substance Use Disorder Conference! ](https://www.eeds.com/portal%5Flive%5Fevents.aspx?ConferenceID=289563&mc%5Fcid=b81fdd8e24&mc%5Feid=5347971af6) **Center for Prevention Services’** Queen City Harm Reduction is hiring for a [Harm Reduction Housing 1st Case Manager!](https://www.qcne.org/employment) **City of Durham NC** is hiring for a [Street Outreach Specialist ](https://www.governmentjobs.com/careers/durhamnc/jobs/4923157/street-outreach-specialist)and [Supervisor](https://www.governmentjobs.com/careers/durhamnc/jobs/4923026/street-outreach-supervisor)! **New Jersey Harm Reduction Coalition** is hiring for multiple positions! [Check them out here.](https://www.linkedin.com/posts/lindsey-kerins-02712a93%5Fcommunity-drug-checking-technician-activity-7325971822112370688-s5WF?utm%5Fsource=share&utm%5Fmedium=member%5Fios&rcm=ACoAAAQ62DUBufbeTX7YLlr007Uf6f7KIKIf09U) **Our friends Istvan and Péter** have long made the best international videos on drug policy and harm reduction. Legends. [Will their current plight in authoritarian Hungary be replicated against NGOs in other countries?](https://drogriporter.hu/en/drugreporter-will-not-be-silenced/) **White House Office of National Drug Control Policy** is seeking input on the 2026 *Strategy* and ancillary strategies by June 20, 2025\. See below. [2025.05.20 Dear Partner letter\_NDCS2025.05.20 Dear Partner letter\_NDCS.pdf152 KBdownload-circle](https://www.opioiddata.org/content/files/2025/05/2025.05.20-Dear-Partner-letter%5FNDCS.pdf "Download") --- # 👋 Meet our Team Members Each month will feature different team members 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/ec14ddfb-7223-4854-bc31-157b12080dcb-2.jpg) ## Shay Louis Our production manager (life saver) who oversees kit production and shipments (vital)! Outside of work, her main priority is spending time and creating core memories with her 3 amazing daughters and husband. She enjoys reading, home/diy projects and traveling. Her happy place is at the beach with a good book. --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! Here's an ***eloquent reminder*** that there is such a thing as too much naloxone, [from Stuart Fisk in Pittsburgh.](https://triblive.com/opinion/stuart-fisk-medical-professionals-respond-to-call-for-higher-dose-naloxone/) Also, a really approachable and useful essay from **doctors who actually treat overdoses with naloxone**. If 2 doses and 10 minutes aren’t working *call 911*. [Read more here. ](https://onlinelibrary.wiley.com/doi/10.1111/add.70060) **Health Affairs:** [Drug Overdose Deaths Are Finally Slowing – Medicaid Cuts Would Undermine That Progress](https://www.healthaffairs.org/content/forefront/drug-overdose-deaths-finally-slowing-medicaid-cuts-would-undermine-progress) **Native News Online:** [CDC’s Tribal Overdose Prevention Team Gutted in Federal Workforce Cuts](https://nativenewsonline.net/health/cdc-s-tribal-overdose-prevention-team-gutted-in-federal-workforce-cuts) **How do we think about meth ODs?** Turns out alcohol (not opioids) are a handy rubric for understanding both the acute toxicity and the long term physiological harms. Both are important, but the way we deal with them is drastically different. Thanks Dr. Phillip Coffin for [this excellent and approachable insight](https://www.sciencedirect.com/science/article/pii/S037687162500153X?dgcid=coauthor)! **This** [**new CDC report on (dex)medetomidine**](https://www.cdc.gov/mmwr/volumes/74/wr/mm7415a1.htm)highlights how the crackdown and scheduling of xylazine is making the unregulated drug supply even more problematic. We disagree with some of the alarmist language about naloxone, but we agree with the conclusion that folks “continue to provide naloxone and linkage to evidence-based treatment. **Here’s an insightful study on** [**xylazine test strips**](https://filtermag.org/xylazine-test-strips-accuracy/)**.** Turns out which manufacturer makes the strips makes a big difference on false positives and accuracy. In fact, accuracy can even vary from batch to batch from the same manufacturer! It’s time that there were some national standards and independent testing for test strips. --- ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/1747835026686-1-1.jpeg) ## ❤️‍🩹 We are saddened to hear of the passing of a true leader in the international harm reduction field. Naomi Burke-Shyne. Our condolences to all who knew and loved her. May she rest in peace. [Here is a link to her memorial.](https://www.linkedin.com/posts/harm-reduction-international%5Fit-is-with-heavy-hearts-that-we-at-harm-reduction-activity-7330951450673455104-uG6M?utm%5Fsource=share&utm%5Fmedium=member%5Fios&rcm=ACoAAAQ62DUBufbeTX7YLlr007Uf6f7KIKIf09U) --- # 🔔 Operation Reminders As our program continues to grow, here's some important program reminders! For new programs who are interested in utilizing our drug checking services, you **must sign a terms and conditions** before kits can be shipped. We do our due diligence to make sure that we align ourselves with programs who are rooted in true harm reduction principle. The people come first and must be protected. 💙 Remember that we all samples must be obtained **voluntarily**. That means asking permission from the sample holder. Also keep in mind we are **not allowed** to test samples for law enforcement because of legal limitations. **For programs who receive invoices**: Coming in about 2-3 months, we are transitioning to a new online system called Infoporte. More to come soon. --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/IMG_1473-1.jpg) Each month, we will showcase boxes we love. Send us more doodles and notes! They sustain us. ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ## Like what you're reading? Get this newsletter in you inbox. Subscribe Email sent! Check your inbox to complete your signup. No spam. Always free. Unsubscribe anytime. ### ACDC Summit 2025 URL: https://www.opioiddata.org/acdc-summit-2025/ Last updated: 2025-06-27T04:08:59.000Z Mark your calendars because you do not want to miss the 6th Annual **Alliance for Collaborative Drug Checking (ACDC) Virtual Summit!** It is just around the corner, and you *don't want to experience FOMO (fear of missing out)* because you didn't register! Taking place **May 27–30** from **12:30PM to 6:30PM ET** each day via Zoom, this event brings together harm reductionists, chemists, syringe service providers, researchers, people who use drugs, and drug checking pioneers from around the world for **four days** of *deep discussion, learning, and community*. Whether you’re brand new to the idea of drug checking or have been testing substances for years, this summit is your chance to dive into the most pressing questions and trends in the field- everything from substances to keep your eye on to ethical considerations and safe supply strategies. Drug checking is more than just analyzing substances; it's a frontline tool in overdose prevention, a strategy to empower informed decision-making, and a direct challenge to the stigma that surrounds drug use. The ACDC Summit offers an incredible opportunity to sharpen your skills, ask tough questions, and connect with others who are pushing this work forward. Sessions will be conducted in both **English and Spanish**, and ACDC’s commitment to access means that *no one is turned away for lack of funds*—just email **ACDChecking@gmail.com** if cost is a barrier. This event is always one of the most inspiring and energizing gatherings of the year. 👉🏾**Register now and learn more here:** [ ](https://www.eventbrite.com/e/acdc-drug-checking-summit-2025-online-tickets-1223805718849) Let’s build safer communities-one test at a time. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/Screenshot-2025-05-14-at-12.41.24-PM-1.jpeg) ### OD Data: Own Your Impact URL: https://www.opioiddata.org/od-data-own-your-impact/ Last updated: 2026-05-11T15:46:15.000Z by [Nabarun Dasgupta](https://www.opioiddata.org/author/nabarun/) & [Adams Sibley](https://www.opioiddata.org/author/adams/) Sometime next week (second full week of May), [CDC will publish](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) 2024 predicted overdose numbers. Now is the time to get ready to tell your story. This guide will help with talking points. --- # What will the numbers say? We predict the 2024 national overdose death count will be between 80,000 and 85,000, [based on our estimates](https://deepnote.com/app/opioiddatalab/WONDER-vs-12-month-Predicted-OD-data-ce7d8424-642b-490e-b484-ef63058a2a98). As Kastalia at *Filter* points out, the CDC predicted national numbers are usually an overcount by [+3,000 deaths](https://filtermag.org/cdc-overdose-deaths-decrease-pandemic/). So the actual count will be lower, once those are finalized about 18 months from now. Next week's data release will compare the total count of predicted OD deaths 2023 vs. 2024; see [how it's calculated](https://www.opioiddata.org/peak-od-phenotypes/#what-exactly-are-we-counting). **We expect the total percent drop from January to December 2024 will be around -27% (give or take 1.1%).** As we [pointed out last month](https://www.opioiddata.org/april-newsletter/), some states (like Nevada and Alaska) will show up orange on the map because of spikes that happened in late 2023 and early 2024\. *This does NOT mean that ODs are increasing in these states.* Fatal ODs in ALL STATES are down from their peak. Here's our table of [state-by-state numbers](https://embed.deepnote.com/8897c4a5-71b3-47b1-a5b8-c66373ecbff0/5979ef11c5fe4b3ba3113d8b5a520678/3401fb888fbe4d01b2d3b320b5cfc43d?height=1772.23291015625) (which we will refresh as soon as the new CDC predicted data are released). # What's special about 2024? After 3 decades of increasing overdose deaths, the -27% reduction is remarkable. Some folks taking credit for the decline will point to actions taken in 2024\. But the truth (see map below) is that **overdoses have declined gradually over a span of 3 years**. **This means that no single factor in 2024 can explain the drop nationally.** We go into [more detail here](https://www.opioiddata.org/peak-od-phenotypes/). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/image.png) Source: [NPR](https://www.npr.org/2025/03/07/nx-s1-5295618/fentanyl-overdose-drugs) --- # What's driving the drop? Our team believes the drop in overdoses is due to 3 factors: 1. **Drugs**: Which drugs reach the community, what do they look like, how much do they cost, and what do they do? 2. **People who use drugs**: Who is using drugs now? Who is starting to use drugs? Who is stopping? Why? 3. **Behaviors**: How do people use drugs? What do they do to keep themselves (and others) safe and healthy? How has community mobilized to prevent overdose deaths? (See also: [summary](https://www.cbc.ca/news/health/fentanyl-overdoses-canada-us-drug-enforcement-1.7504182) and [deep dive](https://www.opioiddata.org/are-overdoses-down-and-why/)) ## (1) Drugs **Our field studies are indicating a general dissatisfaction with the synthetic opioid supply.** We summarized the corresponding changes in the drug supply in the recent webinar linked below. Fentanyl is still around. Some fake pills may have a little less fentanyl per pill, which is within the [normal expected fluctuation](https://pubmed.ncbi.nlm.nih.gov/33977304/) for fentanyl content. Some places are seeing more old school [heroin displacing fentanyl](https://www.cato.org/blog/how-much-drop-fentanyl-related-overdose-deaths-might-be-due-resurgence-heroin). Xylazine is changing people's relationship to fentanyl, making some use less frequently or use smaller amounts. Other synthetic sedating adulterants like [(dex)medetomidine are displacing xylazine](https://deepnote.com/app/opioiddatalab/dexmedetomidine-Tracker-a401c37e-5255-4d15-87a1-252ee09f360d). Collectively, these forces are driving people away from fentanyl; it's just not as good as it used to be. From one of our field studies, collected in late 2023: > I've been an addict for 30 years. If it's got xylazine, I don't want it. I don't want to do that. But this, it’s just everywhere now. I'm to the point where I'm like, in 30 years, I have not been able to quit doing dope. But I have days where I don't do it. And that's never happened. Never happened out of rehab, for 30 years. I've been a hard-core addict for about 30 years. And xylazine scares the fuck out of me. I don't want to lose limbs. I don't want to see people lose limbs. And it’s just nasty shit. (Michigan) (People can call themselves whatever they want. [But word choices matter](https://drugfree.org/article/words-matter).) ## (2) People **The bulk of drug overdose deaths in US are happening in middle-aged folks, 68%.** The biggest category (37%) are happening among 30-44 year-olds, those born between 1980 and 1995\. Folks 45 to 60 years-old (born 1965 to 1979) make up an additional 31%. We are also seeing less initiation of illicit opioid use among Gen Z and Generation Alpha. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/c1746805026314-0.jpeg) Source: Rate per 100k population, [CDC Wonder](https://wonder.cdc.gov/controller/datarequest/D176;jsessionid=B2003A2A4F480C3D867196D7231E), 2023-4 provisional data The US range is slightly wider than our neighbors to the north as [CBC reported this week](https://www.cbc.ca/news/health/fentanyl-overdoses-canada-us-drug-enforcement-1.7504182): "In Canada in 2024, 73 per cent of overdoses deaths happened to men aged 30 to 39, [according to Health Canada](https://health-infobase.canada.ca/substance-related-harms/opioids-stimulants/)." But when you look by race x age, you see some [birth cohort effects](https://www.publichealth.columbia.edu/research/population-health-methods/age-period-cohort-analysis) (aka generational effects by race), as you can see in this excellent visualization. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/image-1.png) Source: [New York Times](https://www.nytimes.com/2025/01/30/upshot/black-men-overdose-deaths.html) ## (3) Behavior People who use drugs have always done things to protect themselves and stay as safe as possible. In addition, there has been a tremendous groundswell of public health interventions that have helped. This is thanks in part to [opioid settlements](https://ncopioidsettlement.org/), but also crucial federal funding. We highlighted these stories in [last month's newsletter](https://www.opioiddata.org/peak-od-phenotypes/#so-what%E2%80%98s-working). Naloxone distribution, expanding drug treatment access, Medicaid expansion to cover more people with more treatment, and many other interventions, are *collectively* making an impact. As we presented in a webinar last week, a major part of what is driving the decline is the interventions on the ground: [Behind the Numbers: Making Sense of Trends in the Drug Supply and Overdose Rates — National Overdose Prevention NetworkHave you had trouble making sense of recent trends in the drug supply and overdose rates? You’re not alone. In recent years, countless new synthetic drugs have entered the drug supply, and various theories are posited for changes in overdose death rates. Join us on Monday, May 5, from 11:30 – 12:30![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-11.ico)National Overdose Prevention Network![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/jakub-zerdzicki-heiYgqp0Tsk-unsplash.jpg)](https://nopn.org/webinars/behind-the-numbers-making-sense-of-trends-in-the-drug-supply-and-overdose-rates) --- # Tell Your Story NOW All your hard work deserves to be shared. Social media is helpful. Also reach out proactively to local news organizations **TODAY**, before the numbers are published. Share this post, give them a heads up what's coming. For socials, here's a basic 3 part formula: 1. One "[Big Ass Number](https://www.datarevelations.com/bans/)" that conveys impact. Try using [social math](https://asistdl.onlinelibrary.wiley.com/doi/full/10.1002/bul2.2016.1720420507) (“We’ve served 1,140 participants this year – that’s enough people to fill a high school gymnasium!”). It could also be a very very simple graph. 2. Photo of your staff person **doing the work**, in a setting of implementation (with permission). 3. A 1 sentence quote. Organization logo optional. ## AI Prompt We used [Claude.ai](http://claude.ai/) to make short work of this. You can optimize the prompt below with your own words, or have a Canva/Insta/TikTok hero do the task. The important thing is to get things out ***quickly***. Get these out on social media right away. Don't overthink it. Tag #overdose and whatever else is trending on this topic next week. *Suggested Prompt:* > Make 3 square png posts for social media to convey public health impact of our program on reducing overdoses. Use consistent eye-catching font and color, based on colors in individual.PNG > > 1. Text "We distributed 1,234 naloxone kits in Any City in 2024" with the number (not year) in very big centered font. Make text fill square. > 2. Combine photo individual.PNG with logo.PNG by placing logo in bottom right corner \[this didn't work in Claude but other AI might be able to\] > 3. Using same background as #1, text: "I know the work I'm doing is making a difference because I see people surviving and making their lives better. - Someone Jones, Outreach Worker" Fill frame with text. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/Screenshot-2025-05-09-at-12.23.33-PM.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/individual-1.PNG) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/05/Screenshot-2025-05-09-at-12.23.45-PM.png) Example output --- # What to do next Public health is working. **Keep going!** Here are the 6 things we advocate for: 1. **Use settlement funds wisely** This money was intended to support your mission. 2. **Be critical - not all interventions are created equal** Keep going with interventions that are proven to work. 3. **Ask who is being left behind** Improvements are not uniform. 4. **Get local information** Employ people with the most recent drug use experience. 5. **Address other drug-related harms** Skin wounds, hepatitis, endocarditis, etc. stem from unregulated drug supply. 6. **Properly resource medical examiners** The key to faster and higher quality data. ## Join 1.5k subscribers and get this free newsletter in your inbox! The Opioid Data Lab is a public service of the University of North Carolina at Chapel Hill. We provide information for public health responses to overdose prevention. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### April Newsletter URL: https://www.opioiddata.org/april-newsletter/ Last updated: 2025-06-27T04:09:12.000Z 🌸 Spring is here! And with it comes fresh energy, renewed purpose, and hopefully some sunshine in your day! We hope all you harm reduction heroes and passionate advocates are holding strong, staying grounded, and finding moments of joy amidst the challenges we face together. As always, we’re bringing you a roundup of updates, resources, and stories to keep you informed, inspired, and connected. We have a lot of infor coming at you this month-so grab your morning drink of choice, settle in and prepare for a good read🌼 # 〽️Service Stats & Updates As of Tuesday April 22, 2025: **12,225** samples analyzed Serving **168** harm reduction programs Reaching **248** counties in **41** states **411** unique substances identified Click below to see Live Reports on cafentanil, (dex)medetomidine, nitazenes, BTMPS and more. [UNC Watchlist](https://www.opioiddata.org/unc-watchlist/) --- # ☠️ OD Numbers You'll notice that the monthly refresh of predicted overdose counts is still being posted by CDC, though it seems to take a bit longer. There are important data, despite the [limitations](https://www.opioiddata.org/peak-od-phenotypes/) we've pointed out. Before you even ask, let's look into what's happening in South Dakota, Nevada and Alaska. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/image-2.png) Source: [CDC](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) ## South Dakota This was clocked as a 2.3% increase for the 12-months ending in November 2024, compared to the 12-months ending November 2023\. The absolute difference +2 deaths, 87 versus 85\. So this is well within background fluctuation. ## Nevada Using our [data app](https://deepnote.com/app/opioiddatalab/WONDER-vs-12-month-Predicted-OD-data-ce7d8424-642b-490e-b484-ef63058a2a98?selected%5Fstate=Nevada), we can see that the predicted 💜 OD deaths (purple line) are consistently a \~25% overestimate from actual 💙 deaths (blue line). Nevada exhibits a spikey pattern, with outbreaks in March and July 2023, and June 2024\. As we [previously explained](https://www.opioiddata.org/peak-od-phenotypes/#nevada), these spikes create inertia that will keep the 12-month predicted rate high artificially. The distance between the purple 💜and orange 🍊 lines is the combined impact of these two reporting artifacts, a whopping 33% monthly overestimate. Still the general upwards trend is concerning. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/newplot--21-.png) Source: [UNC Opioid Data Lab](https://deepnote.com/app/opioiddatalab/WONDER-vs-12-month-Predicted-OD-data-ce7d8424-642b-490e-b484-ef63058a2a98?selected%5Fstate=Nevada) using multiple CDC datasets But hospital emergency department non-fatal overdoses don't always pick up the deaths spikes. The two data systems concurred in July 2023, but not in June 2024\. There has been a general downward trend since last summer, with some end-of-year fluctuation. It is also worth looking at [regional patterns](https://nvopioidresponse.org/initiatives/od2a/) (Reno vs. Las Vegas vs. rural areas). So what do we conclude when fatal vs. non-fatal ODs don't align in time? It could well be that people are using alone, don't have naloxone, or are otherwise dying before they can be helped by EMS or peers. How do we prevent these deaths? ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/image-3.png) ****2024** Data from [Nevada OD2A](https://nvopioidresponse.org/wp-content/uploads/2025/01/OD-Surveillance-January-2024-Statewide%5FADA.pdf) [![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/image-4.png)](https://nvopioidresponse.org/wp-content/uploads/2024/03/OD-Surveillance-January-2024-Statewide%5FADA.pdf) ****2023** Data from [Nevada OD2A](https://nvopioidresponse.org/wp-content/uploads/2024/03/OD-Surveillance-January-2024-Statewide%5FADA.pdf) ## Alaska Alaska OD deaths reported by CDC remain artificially high, due to the December 2023 and January 2024 spike. In those 2 months alone, n=92 people died, compared to n=309 for entire 2024 year. Just like Nevada, the CDC predicted 💜 annual count (n=400) is a substantial 33% overestimate. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/newplot--22-.png) Source: [UNC Opioid Data Lab](https://deepnote.com/app/opioiddatalab/WONDER-vs-12-month-Predicted-OD-data-ce7d8424-642b-490e-b484-ef63058a2a98?selected%5Fstate=Alaska) using multiple CDC datasets That 2023/24 spike shows up in the hospital ED non-fatal OD data below. What is encouraging is that in 2024, hospital visits dropped for 15-24 year-olds substantially throughout the year; the greatest drop among any age group. But it wasn't until early summer that OD deaths started dropping for younger adults (25-44), who make up more than half of deaths. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/image-5.png) Source: [Alaska Department of Health](https://health.alaska.gov/en/education/alaska-substance-use-dashboard/) So who is dying? Overdose deaths occur mostly in Anchorage, [n=220/309](https://health.alaska.gov/en/education/alaska-substance-use-dashboard/) for the 12-months ending October 2024\. About 70% are male. Historically, OD rates are about [2x higher](https://health.alaska.gov/media/tp5fatxo/substance-use-dashboard-accessible-data.pdf) for Alaska Native People, than Alaska Non-Native People. --- # 📊 Explainer Dr. Nab sat down with DPA to explain the leading ideas on why OD deaths have been declining. Here's a video playlist of the highlights. **While the overall decline in overdose deaths is really encouraging, *this is a fragile recovery.*** [Overdose Deaths are Declining: Dr. Nabarun Dasgupta Explains Why - Drug Policy AllianceDr. Nabarun Dasgupta, a scientist who has been studying drug overdose deaths for over 20 years, explains what might be causing recent overdose declines.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-15.png)Drug Policy Alliance![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/Screenshot.2025.04.08.132546.jpg)](https://drugpolicy.org/resource/overdose-deaths-are-declining-dr-nabarun-dasgupta-explains-why/) --- # 📈 Department of Data At the UNC Street Drug Analysis Lab, our *primary mission* is to provide an accurate, affordable, low-barrier, and rapid drug checking service so that people can make better decisions about what they put in their bodies. We also realize that the data generated has value. We have made a commitment (in our Terms and Conditions) to let y’all know when we use our drug checking data to answer questions “research” questions posed by our service users. We do this by posting a [pre-registration](https://www.cos.io/initiatives/prereg), which describes the rationale and methods for the research. Importantly, the plan is public, non-editable, and hosted by an [independent Open Science organization](https://osf.io/), meaning it’s a permanent record to hold researchers (us!) accountable to our community. Here are examples- - Our friends at Prevention Point Pittsburgh asked us to investigate whether (dex)medetomidine could be causing hallucinogenic side effects that their participants are experiencing. Dr. Adams Sibley on our team has registered [this study.](https://osf.io/4agfx) It’s an interesting question because (dex)medetomidine is widely used in US hospitals to sedate people after surgery if they are having episodes of agitation, psychosis, or hallucinations. But there are many reports of hallucinations in the dex(medetomidine) samples we’ve tested, enough to warrant a study. - RTI International provided a link to the [federal grant record that contains a description](https://taggs.hhs.gov/Detail/AwardDetail?arg%5FAwardNum=R01DA059457&arg%5FProgOfficeCode=114) of Dr. Jon Zibbell’s exploration of skin wounds and drug supply in North Carolina. Future studies will be preregistered before the start of sample collection. --- # Government Affairs There is a lot happening at state and national levels with new bills proposed at the NC General Assembly, and myriad federal agency cuts. - The White House [Statement of Drug Policy Priorities](https://www.whitehouse.gov/wp-content/uploads/2025/04/2025-Trump-Administration-Drug-Policy-Priorities.pdf) was released with naloxone distribution, expanding access to MOUD, peer recovery, and (implicitly) drug checking were listed, among standard Drug War priorities. We think it's smart that policies that have worked to bring down overdoses are continuing. - The **Public Health Emergency** on opioid overdose has been renewed, thankfully. This wonky designation is really really really important, as Blaire Bryant from NACo [explains](https://www.naco.org/news/hhs-renews-public-health-emergency-declaration-address-national-opioid-crisis). This administrative act also helps make low-barrier bulk naloxone distribution easier. Please keep this going, as too many people we love are still dying. - If you want to read **excellent commentary on national drug policy**, subscribe to [Regina LaBelle's Substack](https://substack.com/@reginalabelle?), where she mentions here recent [actionable roadmap](https://www.healthaffairs.org/content/forefront/policies-and-programs-accelerate-declines-u-s-drug-fatalities) for this pivotal moment as we face down overdose deaths. - On the **international front**, former president Duterte of the Philippines is [facing justice](https://www.pbs.org/wgbh/frontline/article/duterte-arrested-icc-warrant-deadly-war-on-drugs-philippines/) for a years-long exaggerated "War on Drugs" that led to thousands of extrajudicial killings. Here's an [audio story](https://www.npr.org/2025/03/23/1240470120/the-long-shadow-of-dutertes-drug-war), and the [Human Rights Watch report](https://www.hrw.org/report/2017/03/02/license-kill/philippine-police-killings-dutertes-war-drugs). It's a rare rebuke of political leaders who use the spectre of drugs problems for political gains. --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. There is a ton of cool and exciting things happening in the Harm Reduction community (as always 😜) -Take a look ⬇️ - Turn complex data into life-saving public health insights—**Vital Strategies** is hiring a ***Technical Manager, Substance Use Data Communicator*** in NC. If you’re passionate about translating overdose prevention data into impactful messages for policymakers and communities, [click to learn more and apply](https://phg.tbe.taleo.net/phg01/ats/careers/v2/viewRequisition?org=VITASTRA&cws=37&rid=793). - Join **Remedy Alliance's comprehensive drug checking training** in Minneapolis from June 25-27, 2025, designed for new technicians and programs with FTIR spectrometers seeking formalized instruction. Participants must have lab verification contracts, equipment, and sample collection capabilities before attending this three-day intensive training. [Click here to complete the registration form](https://docs.google.com/forms/d/e/1FAIpQLSfe1XuDp8nWVhfNBny8t6ce5bbCi30kW2VSKtHrO43EP7wQcg/viewform?pli=1) and learn more about pricing options. - There's a new **Drug Policy Archive!** A comprehensive digital collection of 2,600 books on *drug policy, harm reduction, and addiction studies* resulting from a collaboration between DPA and the Substance Abuse Librarians and Information Specialists. This free online resource, available at the [Internet Archive](https://archive.org/details/salis), preserves rare materials from Ethan Nadelmann's personal collection and serves as an invaluable tool for researchers, educators, advocates, and the general public. Access the complete collection and learn how to navigate it with this [step-by-step guide](https://archive.org/details/salis/page/n0/mode/1up) and explore this unique repository of knowledge to advance your teaching, research, or advocacy work. - Join the **UNC IPRC Opioid Student Research Group** on Thursday, April 24th, 2pm-3pm *(today!)* to hear Dr. Shabbar Ranapurwala, an associate professor of Epidemiology, president-elect of the SAVIR, and faculty mentor for the UNC IPRC speak about overdose deaths among formerly incarcerated people, either in person or via Zoom. [Click here](https://unc.zoom.us/j/92651150207) to attend this presentation you don't want to miss! - **Durham County DPH** is hosting ***"Together in Faith and Hope: Strategies to Prevent Overdose Conference"*** on Saturday, April 26 from 12:30-4:00pm, bringing together faith communities, substance use disorder experts, and community leaders to explore overdose prevention strategies. Register [here](https://www.registrationlink.com)! - Check out **Guilford County's Harm Reduction Hangout!** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/image-1.png) --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! [NC Health News: ](https://www.northcarolinahealthnews.org/2025/04/03/settlement-outreach-in-rural-nc/)Discover how three rural North Carolina counties are utilizing opioid settlement funds to implement community-driven strategies aimed at reducing overdose deaths. We were saddened to hear of the passing of Howard Josepher, a harm reduction legend. Read Tony Newman's tribute:[ How One Man Helped 10,000 People With Serious Drug Problems ](https://www.huffpost.com/entry/how-one-man-helped-10000%5Fb%5F6572632) **🤓 Scientific Literature** - ["Four decades of overdose prevention centres: lessons for the future from a realist review”](https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-025-01178-z) – This is a handy review of the evidence around Overdose Prevention Centers from around the world. It also has a compelling model of how OPCs improve health beyond preventing overdose. - We found this fascinating! Olinde, A., et al. (2025). [A survey study of urban retailers selling alkyl nitrites (“poppers”) in the New York City area which led to public health interventions.](https://www.tandfonline.com/doi/full/10.1080/15563650.2025.2455531#abstract) *Clinical Toxicology*, 1–5\. --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/IMG_3919-1.jpg) --- # 👋 Meet our Team Members Each month will feature different team members 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/04/Illyana.jpeg) ## Illyana One of our community liaisons-She's a licensed social worker associate with a public health background. She is also the editor of this newsletter 😉 Fun Fact-her dad named her after a Marvel comic book character🦸🏽‍♀️ --- ## Like what you're reading? Get this newsletter in you inbox. Subscribe Email sent! Check your inbox to complete your signup. No spam. Always free. Unsubscribe anytime. ### March Newsletter URL: https://www.opioiddata.org/march-2025-newsletter/ Last updated: 2025-05-15T13:06:22.000Z Happy March!! 🏀 We're glad you're here—let’s dive in and stay connected on all things harm reduction, data, community, and support 🪄 We understand that the landscape of drug overdose prevention is shifting rapidly. Many of you in government and frontline programs fear for your jobs, while others find themselves tasked with allocating opioid settlement funds. Drug overdose deaths are declining overall, but far too many people are still dying, with some communities facing greater burdens than ever. In some areas, harm reduction is flourishing; elsewhere, we witness the curtailing of lifesaving services. Younger activists are charting a new path forward, while established organizations rethink their strategies. These are disorienting times. As a society, we can be—and always have been—many things at once. While it may feel like there is no cohesive path forward, we encourage you to recommit to meeting the needs of the people you serve. We are on the right path, and this is a time for fortitude. It is also a time for grace. There will be setbacks, and we can only suggest that **resilience through rest** will be an essential coping strategy. Hang in there; we got each other! --- # 〽️Service Stats & Updates As of Wednesday March 26, 2025... **11,578** samples analyzed Serving **167** harm reduction programs Reaching **244** counties in **40** states **404** unique substances identified No changes to our Watchlist, but click below to see Live Reports on cafentanil, (dex)medetomidine, nitazenes, BTMPS and more. [UNC Watchlist](https://www.opioiddata.org/unc-watchlist/) --- # NC Summit on Reducing Overdose ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/image-20250325-141747-1.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/IMG_7347-1.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/IMG_7344.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/group-1.png) Top left/bottom right: Our UNC SDAL team; Top right/bottom left: Our team participating in a naloxone training and kit making making event held by Remedy Alliance's rockstars Maya and Eliza. Our team attended the [NC Summit on Reducing OD](https://www.ncacc.org/events-training/nc-summit-on-reducing-overdose/), in Raleigh, NC March 18-20, 2025\. We engaged in insightful workshops, collaborative sessions, and inspiring keynotes [(slides)](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/js956w76h?locale=en) that deepened our understanding and commitment to harm reduction strategies- one of those being our very own Dr. Nab😃 . The summit reinforced the power of community-driven solutions in reducing overdoses and supporting the health and well-being of people who use drugs. (Welcome to our new readers from the conference) --- # Department of Data In exciting news, scientists in Sicily, Italy have independently determined the precise mechanism of interaction between xylazine and the kappa opioid receptor. They also point to strong binding to serotonin receptors, confirming computationally *in silico* what [we observed experimentally](https://www.sciencedirect.com/science/article/pii/S2772392524000142). An eye-opening component of their analysis was to create 500 new virtual molecules that had similar binding properties at kappa and serotonin receptors; they conclude: "The results of all the series \[of virtual molecules\] indicate that the chemical landscape for this class of compounds is still huge and that small modifications may further increase the activity of the parent molecule." **This is the scientific first warning note that cracking down on xylazine now could readily lead to the synthesis and emergence of new knock-off xylazine-alike street drugs tomorrow.** See the [open access paper](https://onlinelibrary.wiley.com/doi/full/10.1002/ardp.202500041) by Floresta et al. for the \[highly\] technical details. [Xylazine as an emerging new psychoactive substance; focuses on both 5-HT7 and κ-opioid receptors’ molecular interactions and isosteric replacement - PubMedXylazine, traditionally used as a veterinary sedative, has recently emerged as a new psychoactive substance, being typically ingested in combination with fentanyl derivatives and hence raising significant public health concerns. Despite its increasing prevalence, little is known about its molecular …![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-192-1.png)PubMedGiuseppe Floresta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/pubmed-meta-image-v2.jpg)](https://pubmed.ncbi.nlm.nih.gov/40091602/) Back on the street, after climbing steadily last summer and into the fall, we [have started to see](https://deepnote.com/app/opioiddatalab/dexmedetomidine-Tracker-a401c37e-5255-4d15-87a1-252ee09f360d) a slight dip in xylazine and (dex)medetomidine in fentanyl samples since the start of the calendar year. This may be because folks are used to expecting it, or may signal yet another shift in the drug supply. This is a bit puzzling since we expected these substances to proliferate, or perhaps there is enough consumer pushback to change the market? We know there is deep dissatisfaction with the synthetic opioid supply right now. If what we are seeing in our raw data is borne out by more complete analyses, it could be that these trends may already be changing *before* the expected passage of the [HALT Fentanyl Act](https://drugpolicy.org/news/parents-police-and-advocates-condemn-senate-passage-of-halt-fentanyl-act-demand-lifesaving-health-solutions-to-fentanyl-and-overdose/). But we encourage caution in drawing too many conclusions! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/image-2.png) --- # New Substances Detected ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/image-3.png) We saw an influx of new pharmaceuticals submitted to our service, which we think could be due to folks testing out the limits of our detection capabilities. What's more relevant is that we (and other drug checking programs) are seeing an uptick in interest and samples containing (unregulated) hormones purchased online. Our methods are good at detecting them, and I don't think many of us are surprised. We'll get back to deeper analyses of new detections next month, but you can [see the new detections here](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823) in the meantime. --- # 🤔Thinking of getting a FTIR? Read more about whether an FTIR machine would be a feasible option for your program! [Why you need lab support💡This page goes over information that is intended to help programs discern whether an FTIR machine would be a feasible option for their organization. It goes over various considerations to be taken into account when considering starting an on-the-ground drug checking program If you have or are thinking about getting![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-23.png)Opioid Data LabColin Wasson Miller![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/alpha-ii-eco-atr-bruker.jpeg)](https://www.opioiddata.org/why-you-need-lab-support/) --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. - **ACDC Summit** The 6th annual Alliance for Collaborative Drug Checking (ACDC) Virtual Summit will be held May 27-30th (12:30PM-6:30PM ET). The registration page is live! This is a great opportunity to hear from a wide variety of folks about all things drug checking. Last year’s topics included: Safe(ish) supply: Drug checking's role in DIY safe supply, Legislation and Advocacy for Drug Checking Programs, and Considerations in Advancing Drug Checking: Ethics, Research Relationships and the Limits of Data. [Check out more here.](https://www.eventbrite.com/e/acdc-drug-checking-summit-2025-online-tickets-1223805718849?aff=oddtdtcreator) - **DHHS/Vital Strategies** is hiring for a naloxone coordinator in NC. [Click here to learn more](https://phg.tbe.taleo.net/phg01/ats/careers/v2/viewRequisition?org=VITASTRA&cws=37&rid=786). - *ICYMI* the [great panel discussion on recent changes in the drug supply](https://www.youtube.com/watch?v=ovzo5wiWvmM) at the **Drug Policy Alliance** virtual series is now up. Catch the rest on **New Drugs and Markets: Meeting the Challenge of a Changing Drug Policy Landscape.** April 10, 2025 | 3:30pm – 5:00pm ET | [**Panel 2: Addressing Myths, Misinformation, and Real Harms**](https://www.eventbrite.com/e/new-drugs-and-markets-session-2-addressing-myths-misinfo-and-real-harms-tickets-1198997637209?aff=oddtdtcreator) May 8, 2025 | 3:30pm – 5:00pm ET | [**Panel 3: Understanding Drug Markets**](https://www.eventbrite.com/e/new-drugs-and-markets-session-3-understanding-drug-markets-tickets-1199183081879?aff=oddtdtcreator) May 29, 2025 | 3:00pm – 5:00pm ET | [**Panel 4: Scaling Up Drug Checking, Envisioning Safe Supply, and Exploring New Horizons**](https://www.eventbrite.com/e/new-drugs-and-markets-session-4-exploring-new-horizons-tickets-1199352578849?aff=oddtdtcreator) - A study is being conducted for individuals impacted by the **Felony SNAP ban** due to a **drug-related conviction**. They are seeking participants who either have children or were affected as children when their parents were unable to access SNAP benefits. **Participants will receive $50 per interview.** [Click here to find out more.](https://www.opioiddata.org/felony-snap-ban-2/) --- # 🎙️ Podcasts Dr. Stefan Kertesz at the University of Alabama in Birmingham released this excellent podcast entitled “Caring for Patients or Policing Them? Prescription Drug Monitoring, Doctors and Opioids” with author [Liz Chiarello](https://www.lizchiarello.com/Book.php). [Caring for Patients or Policing Them? Prescription Drug Monitoring, Doctors and OpioidsPodcast Episode · On Becoming a Healer · 03/18/2025 · 1h 9m![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-180-1.png)Apple Podcasts![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/1200x1200ECA.PESS01-60.jpg)](https://podcasts.apple.com/us/podcast/caring-for-patients-or-policing-them-prescription-drug/id1530748958?i=1000699628538) --- # 🥼 Lab Visits ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/IMG_3399-1.png) This month Robert Heimer, Eliza Wheeler, and Maya Doe-Simkins dropped by the lab to check us out! --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! **JAMA Network Open:** More on the [**Drug Bust Paradox**](https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307329)**.** A [**new study**](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2831697) out of San Francisco found a 74% increase in fatal opioid overdoses within 100 meters the day following drug seizure events. ([news coverage](https://www.sfchronicle.com/opinion/nualabishari/article/san-francisco-drug-overdose-20226194.php)) The risk persisted for a week. The study is consistent with another one [from Indianapolis](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2023.307291). **CDC’s Injury Center** has launched the **Mapping Injury, Overdose, and Violence Dashboard**, providing localized, real-time data on overdose, suicide, and homicide deaths down to the census tract level. This tool can help federal, state, local, and tribal partners better understand and prevent injuries and violence in their communities. [**Explore the dashboard today** to access timely, actionable data that can support public health strategies.](https://www.cdc.gov/injury-violence-data/data-vis/index.html) **Bloomberg News** did a [nice story](https://www.bloomberg.com/opinion/articles/2025-03-21/opioid-crisis-deaths-including-fentanyl-are-down-here-s-why) entitled "What We're Getting Right Fighting the Overdose Epidemic," including an important perspective from Indigenous communities. It's behind a paywall, but, [ahem](https://archive.ph/). --- # ✈️ Out and About ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/IMG_9440-1.jpg) Adams down in Sacramento at SANE with Shilo & the legendary Franz. Click hear to find out about data collection Adams is doing [here.](https://www.opioiddata.org/on-the-road-again/) We wrapped up our third and last site of a FDA-funded study on how people actually use naloxone. Through 75 in-depth interviews, we explored how many doses people use, how folks modify their risk for overdose, and other themes. Stay tuned for more on this important work. And thanks to taxpayers for funding science that saves lives. --- # 👋 Meet Our Team Members All team members play a part in making our newsletter come to life 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/IMG_6908.jpg) ## Paula Paula joined our team last year to help out during a transition period and has stuck around (guess she likes us😜). She has a depth of experience in public health and research study methodology and operations (and furbabies). --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/box-1.png) --- ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ## Like what you're reading? Get this newsletter in you inbox. Subscribe Email sent! Check your inbox to complete your signup. No spam. Always free. Unsubscribe anytime. ### Handheld or Raman device? We can help. URL: https://www.opioiddata.org/handheld-support/ Last updated: 2025-03-27T20:14:50.000Z 🤖 Did you buy a MX 908, TruNarc, or Amplifi ID (Spectra Plasmonics)? We can help you determine if our results are accurate enough to use for public health purposes. We get that the current paradigm of technician-based FTIR drug checking can be cumbersome, and folks are looking for cheaper/easier alternatives. But corporations are making aggressive marketing claims about handheld devices that are unsubstantiated. Therefore, it is encumbent on you to evaluate device performance *before* you can safely roll out your service to participants. At the heart of the matter is that these devices were designed to put people in prison by detecting a \[single\] controlled substance. In general, they may not be able to identify *all* the substances that are found in today's street drugs. For example, on average fentanyl-containing samples we test via GCMS have 4.7 *additional substances beyond fentanyl*. And the methods used in the commercial handheld devices are a black box. We owe it to our participants to provide the most accurate data possible. Lives depend upon it. --- # Independent Lab Verification So now you've got one of these devices. Here's how we can help you evaluate the accuracy. 1. We publicly register that we are going to do this analysis on [OSF.io](https://help.osf.io/article/330-welcome-to-registrations). This is so that the community of practice can learn with you. It also keeps us all accountable. 2. We work with you to figure out what kinds of drugs to sample. In general we recommend at a minimum a mix of opioids and stimulants, but also psychedelics or synthetic cannabinoids if those are likely to show up in your catchment area. 3. [Request kits](https://www.streetsafe.supply/contact), sign our terms and conditions, watch our [10-minute training video](https://vimeo.com/571816432). Then we will send you 20 kits. 4. Analyze **20 samples**, *by one technician*, using your handheld device, and put a couple of scoops of each sample into the vials in our kits. Keep track of the sample ID numbers, and report the results to us in a spreadsheet with our corresponding sample IDs. Mail us back the kits. 5. Once we get the samples, we will analyze them using GCMS (and FTIR if needed), and send you the results. 6. In addition, we will calculate [accuracy statistics](https://www.ncbi.nlm.nih.gov/books/NBK557491/) comparing your handheld results with our GCMS lab results. For this purpose, we consider our GCMS results to be the "gold standard." The stats we will calculate are: overall accuracy, sensitivity (true positive), specificity (true negative), positive predictive value, negative predictive value, likelihood ratio + and -, and ROC. 7. We will post the results of accuracy statistics to OSF.io. You are welcome to share these results. ## How much does this cost? Our pricing is [here](https://uncopioid.atlassian.net/wiki/external/Nzk4NWZhYWRlYTBkNDdlOTkzMTNlODkxNmU0ODlkNjA). Twenty kits are $400 for harm reduction orgs, and $1,200 for health departments. This includes qualitative GCMS analysis and shipping. ## How long is the turnaround? Depending on the specific contents of your samples, we expect this process to take about a month. --- # Helpful Reading These 3 resources will help you in understanding the different technologies and machines. [Considerations for New Drug Checking Technologies](https://www.drugcheckingftp.org/resources/considerations-for-new-drug-checking-technologies) from the Remedy Alliance Drug Checking team. [Considerations for Purchasing Drug Checking Technologies: Perspectives from Toronto’s Drug Checking Service - PMCWith the unregulated drug supply—particularly the unregulated opioid supply—becoming increasingly more toxic, more contaminated, and less predictable, drug checking has emerged as an essential public health service: informing individuals who use…![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-14.png)NCBI home page\*Correspondence: drugcheckingcdpe.org![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/nih-nlm-ncbi--white.svg)](https://pmc.ncbi.nlm.nih.gov/articles/PMC10418928/) [Point-of-care community drug checking technologies: an insider look at the scientific principles and practical considerations - Harm Reduction JournalDrug checking is increasingly being explored outside of festivals and events to be an ongoing service within communities, frequently integrated within responses to illicit drug overdose. The choice of instrumentation is a common question, and the demands on these chemical analytical instruments can be challenging as illicit substances may be more complex and include highly potent ingredients at trace levels. The answer remains nuanced as the instruments themselves are not directly comparable nor are the local demands on the service, meaning implementation factors heavily influence the assessment and effectiveness of instruments. In this perspective, we provide a technical but accessible introduction to the background of a few common drug checking methods aimed at current and potential drug checking service providers. We discuss the following tools that have been used as part of the Vancouver Island Drug Checking Project in Victoria, Canada: immunoassay test strips, attenuated total reflection IR-absorption spectroscopy, Raman spectroscopy from powder samples, surface-enhanced Raman scattering in a solution of colloidal gold nanoparticles, and gas chromatography–mass spectrometry. Using four different drug mixtures received and tested at the service, we illustrate the strengths, limitations, and capabilities of such instruments, and expose the scientific theory to give further insight into their analytical results. Each case study provides a walk-through-style analysis for a practical comparison between data from several different instruments acquired on the same sample. Ideally, a single instrument would be able to achieve all of the objectives of drug checking. However, there is no clear instrument that ticks every box; low cost, portable, rapid, easy-to-use and provides highly sensitive identification and accurate quantification. Multi-instrument approaches to drug checking may be required to effectively respond to increasingly complex and highly potent substances demanding trace level detection and the potential for quantification.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-582ef1d0f5.png)BioMed CentralLea Gozdzialski![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/12954_2023_764_Fig1_HTML.png)](https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-023-00764-3) ### Why you need lab support URL: https://www.opioiddata.org/why-you-need-lab-support/ Last updated: 2025-05-20T14:53:41.000Z 💡 This page goes over information that is intended to help programs discern whether an FTIR machine would be a feasible option for their organization. It goes over various considerations to be taken into account when considering starting an on-the-ground drug checking program If you have or are thinking about getting an FTIR machine and are interested in complementary testing (aka reference lab, secondary verification lab, complementary testing, secondary testing, “confirmatory”), here is a range of circumstances where a partnership with a lab might be helpful. 🌈 We highly recommend FTIR-based drug checking programs check out [this primer](https://www.drugcheckingftp.org/drug-checking-implementation-workbook/module-v-building-the-program#5-establish-secondary-verification-testing-partnership) on why lab partnership's lead to more accurate information for participants. **For FTIR-based programs, we recommend budgeting for 20% of samples in the first year to be sent for lab-based testing.** ## FTIR Quality Assurance - New technician training - Some programs require FTIR technicians to show concordance (within instrument limits) with the first couple hundred samples they run. - Random 10% of ongoing samples for quality assurance - After the first year of a program, lab needs may evolve. Some FTIR programs have annual or ongoing quality control periods for established technicians. Other programs routinely send a percent or number of samples randomly selected per month to ensure quality assurance. ## FTIR Ongoing Support Some reasons why you might want to send a sample to the lab: - The first time you see a new drug on FTIR - Liquid drugs - Low FTIR match scores for active ingredient - Unknown/unidentifiable peaks on FTIR - Distinguishing between fentanyl analogues - Suspected nitazene - Benzodiazepines - Most pills, fake or real - Organic substances (cannabis leaf, mushrooms) - No detectable opioid matches on heroin/fentanyl/dope samples - Drug mixtures that have 4+ substances - Sample FTIR spectra and library hit don't line up well ## Test Strip Accuracy - Evaluating accuracy of new vendor or batch of test strips - Evaluating accuracy of process for using test strips (dilution, etc.) - Positive test strip, but negative on FTIR (low concentration or contamination) ## Scientific Integrity - Subset validation for research publication - If you're writing a paper based on FTIR data, it gives you more credibility if you can show that you "validated" a portion of your FTIR results using GCMS or LCMS or qNMR– it can be a random 10% of the FTIR samples. It generates in 1 short paragraph in Methods and 1-2 sentences in Results. But it's helpful for getting your work published. - Here's an [open access example](https://academic.oup.com/aje/article/191/2/241/6274219) from Tobias et al. in Vancouver - Comparison/reference for new labs starting up - Got a new local lab partnership? Great! But they don't have lots of solid drug experience? We got you! Some programs will send the same samples to us and their new local lab to give you the info you need to assess confidence in working with them. - Hand-held drug checking devices - Got a new handheld device? Those usually use Raman IR technology. Put them through the paces by comparing our lab-confirmed GCMS results with the output from the handheld. --- ### February Newsletter URL: https://www.opioiddata.org/february-newsletter/ Last updated: 2025-03-28T13:30:01.000Z We’re excited to bring you our first newsletter of the year—hoping you’re settling in, finding your rhythm, and taking care of yourself ❤ --- # 🎉 10,000 samples and counting! 🎉 Since launching in 2022, our drug checking lab has grown beyond what we could’ve imagined, and now we’re celebrating over 10,000 samples analyzed! Huge thanks to the incredible programs that utilize our services and to every participant who trusts their community—and us—in this harm reduction work. We know drug checking doesn’t magically make the supply safe, but every test is a step closer to knowledge, transparency, and safer choices. Here’s to many more samples, conversations, and moments of care! 💛 --- # 〽️Service Stats & Updates As of Tuesday February 25, 2025... **10,891** samples analyzed Serving **163** harm reduction programs Reaching **240** counties in **40** states **394** unique substances identified No changes to our Watchlist, but click below to see Live Reports on cafentanil, (dex)medetomidine, nitazenes, BTMPS and more. [UNC Watchlist](https://www.opioiddata.org/unc-watchlist/) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-17.png) [Demo results page](https://results.streetsafe.supply/) ## New Results Page Coming! Since we knew we would max out our original hosting service, our software dev David has been working on a fresh new results page for months. You can check it out at and [read all about the upgrades](https://www.opioiddata.org/new-results-page/). We will be updating the original and new site- so if your results are missing, try the new URL. Bear with us through a few hiccups! The data is safe, and the GitHub won't be affected. Our service users will be receiving a questionnaire in the coming weeks so that we can update into the new system so be on the lookout for that too. --- # Peak OD Phenotypes ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-16-1.png) [Source](https://www.opioiddata.org/peak-od-phenotypes/) 🚨 In case you missed this post, you’ll definitely want to check it out! The Opioid Data Lab breaks down “Peak OD Phenotypes,” shedding light on patterns in overdose risk that could help shape better responses and interventions. If you’re interested in data-driven harm reduction, understanding who is most at risk, and how we can act on this info, this is a must-read. [Click the link to dive in!](https://www.opioiddata.org/peak-od-phenotypes/) --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. **North Carolina Harm Reduction** (NCHRC) is hiring for multiple positions. [Check them out here! ](https://www.nchrc.org/home/about/work-at-nchrc/) In case you missed it, you can check out the **FORE Webinar: Supporting Children and Families Impacted by Addiction** from 1/28/25 [here](https://www.youtube.com/watch?v=HIUYbT20qVM)! FORE is one of our generous funders that helps make our work possible! What's super cool is that it's the re-introduction of a muppet, Carli, who's mom is dealing with addiction. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-18-1.png) [People magazine](https://people.com/tv/sesame-street-addresses-addiction-karli-the-muppet/) **New Virtual Series Alert!** **Drug Policy Alliance** is bringing together experts to tackle the rapidly changing drug landscape in their four-part series, **New Drugs and Markets: Meeting the Challenge of a Changing Drug Policy Landscape.** From emerging synthetic drugs to harm reduction strategies, these panels will break down myths, explore real risks, and spark bold solutions. Don’t miss out—[register now! 🔗👇](https://bit.ly/NewDrugs1 ) We'll be presenting on March 13th! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/New-Drugs-and-Markets-Series---2025--horizontal--25--1.png) --- # What's really going on? - Canada's Take👇 🚨 What’s really in the unregulated opioid supply, and what risks do different adulterants bring? A new study led by Sam Tobias out of British Columbia analyzed over **80,000** drug samples and found that benzodiazepines and xylazine in opioids significantly increase the risk of adverse events like overdose and prolonged sedation. Understanding these patterns helps shape harm reduction strategies that meet the moment. 📊🔎 [Dive into the findings and what they mean for public health here!](https://link.springer.com/article/10.17269/s41997-024-00990-7) This was Sam's dissertation paper, so congrats!! --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! Salon: A new alternative to naloxone? 🚑 Scientists and healthcare professionals are exploring a promising option that could expand how we reverse opioid overdoses—especially in fentanyl-related cases. [Read more about this potential game-changer from Claire Zagorski!](https://www.salon.com/2025/02/06/naloxone-alternative/) MA decriminalized drug checking after conference bill reconciliations. Means no more MOUs with police departments, so no more asking permission! [Read more here.](https://www.mass.gov/news/governor-healey-signs-bill-making-substance-use-disorder-treatment-and-recovery-support-more-affordable-and-accessible) Dive into '[A Week of Chaos in Public Health](https://yourlocalepidemiologist.substack.com/p/a-week-of-chaos-in-public-health?utm%5Fsource=post-email-title&publication%5Fid=281219&post%5Fid=155537797&utm%5Fcampaign=email-post-title&isFreemail=true&r=av0k0&triedRedirect=true)' for an essential breakdown of recent public health controversies that directly impact you and your family. Dr. Jetelina offers critical context about CDC changes, mask effectiveness debates, and concerning public health leadership shifts that mainstream media isn't fully explaining. PA Groundhog: [Report Exposes Major Disruption in Opioid Supply](https://email.cloud.secureclick.net/c/36486?id=28345.166.1.83e15a7a2e909046a72d241e13ecdf71) & [PAG RELEASES NEW ADULTERANT REPORT](https://email.cloud.secureclick.net/c/36486?id=28345.164.1.57195ceb38367b0e3460d9f889ae0ddc) Stat News: [DEA unveils telehealth rules for Adderall, buprenorphine, other controlled medications](https://www.statnews.com/2025/01/15/telehealth-adderall-buprenorphine-dea-rules/?utm%5Fcampaign=rss) ### 🤓 Scientific Literature - Bufanda, L.P., et al. [Managing xylazine-involved overdoses in a community harm reduction setting: lessons from Tijuana, Mexico](https://harmreductionjournal.biomedcentral.com/articles/10.1186/s12954-024-01143-2#citeas). *Harm Reduction Journal.* 2025. - Volpe, I., & Barratt, M.J. [How do drug checking services share their findings with the public? A global review for Victoria, Australia.](https://research-repository.rmit.edu.au/articles/report/Drug%5Fchecking%5Fpublic%5Fcommunications%5Freport/28355702?file=52250453) Melbourne, Australia: RMIT University. 2025\. 📢 **This global review of communication methods and data for drug checking is awesome. We 💖 Monica and the whole team in Melbourne!** - Zoorob MJ, et al. [Drug Decriminalization, Fentanyl, and Fatal Overdoses in Oregon.](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823254) *JAMA Network Open.* 2024. --- # 🥼 Lab Visits Justin Elkins & Beth Ockerbloom from Queen City Harm Reduction, Charlotte, NC swung by to check out the lab! [Find out more about their awesome work here!](https://www.qcne.org/) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/IMG_0698-2-1-1-1.jpg) --- # 📣 Team Voices Check out monthly blog posts from members of our team! [👑 Gold Seal 🦭Erin Tracy & Jalice Manso If we continue our journey from the sample inlet downward (see last month’s post diving into the injection port), the next part of the instrument is the gold seal. This little disk is tiny, but important. Big picture orientation – once the drug samples arrive at the![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-19.png)Opioid Data LabErin Tracy![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/IMG_C0A4D940A1D2-1-1-1-1.jpeg)](https://www.opioiddata.org/gold-seal-2/) --- # 👋 Meet our Team Members Each month will feature different team members 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/IMG_6045.jpeg) ## Dmitri Fisher Dmitri's love for community and the people in his life who use drugs fuels his passion for harm reduction—because everyone has the right to autonomy plus health and care shouldn’t depend on sobriety! After volunteering with NCHRC’s SSP outreach and co-leading a naloxone training at Gillings School of Global Public Health, he’s thrilled to join the Street Drug Analysis Lab team as an intern & we're thrilled to have him! --- # 💝 Helping Out With a Donation The devastating wildfires in Los Angeles has forced 180,000 people to evacuate and severely impacted unhoused and marginalized communities. With L.A. County home to the largest unhoused population in California, harm reduction organizations are providing urgent relief and long-term support. Check their sites for immediate needs but shelter supplies, hygiene items, and financial donations always help sustain rebuilding efforts. The harm reduction community remains committed to standing with those most affected and addressing the systemic injustices that worsen these crises. [Click here to see how to donate. ](https://www.opioiddata.org/la-wildfire-donations/) --- # 🔔 Operation Reminders As we begin the new year, we'd like to share some important program reminders. Our commitment to accessibility means ensuring all participants receive timely access to their results. Please distribute the **Blue** QR code cards to everyone using our drug checking service. The people come first☺️ Regarding shipping: While we deeply appreciate your willingness to use your own supplies, we must ask that you ***exclusively*** use our provided materials (boxes, vials, etc.). And ***only*** FedEx Ground. Our program operates under specific legal and environmental requirements, so standardized shipping materials helps us maintain these compliance standards to continue serving your communities. If it's sent any other way, we risk a $10,000 fine😬 No joke. We appreciate everything that you do for your communities! 🥰 --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/IMG_7058-1-1-1.jpg) --- ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ### New Results Page URL: https://www.opioiddata.org/new-results-page/ Last updated: 2025-02-27T01:00:13.000Z With our 10,000th sample completed in January, our website’s hosting capability maxxed out. 😳 Starting last summer, our awesome software developer David has been working on a new results page that is purpose-built. We aren’t updating it on the regular yet but here's a preview. Yup, we'll still be keeping the streetsafe.supply domain name. [UNC Street Drug Analysis ResultsGenerated by create next app![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-8.ico)![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image)](https://results.streetsafe.supply) ## The old way Squarespace served us well for 3 years. Behind the scenes our original results page was just a storefront with each sample being a "product" worth $0\. We couldn't accept payments and the shopping cart was disabled. We were always worried they were gonna shut us down because from the backend we resembled a cryptomarket! We did give Squarespace a heads up and conveyed out legitimacy at the outset. And wow, it worked. Why did we have to do it this way with Squarespace? Well, because when we started out, REDCap flat out told us what we were doing is illegal 🖕🏾 Right now we enter results and card data manually into a massive shared Excel sheet. Yeah, we know it's ridic. The lab tab has 40,000+ rows for each substance detected in each sample. This system is not going to be viable much longer. ## The new way The frontend of our new platform is hosted on S3 and rendered with React, the backend is PostgreSQL data tables, and records are stored in JSON format. All this will mean is that we can deliver results faster with fewer mistakes. We also have more layers of backup and better security. David built the whole thing from the ground up! 😍 ## Improvements The new site is MUCH faster to load and search. We'll be able to build all the new features you've been asking for, like location and filtering. We'll also be able to build communications tools, like explanations of substances. And we can deliver results as APIs for those so inclined. ## Legacy Data Yup, we can keep all the old pages too. ## Blue cards? We'll update the URL linked to the QR code on the blue cards. So, folks with older cards can use them the same way, no interruption. Phew, glad we had thought of that at the outset! ## URL Replacement If you're using The new URL format will look like this: The current URL format is this: We hear some of y'all have been keeping links to samples in Excel. We got you. Once we launch you could do a search-replace to update the spreadsheet: Search “https://www.streetsafe.supply/results/p/” Replace “https://results.streetsafe.supply/sample/” ## Tell us what you think! We wanna hear from our power users. Drop is a note at opioiddatalab@unc.edu ### Peak OD Phenotypes URL: https://www.opioiddata.org/peak-od-phenotypes/ Last updated: 2026-05-11T15:46:46.000Z 📣 This post was covered on National Public Radio (NPR) [Morning Edition](https://www.npr.org/2025/03/07/nx-s1-5295618/fentanyl-overdose-drugs) and All Things Considered on Monday March 10, 2025. 💡 Overdoses seem to have dropped **abruptly* and we seek explanations. But when did declines actually start? Surprisingly, nearly all states declined gradually after peaking in 2022-3\. The revised timeline has policy implications. Yet, this is not a celebration since we continue to lose too many people we love. Instead of our standard monthly newsletter, we want to follow-up on our two [previous](https://www.opioiddata.org/are-overdoses-down-and-why/) [analyses](https://www.opioiddata.org/the-model-that-predicted-od-drop/). By: [Nabarun Dasgupta](https://www.opioiddata.org/author/nabarun/), [Colin Miller](https://www.opioiddata.org/author/colin/), [Adams Sibley](https://www.opioiddata.org/author/adams/) We were mortified at year's end when politicos did a [victory](https://www.usatoday.com/story/opinion/2024/11/26/dea-drug-deaths-fentanyl-mexican-cartels/75487168007/) [lap](https://www.whitehouse.gov/ondcp/briefing-room/2024/10/16/white-house-drug-policy-director-statement-on-latest-drug-overdose-death-data/) over declining overdose deaths. Instead, we are going with [Leonard Cohen](https://www.youtube.com/watch?v=kzWeN-bVDUc): > “But listen, love is not some kind of victory march, > no, it’s a cold and it’s a **very broken** hallelujah.” What was missing was the love: The failure to acknowledge tens of thousands of you who have served tirelessly *for years* to care for neighbors and families and patients and communities. This immense national effort. This tireless service borne out of compassion. This service the pediment upon which politicos hoist their triumphal flags. In November the head of DEA [claimed](https://www.usatoday.com/story/opinion/2024/11/26/dea-drug-deaths-fentanyl-mexican-cartels/75487168007/): "We targeted drug cartels to stop fentanyl. Now, overdose deaths are dropping." Seductively simple, bless her heart. **We find that the drop in overdose deaths started in nearly all states in 2022-23.** Most states had already reached peak OD *well before* major cross-national DEA actions (Operation Blue Lotus, Operation Apollo, Operation Plaza Strike, etc.). The declines started before the [2024 arrests](https://www.cbsnews.com/news/sinaloa-cartel-leader-ismael-el-mayo-zambada-agrees-new-york-transfer-trial/) of Sinaloa Cartel bigwigs. The "evidence" proffered by DEA for the drop is less fentanyl per pill: > The cartels have reduced the amount of fentanyl they put into pills because of the pressure we are putting on them... For first time since 2021, DEA has seen a decrease in the potency of fentanyl pills. The latest DEA laboratory testing indicates 5 out of 10 pills tested in 2024 contain a potentially deadly dose \[2 mg\] of fentanyl. This is down from 7 out of ten pills in 2023 and 6 out of ten pills in 2022. > Source: [DEA Press Release](https://www.dea.gov/press-releases/2024/11/15/deas-third-annual-national-family-summit-fentanyl-highlights-progress), November 15, 2024 ## Fentanyl purity DEA have yet to release data in support. So we asked the nation's premier private lab, [CFSRE](https://www.cfsre.org/) to fill the gap. In 2024 they quantified fentanyl, heroin, and *para*\-fluorofentanyl in n=962 samples. Purity ranged from 2.1% to 9.5% by region of the country. Over the course of the year there was no observable trend of decrease nationwide. *Editor's note: We had previously published a graph of fentanyl purity time trends by region in the email newsletter. It was removed at the request of harm reduction programs in New England.* Extrapolating purity by testing a few samples has limitations. It’s Schrödinger's Cat: High potency and low potency versions of the same batch exist simultaneously in the wild until we test them. At that point, we assume the only truth is the one observed in the lab. Let's make that tangible. When one of us lived in Philly years ago, dealers would give out free higher purity “tester” bags early in the morning to the locals. The strongest bags would benefit those selling; locals would direct monied customers from out-of-town to the corners with the most potent shit. But the con was on. By mid-morning when out-of-towners showed up, the potency per bag would have dropped as the product was diluted to extend profit. *The stamped brand on the bag would remain the same.* So, which is the true sample of purity, the influencer’s bag or the visitor’s? In complex open air drug markets, social networks and even time of day matter. Local details are always relevant. Sweeping generalizations about purity-up and purity-down are naïve. For both drugs and data, **you’ve got to know your source.** ## **Fentanyl prices** In street prices in North Carolina, we observe that 1 gram of fentanyl has gotten cheaper: $100-$140 four or five years ago, to $60-$80 today. Similarly. East Coast prices on pre-packaged bags and bundles (of 10) have also gone down significantly, from $10 bags and $80 bundles, down to $5 bags and $40 bundles. To get broader perspective, we reached out to our friends at LexiGraph who run [StreetRx.com](https://streetrx.com). The crowdsourcing website has over 440,000 data points going back to 2010, and is [used routinely](https://scholar.google.com/scholar?hl=en&as%5Fsdt=0%2C34&q=streetrx.com&btnG=) in street price analysis. We plotted street price for 1 gram of unregulated fentanyl, alongside US Customs and Border Patrol data on the volume of fentanyl border seizures. Looking at n=253 price reports from 40 states through December 2024, the crowdsourced data and what we've seen in NC are consistent. We don't see any meaningful correlation between street price and seizure volume. Do you? ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-10.png) Sources: [StreetRx.com](https://streetrx.com) and [CBP](https://www.cbp.gov/newsroom/stats/drug-seizure-statistics) In the absence of government releasing data to back claims, we aren't going to lean too heavily into these analyses because price and purity have a lot of caveats. If you have other sources, we'd love to hear about it in the comments. Onward to things we can observe better. ## Don’t miss new investigations from the Opioid Data Lab @ UNC Get our free twice a month newsletter! Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. --- # So what‘s working? In taking credit for the OD decline, politicos consistently fail to acknowledge the [Invisible Work](https://www.jstor.org/stable/10.1525/j.ctv1xxwt7) that everyone does, day in day out. It is false pride built on the work of others. Drug users have always kept each other alive, and ignored were the actual people reversing friends' and loved ones' overdoses, distributing supplies to reduce drug harms, or providing effective treatment to those in need. So that’s where we start. Specifically, Louisiana and St. Louis. Two incredibly hard working teams that changed OD rates locally, and can prove it. In epidemiology there is a nasty practice of [dismissing local work](https://pubmed.ncbi.nlm.nih.gov/31422173/) as "secular trends," and assuming interventions either had uniform impact everywhere, or zero impact. In an effort to explain the drop in overdose **individual local efforts** cannot be ignored. Especially when they can be replicated community-by-community nationwide, and when this work has been going on quietly for years. --- ## Louisiana ![the sun is setting over a swampy area](https://images.unsplash.com/photo-1653835654515-e6a14c1beb00?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wxMTc3M3wwfDF8c2VhcmNofDl8fCUyMmxha2UlMjBjaGFybGVzJTIyfGVufDB8fHx8MTczODc3NzU2Mnww&ixlib=rb-4.0.3&q=80&w=2000) Photo by [Lori Stevens](https://unsplash.com/@lancetraveler60) / [Unsplash](https://unsplash.com/?utm%5Fsource=ghost&utm%5Fmedium=referral&utm%5Fcampaign=api-credit) Located in the southwestern heel of Louisiana is Calcasieu Parish. During 2020 and 2021 the volume of fatal overdose cases was doubling, and many people had been seen at the Lake Charles Memorial Hospital emergency department for a non-fatal overdose, prior to a fatal overdose. In 2021, a team of concerned clinical and public health practitioners reached out to the [BRIDGE](https://bridgetotreatment.org/addiction-treatment/ca-bridge/) program in California. Big shout out to Sarah Windels and Arianna Campbell who helped the local hospital establish an instance of their groundbreaking model, providing technical assistance for hospitals to start prescribing buprenorphine in the emergency department. (Reach out to them! They can help.) Other interventions followed, including but not limited to widespread naloxone distribution, both at the hospital and community level with amazing harm reduction partners [SWLA Do No Harm](https://www.swlahec.org/swla-harm-reduction). The key thing was that the community was now activated, and they were adapting scientifically proven interventions to local needs. In a presentation at NACCHO360 in 2024, Traci Hedrick and Melissa Stainback presented this slide (shared here with permission). Overdose deaths went down from 100 in 2021 to around 50 in 2024\. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-13.png) Source: Calcasieu Parish Coroner’s Office You can see the whole presentation here: [Louisiana BRDIGE presentation at NACCHOJuly 2024, Detroit, MichiganNACCHO360\_Louisiana-BridgePPT\_7-25-2024.pptx.pdf9 MBdownload-circle](https://www.opioiddata.org/content/files/2025/01/NACCHO360%5FLouisiana-BridgePPT%5F7-25-2024.pptx.pdf "Download") We reached out to Stainback and Dr. Lacey Cavanaugh for an update. Partners at the local Office of Public Health and Imperial Calcasieu Human Service Authority lead [Louisiana BRIDGE](https://imcalhsa.org/louisiana-bridge-program/). They are replicating their early success in other health systems: CHRISTUS Ochsner St. Patrick and Lake Area, West Calcasieu Cameron, and Ochsner American Legion hospitals in Lake Charles, Sulphur, and Jennings. They're working on a formal evaluation, so follow their work. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-11.png) The people who do the actual work. 🏩❤️‍🔥 There is no possible way you can convince us that this effort isn't making a difference. This is not some passive background process; this is a front and center way this community has risen up to the challenge and persevered. --- ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-63.png) Source: Dr. Rachel Winograd ## St. Louis Missouri stands out as having one of the [top naloxone distribution systems](https://ajph.aphapublications.org/doi/10.2105/AJPH.2024.307893) nationwide. They achieved unprecedented scale and saturation through fiscal responsibility: The state purchased less expensive generic forms of naloxone, and distribution channels heavily prioritized networks of people who use drugs, in order to ensure that the naloxone was actually being used. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-67.png) Source: Dr. Rachel Winograd In addition to naloxone, Missouri's [Medication First approach](https://www.sciencedirect.com/science/article/pii/S2949875925000013) to opioid use disorder, [expanded telemedicine](https://journals.sagepub.com/eprint/DN9MEBR6WTWSMXH6BTTH/full) services, and [work with first responders](https://link.springer.com/article/10.1186/s40352-024-00309-1) shows a broad community that is engaged and implementing scientifically proven strategies in a way that fits them locally. Sound familiar? Here's the impact. In 2024, compared to the same months in 2023, overdose deaths in Missouri dropped by 23%. And it wasn't just opioids. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-27.png) [Source](https://mimhaddisci.org/missouri-statewide-reports): Univ. of Missouri St. Louis > **The most significant reductions occurred in the St. Louis region, where overdoses among Black residents dropped by almost 50%.** These positive trends are hopefully a testament to targeted investment to serve Black communities with a comprehensive continuum of drug prevention, harm reduction, treatment, and recovery services. ([source](https://mimhaddisci.org/stl-area-drug-involved-deaths)) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-25-1.png) [Source](https://mimhaddisci.org/stl-area-drug-involved-deaths): Univ. of Missouri St. Louis ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-68-1.png) Source: Dr. Rachel Winograd We’ll get to [disparities](https://www.kff.org/mental-health/issue-brief/opioid-deaths-fell-in-mid-2023-but-progress-is-uneven-and-future-trends-are-uncertain/) when we go deep on Pennsylvania and Indiana below. ## All the Light We Cannot See We'll miss seeing these stories if we obsess over a *single cause* for the OD decline. Our minds crave a tidy explanation, but the unstated cost of simplicity is the implication that *all these things* folks are doing aren't effective. [Psychologists point out](https://www.youtube.com/watch?v=%5FlSTkk5dtn0) that the more distant we perceive the *cause* of a problem, the less empowered we feel to affect change. We highlight two key things connecting Calcasieu and St. Louis. First and foremost is community action, as we've [seen before](https://journals.sagepub.com/doi/full/10.1177/1524839918756887). Motivated people with solid local leadership, made real changes. Second, these communities relied on strategies proven to work elsewhere and adapted them locally. How do they know the results are real? Simple: In small towns and midsized cities you actually *know* the people you’re helping. Sure, numbers confer legitimacy, but the real metric is fewer holes in the fabric of our communities. --- # A sudden drop? Turning back to national numbers, yeah we get it, mortality data have [many problems](https://www.opioiddata.org/deep-dive-overdose-mortality-data-caveats/). We don't know when the next update will come, but let's look at the data we have. **The national overdose death count *seems* to have peaked in July/August 2023\. So it *appears* as if the reduction in overdoses was sudden. This *perceived* precipitous fall has been central to hypotheses about a single, national, sudden cause.** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-53-1.png) [Source](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm): CDC --- # Simpson's Paradox, revisited Now is an excellent time to refresh [our earlier warning](https://www.opioiddata.org/are-overdoses-down-and-why/#:~:text=Paradox) about **Simpson's Paradox**. TLDR: In the national aggregate, earlier OD decreases in smaller population states may be masked by simultaneous increases in large population states. Put another way, relying on the national aggregate obscures trends happening locally. ![](https://media.tenor.com/5ZaqLMiW4BkAAAAC/homer-dynamite.gif) And this is exactly what transpired. Most states hit peak OD and started declining in 2022 and early 2023\. Some larger volume states started declining in July/August 2023 (CA and NY) amplified by mid-population states (like NC). Collectively these changes started to visibly bend the curve nationally. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-8.png) Source: UNC Opioid Data Lab using CDC data "Bend the curve" is giving us flashbacks, ugh. --- # What exactly are we counting? The [official overdose graph](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) that drives so much of policy and public discourse is officially titled: "12 Month-ending Provisional Number of Drug Overdose Deaths." It displays "predicted" and "reported" values. Let's unpack: "**predicted**" means CDC is running some very reasonable (and disclosed) math to fill in known reporting lags–specific to overdose deaths. The "provisional" part is related, and a designation before states finalize autopsy results. "**reported**" means the final official data coming from the states directly, for all deaths. "**12 Month-ending**" means that the number on the vertical axis is the cumulative sum of deaths that happened during the preceding 12 months. But, usually when we see monthly time graphs we expect each data point to be the count for that month. The official graph uses a convention that is atypical: Horizontal axis = calendar ***month*** Vertical axis = ***yearly*** count This matters!! A lot. Understanding this is key to the timing (and hence possible causes) of overdose decline. --- # 🛼 Smoothing inertia Under the hood, the national OD number is actually "smoothed." In epidemiology we could call it a *cumulative sum of 12-month rolling windows*. It sounds awkward because it is! It's the total number of people who died of overdose in the previous 12 months. So June and May share 11 months of identical data, with one new month added, and the oldest month lopped off. Smoothed metrics are, by design, intended to reduce noise by leveling out peaks and valleys to reveal patterns. It prevents panic from small ups and euphoria from small downs. But, smoothing also generates **inertia**: *It delays when we observe the start of a downward trend*. This matters because if OD declines started before August 2023, then our universe of possible *causes* will expand. Smoothing inertia also hides sudden upticks. One reason why we are going into detail here is for the future: The same smoothing process could also obscure or delay when we observe potential increases in OD fatality, say from nitazenes or carfentanil. Look, it’s just math. And nothing more complicated than addition. This isn’t an evil algorithm. It’s not a conspiracy. All the data and methods are public. Smoothing is commonly done in other domains and reasonable. So before we can identify "peak OD" or when overdoses started to decline in each state, we have to understand the effect of smoothing. ## 4 States in Focus Arizona, Pennsylvania, Nevada, Indiana ## Arizona Let's look atArizona to see smoothing in action. The official graph looks like an increase coincident with COVID restrictions, a plateau, and decline starting in late 2023\. As you can guess, this isn't quite right. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-33.png) [Source](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm): CDC We [remade the dashboard](https://deepnote.com/app/opioiddatalab/WONDER-vs-12-month-Predicted-OD-data-ce7d8424-642b-490e-b484-ef63058a2a98?utm%5Fcontent=ce7d8424-642b-490e-b484-ef63058a2a98&selected%5Fstate=Arizona) and added overdose fatality data by month. (Thanks to Svetla Slavova at University of Kentucky for the idea!) Below, the violet 💜 line is official data from the [CDC overdose dashboard](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm), the same exact data as the graph above. Below, the orange 🍊 line is the *monthly* count of final certified overdose deaths, aka the messy "truth." But it takes years for those data to post. We downloaded them from [WONDER](https://wonder.cdc.gov/), where they go through 2023\. The Carolina blue-ish 🩵 is a *yearly* line we calculated ourselves by summing the monthly 🍊 "truth" data, a recreation of the *yearly* violet 💜 prediction. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/newplot.png) [Source](https://deepnote.com/app/opioiddatalab/WONDER-vs-12-month-Predicted-OD-data-ce7d8424-642b-490e-b484-ef63058a2a98?utm%5Fcontent=ce7d8424-642b-490e-b484-ef63058a2a98) UNC Opioid Data Lab Follow the 🍊 line by month. In Arizona overdoses consistently spike in July. Every year, summer months see an 150 extra deaths... from Sonoran Desert heat? But the 12-month cumulative annual lines 🩵💜 make the peaks disappear. It also artificially elevates the monthly OD rate, a phenomenon called [seasonality](https://pmc.ncbi.nlm.nih.gov/articles/PMC9557844/). *Behold, smoothing.* If you’re providing direct service, which line, orange 🍊 or violet 💜, more accurately represents your experience? You're probably hustling to deal with a serious spike in overdoses in \~July each year. The rest of the year, Arizona has fewer ODs than other states (thanks in good part to an [effective naloxone distribution network](https://www.thelancet.com/article/S2468-2667%2821%2900304-2/fulltext)). A smart policy response would be to surge efforts in the hot summer months, as well as understanding the nexus of heat and dehydration and housing and overdose. Here's more up-to-date data from the Arizona state health department. In 2024 they saw the usual monthly spike in opioid overdose deaths in July, with the last 4 months of data incomplete. (Note: this is only opioid ODs, whereas our app is all drug ODs.) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-35-1.png) [Source](https://www.azdhs.gov/opioid/dashboards/index.php?ref=opioiddatalab.ghost.io#overdose-deaths): AZ Dept. of Health Services ### What could account for the decline? Starting in October 2024, there was a huge increase in the number of reported administrations of naloxone: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-41.png) [Source](https://www.azdhs.gov/opioid/dashboards/index.php?ref=opioiddatalab.ghost.io#overdose-deaths): AZ Dept. of Health Services Once the CDC WONDER data for 2024 are released, we'll be able to see if the predicted decline in violet 💜 is even more precipitous during the period of high naloxone reversals. On the other hand, summer 2024 was hotter than usual, so any hypothesis needs to account for seasonality. To figure out what's causing the decline in overdose, the smoothed 12-month data are simply inadequate. The monthly WONDER and state data are more scientifically defensible. Both are public CDC datasets. It's up to us to choose the right one in making assertions. Our takeaway: We have to look at raw local data, and measure alternative hypotheses, and must analyze things with granular time periods. **Ascribing a single national explanation for the drop in overdoses is not grounded in data.** --- ## Pennsylvania We'll use the Keystone State to make two points: 1) additional detail afforded by querying state data in tandem; 2) the impact of metric used to measure peak OD. Pennsylvania is an "early peak" state, with a first increase in overdose deaths *prior* to COVID, and then a later increase during the second year of the pandemic. From a peak in October 2021 with 5,622 annual deaths, by August 2024 the predicted annual count was 3,820, representing a whopping -32.1% decline. Starting with the official 12-month cumulative graph: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-14.png) [Source](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm): CDC Despite the declines in overdose ***fentanyl hasn't gone away.*** The [state dashboard](https://public.tableau.com/app/profile/pennsylvania.pdmp/viz/PennsylvaniaODSMPDrugOverdoseSurveillanceInteractiveDataReport/Contents) shows that 76.7% of overdoses deaths in 2023 involved fentanyl. In the "early peak" in 2017, hardest hit were young men, both White and Black races. After that, OD mortality started falling among Whites, but *doubled* among Blacks during COVID. Rapidly updated state dashboards are critical public health infrastructure, especially to understand what drugs are involved, who’s impacted, and who's left behind. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/PA-od-demographics.png) [Source](https://public.tableau.com/app/profile/pennsylvania.pdmp/viz/PennsylvaniaODSMPDrugOverdoseSurveillanceInteractiveDataReport/Contents): PA Department of Health Back in [our app](https://go.unc.edu/oddata) we can see the benefit of plotting the smoothed cumulative CDC data 💜 below because it allows us to see the peak in 2017 compared to our 🩵 recalculated. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/newplot--13--2-1.png) It's clear that the highest single month of confirmed deaths 🍊 was **May** 2021\. However, the smoothed lines 🩵💜 make it *seem* like ODs peaked in **November** 2021 instead. This brings us up a central question: ***When do we start the clock for measuring a decline from peak*?** Worst-Month-Ever 🍊 is legit, but Worst-Year-Ever 💜 is also valid. In our conversations it seems folks are using 💜 to ascribe causes for the decline. If we go with the latter 💜 then the peak appears to be *six months* *later* than the actual 🍊 peak. (We will revisit this 6-month lag later 📌.) --- ## Nevada Cumulative smoothing also amplifies bad months when they happen in close succession. You know how on the [CDC map](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) Nevada looks like a major outlier where ODs are increasing? But actually, the picture in Nevada may not be so bleak. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-22-1.png) Follow the orange and purple lines below. Two bad months (March and July 2023), that sucks. 😔 The nature of the smoothing makes it so that when there are a pair of big single-month spikes, the official purple line stays elevated for *a year* afterwards. Seasonality aside, spikes are very likely to be related to changes in the drug supply. On the other hand, sustained elevated ODs are likely to be fundamental behavioral or social causes. **Spikes and smoothed lines can tell us different stories about overdose causes.** So, in order to evaluate what is causing the decline, we need to disentangle spikes and sustains. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/newplot--3--1.png) [Source](https://deepnote.com/app/opioiddatalab/WONDER-vs-12-month-Predicted-OD-data-ce7d8424-642b-490e-b484-ef63058a2a98?utm%5Fsource=app-settings&utm%5Fmedium=product-shared-content&utm%5Fcampaign=data-app&utm%5Fcontent=ce7d8424-642b-490e-b484-ef63058a2a98&selected%5Fstate=Nevada) UNC Opioid Data Lab A solution is to go local. Below are Nevada's 2024 hospital ED data for comparison. The state's data (plotted on a proper monthly axis, ha!) show that OD rates have been DECREASING. Assuming mortality is similarly trending, on the CDC website we expect it will take \~6 months from now for the smoothed line to start dropping, and that orange color on the map to cool to blue. But ODs already started declining in June 2024\. So for a whole *year* the smoothing inertia could fuel a misinformed narrative. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-24.png) [Source](https://nvopioidresponse.org/initiatives/od2a/): Nevada OD2A So, we built an app for ourselves to look at trends by month. Alaska, Nevada, Washington, Oregon – states that appear to be rising in the smoothed data may already be on the downturn. Link below or [go.unc.edu/oddata](https://go.unc.edu/oddata) [WONDER vs. 12-month Predicted OD dataData apps for data scientists and data analysts.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-11.png)DeepnoteOpioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/social-image-3)](https://deepnote.com/app/opioiddatalab/WONDER-vs-12-month-Predicted-OD-data-ce7d8424-642b-490e-b484-ef63058a2a98?utm%5Fcontent=ce7d8424-642b-490e-b484-ef63058a2a98) 💪 Let us be clear: We are deeply appreciative of NCHS staff who assemble this public dataset for all our benefit. We have faith in the national vital statistics system. The technical details we expound upon are explicit in the public methods notes and, we are only pulling from public data. The data aren’t fundamentally wrong. Rather, it is incumbent upon us to select the most appropriate metrics to evaluate possible causes for OD declines. --- ## Indiana Last example is a state that peaked early and had a dramatic decline. Seems like something good is happening in the Hoosier State? Comparing the official graph with [our app](https://go.unc.edu/oddata), smoothing erases the early-COVID increase in May-July 2020, making it seem later and shallower than reality. Overdoses peaked in February 2022, with some monthly spikes like in July-August 2023\. Are the spikes "just noise" or do they represent fluctuations? ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-47.png) [Source](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm): CDC ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/newplot--7-.png) Source: UNC Opioid Data Lab (The near perfect overlap between 🩵 and 💜 indicate this is a high quality and timely data reporting state.) The [state dashboard](https://www.in.gov/health/overdose-prevention/overdose-surveillance/indiana/) and [state report](https://www.in.gov/health/overdose-prevention/files/2023-Indiana-Overdose-and-Suicide-Report-%5FFINAL.pdf#page=17.13) confirm the pattern above, and also provide data by race. Among Whites, the OD rate fell by 19% between 2022 and 2023 to 30.6 per 100,000, bringing it right in line with the [national average](https://www.cdc.gov/nchs/products/databriefs/db522.htm) of 31.3\. The good news is that among Blacks the OD rate fell by 14%. But astoundingly, that drop still means that a rate of 55.3 is **77% higher than the national average**. The number of Hispanic/Latino OD deaths jumps around wildly. Suicide rates among Whites are much higher than other races. We must pay attention to who is being left behind. And it's not just race x overdose. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-49-1.png) [Source](https://www.in.gov/health/overdose-prevention/files/2023-Indiana-Overdose-and-Suicide-Report-%5FFINAL.pdf#page=17.13): Indiana Department of Health ### The Drug Bust Paradox Could the [Drug Bust Paradox](https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307329) be playing out in Indiana? This [causal model created by a former police chief](https://papers.ssrn.com/sol3/papers.cfm?abstract%5Fid=5017462) lays out how drug busts can actually increase overdose. Want evidence? [This study](https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307291) showed that overdoses *increased two-fold* in Indianapolis when drugs were seized by law enforcement in 2020 and 2021. In the other direction, the number of substance abuse counsellors sharply increased in Indiana before the increase in overdose. We wonder about cause and effect. Could increased treatment providers in 2018-20 have a delayed impact driving down overdose rates in 2022-24? ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-50.png) [Source](https://justicereinvestmentinitiative.org/wp-content/uploads/2024/01/Indiana-Criminal-Justice-Data-Snapshot%5Faccessible.pdf): US Department of Justice Or what about Indiana having [relatively high pharmacy dispensing of naloxone](https://www.cdc.gov/overdose-prevention/data-research/facts-stats/naloxone-dispensing-rate-maps.html)? What about the incredible work of [Indiana Recovery Alliance](https://indianarecoveryalliance.org/) reaching those left out? **Our takeaway is that we cannot simply ignore local impacts; the cumulative effect of interventions cannot possibly be zero. It may be modest, but not zero.** --- ## Peak OD A fresh look at declines by state To postulate causes of overdose decline, we first must mark the month *when ODs started declining* by state. We operationalize this by finding the month with the highest number of drug overdose deaths by state from the smoothed data. So let's recast the data in the official all-USA line graph as a heatmap. This representation will allow us to quickly compare across states. ([Here's the code](https://github.com/opioiddatalab/overdosedata) if you want to Python along at home.) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-13.png) By longstanding convention, data scientists *always* plot values at the mid-point of the range. But the official line graph does not. Meaning, the dots on the line could reasonably be shifted six months backwards. Why? Because one dot actually represents an entire 12-month interval. And the midpoint is 6 months prior. Of course, this invalidates some of the point of having speedier provisional data! If monthly predicted counts had also been released this would not be an issue. With the heatmap we can represent this with more fidelity: The orange box is the 12-month smoothed window leading up to the orange line. In the heatmap below each row is a state. Time (month) is horizontal, from January 2020 to July 2024\. Each box in the plot area represents overdoses by state-month. We set the darkest purple to be the highest peak for each state. Purple 💜 = Peak. (Mathematically color intensity purple-to-white represents the percent difference in the absolute smoothed cumulative number of overdoses in a given month, compared to the peak month for that state. We remake the heatmap using a different metric later.) Rows are ordered vertically from earliest to most recent peak OD month. Blur your eyes and you can see a dark purple diagonal going from middle-top to bottom-right. That's peak OD month in each state, made more explicit with a hand drawn orange line along this spine of color density. Imagine what a *sudden* drop in overdose would look like spread out over states: The orange line would be *straight up and down*. We could then correlate this date to a national policy change, international action, or sudden drug supply shift. But we see a undulating orange trend line of peak OD month instead. Y'all, the drop was not sudden! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/state_odmortality_heatmap_plain_high_res-5-1.png) Smoothed 12-month cumulative mortality by state, January 2020 to July 2024 Now we set it all together with orange boxes marking the highest overdose month 🍊 in each state from confirmed data. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/state_odmortality_heatmap_high_res-7.png) [Download high resolution heatmap of peak ODReuse license CC BY-SA 4.0 Attribution-ShareAlike 4.0 Internationalstate\_odmortality\_heatmap\_high\_res.png564 KBdownload-circle](https://www.opioiddata.org/content/files/2025/01/state%5Fodmortality%5Fheatmap%5Fhigh%5Fres-1.png "Download") **Wait wait wait wait wait.** Did overdose deaths start peaking in states \~3 years ago, but we are just now only learning about it? 😳 --- ## Phenotypes of Decline Patterns emerge! We have to ask **when, how,** and **how long** about overdose peaks. We can start to see *some* patterns in how overdose mortality has evolved in the past six years (though we are not conjecturing about the **why** here). **Example one**: A linear increase in deaths that's just peaking (or yet to peak). Here's Washington, Oregon, and Alaska: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-30.png) Washington, Oregon, Alaska **Example two**: States where surges *preceded and continued through* the COVID-19 pandemic, peaked, then dropped: Connecticut, Iowa, and Florida. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-16.png) Connecticut, Iowa, Florida **Example three:** States where mortality surged suddenly *during* COVID then flattened into a sustained peak before dropping. Kentucky, Virginia, and Tennessee had precipitous rises during the first year and a half of COVID then had sustained peakedness (platykurtosis for the wonks) for two years before dropping. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-17.png) Kentucky, Virginia, Tennessee **Example four:** States where mortality surged sometime *during* COVID (broadly construed), had a rather quick peak, then declined. Indiana, Georgia, and North Carolina exhibit this pattern (with Indiana peaking earliest of the three). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-18.png) Indiana, Georgia, North Carolina Are these patterns indicative of anything or merely coincidence? After all, some states have unique trend lines – like Arizona (clear seasonal trend), Idaho (ostensibly resistant to the 2020 COVID surge), and South Dakota (too sparse data and noisy to detect a pattern). We're not ready to model these data and offer the reminder that we should be looking to **states and communities to guide our answers.** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-19.png) Arizona, Idaho, South Dakota --- ## Geographic Patterns Putting it all together **Drugs don't sweep across the continent like weather fronts.** **Instead, it's more like stones skipped across a pond.** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/weather-front-small.gif) Hand drawn by our amazing resident illustrator [Brittain Peck](https://brittainpeck.com/) Yes, there was a general east-to-west directionality to the spread of fentanyl, but for *most* of the country the pattern was more erratic. To visually compare states, we used the 12-month smoothed data to create another visualization. We plotted [z-scores](https://en.wikipedia.org/wiki/Standard%5Fscore) of monthly overdose counts from January 2020 to August 2024, by state. ([data and code](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/mw22vm70m?locale=en)) Z-scores set the state mean overdose count to zero; positive values (red) indicate higher than average, negative values (blue) are lower than average. Each integer represents one standard deviation away from the mean in either direction. (Thanks to Michael Gilbert for feedback on visuals!) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/sparkline-legend.png) Legend for figure below using one state as demonstration. [Source](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/mw22vm70m?locale=en): UNC Opioid Data Lab The grey horizon line is that state's average "monthly" overdose count. We can also look at differences in height from pre-COVID baseline compared to August 2024\. Similarly we can look at difference from highest peak height to most recent point to get the change from the worst 12-month period. ([data & code](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/mw22vm70m?locale=en)) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/allstates-1.png) [Source](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/mw22vm70m?locale=en): UNC Opioid Data Lab We debated on whether to plot these in time as-specified by CDC, or whether to stagger back 6 months, which would be equally scientifically justified. We chose the former for the sake of transparency, but intentionally focus attention on curve *shape*. High resolution version of graphic can be downloaded here: [Graphic depicting overdose trendlines by statesSmoothed 12-month cumulative overdose count z-scores.allstates.png1 MBdownload-circle](https://www.opioiddata.org/content/files/2025/02/allstates.png "Download") --- ## Return to pre-pandemic baseline There are **19 states**, as of August 2024, that were near or *even lower* than their January 2020 pre-COVID pandemic baseline. States already lower are: NH, CT, MA, NJ, DE, MD, PA, NC, OH, MI, IL, and NE. States close and trending to pre-pandemic baseline: VA, WV, FL, IN, WI, AR, and MO. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/precovidbaseline-1.png) States with OD counts near or below pre-COVID baseline. [Source](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/mw22vm70m?locale=en): UNC Opioid Data Lab Too many people we love are still dying. A return to a pre-COVID baseline in overdose rates is not a pure victory, because ODs were too damn high before the pandemic. And we strongly caution that sudden changes constricting fentanyl (or xylazine) supply could [predictably](https://pubmed.ncbi.nlm.nih.gov/28735773/) lead to rapid expansion of more potent opioids and sedatives; we are tracking: [nitazenes](https://deepnote.com/app/opioiddatalab/Nitazene-tracker-bf05bd9a-a8e1-448f-9e56-87615fd02bde), [carfentanil](https://deepnote.com/app/opioiddatalab/carfentanil-0e647c95-ec05-4dd9-8ec8-3f2d1b1765b9), [bromazolam](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3?selected%5Fsubstance=bromazolam), and [dex(medetomidine)](https://deepnote.com/app/opioiddatalab/dexmedetomidine-Tracker-a401c37e-5255-4d15-87a1-252ee09f360d). We caution that we are at a critical time with improvements that are fragile. Abrupt changes in drug policy could perturb the balance and reverse these encouraging gains. [Scientists](https://pmc.ncbi.nlm.nih.gov/articles/PMC10414597/) have pointed out [inconsistency](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2829860?resultClick=3) in linking the start of COVID to overdose increases. But we lived through that chaos, many of us providing direct services. The graphs above may explain the disconnect. First, overdoses didn't spike *everywhere simultaneously* in Spring 2020 precisely. In some places (NH, DE) there was a drop. A second wave occurred during 2022 (WI, MI) and another in 2023 (AL, VA). How we define the "COVID period" is subjective: A point in time pursuant to a government declaration? Or, a mini-era of misery. What is factual is that ALL states had increases in overdose deaths after March 2020\. Some states had an A-shaped single peak, others had two M-shaped peaks. --- ## A-shapes: Single-peak states In 15 states we saw what appears to be a single large peak before ODs started to decline: ME, AR, OK, FL. IN are clear. Some of these may be two overlapping peaks close together in time; hard to tell from smoothed data (NC, AL, NY and OK could well be biphasic.) Still, any explanation of the cause(s) for OD declines has to contend with understanding what was happening on the ground in these places. Spurred by the uptick, could there have been a strong community response and effective interventions that led to the decline? Maybe. We can't discount that possibility. Or was there an abrupt change in the drug supply that led to the increase, and then another change (or reversion) that precipitated the decline? For example, we hear in some places that plant-grown heroin is making a comeback. In others, the downward slope is coincident with the establishment of xylazine. The takeaway: To understand causes of increase or decline, there are other factors that need to be measured independently. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-6.png) A-peak states. [Source](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/mw22vm70m?locale=en): UNC Opioid Data Lab Is state even the right unit of geographic measure? Oklahoma and Texas have similar trajectories, but nearby Arkansas is different. For overdose death *counts,* much of the volume comes from *cities*. Ergo, aggregating by state is suspect, albeit convenient. **County-level data would be preferable.** Alas, county-month data are not easily accessible. The process for getting county-month data from CDC is replete with well-meaning-but-arcane data suppression rules (less than 5 deaths? 🙈 No data!). And you're limited to what you can say publicly because you can't share the data. And the data are delayed by 3 years. And there's a lengthy application process. Bummer, dude. In the national interest, it's time NCHS was unbound from these antiquated rules. (Chris Delcher at the University of Kentucky has a [great report](https://journals.lww.com/stdjournal/abstract/2023/08000/balancing%5Fdata%5Fprovision%5Fand%5Fdata%5Fprotection%5F%5Fa.4.aspx) on this.) As an aside, we were struck by the similarity between Washington and Oregon. Those curves are so nearly identical that we looked back to source to make sure things are coded correctly. (They are.) [Others have shown](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823254), in much more sophisticated analyses, that there's no direct observable impact of M110 in Oregon on overdose deaths once you de-trend for the appearance of fentanyl. The similarity of the curves between WA and OR offer visual support. --- ## M-shapes: Two peak states One of the most perplexing facets of explaining the OD decline are that some \~20 states show multiple peaks, separated by months if not years. Utah and West Virginia are perfect examples. When we evaluate causes of "the decline," which decline is it that we are talking about? ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/twophase.png) Biphasic overdose pattern. [Source](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/mw22vm70m?locale=en): UNC Opioid Data Lab That many of these second peaks happened around the same time in early 2023 suggests maybe there is a strong supra-state acting force. Could this be related to changes in drug supply? Pinpointing exactly when the second wave happened gets us back to smoothing. If the second peak shows up in mid-2023 in the smoothed cumulative data, then the real peak probably happened \~6 months earlier. The [example above](https://www.opioiddata.org/peak-od-phenotypes/#pennsylvania) 📌 from Pennsylvania is textbook. That puts us around the 2022-2023 calendar year boundary for the second peak, instead of mid-2023. --- ## East to West Yes, states with declines are mostly in the east and center of the USA. Yes, some of these are places where unregulated fentanyl had purchase earlier than the West. But declines are inconsistent. Why would states decline even as fentanyl lingers? Some geographic patterns are puzzling. Even nearby states had OD death peaks separated from each other by *years*. See Maryland versus DC. We may be seeing the imprint of distinct drug distribution networks, customer preference, and/or impact of local interventions (including interdiction). But we can't tell from the overdose data *when* fentanyl started dominating the local drug supply. Luckily Zoorob et al. did that work, encapsulated in the graph below: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/image-2.png) [Source](https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2823254) Zoorob et al: Changepoints when fentanyl started to dominate local drug supply using DEA NFLIS drug seizure data. The takeaway is that some (not all) states where fentanyl was established earliest, in New England and the Mid-Atlantic, are also showing the most prominent declines in 2024\. But NE, AR, MI, MO don't fit the pattern. And these data do not speak to age, urbanicity, race, or other demographic factors. And some of these are large states where aggregating makes little biological sense (e.g., Pittsburgh vs. Philadelphia) given differences in local drug supply (which we've observed in our drug checking). --- ## Smoothed vs. monthly trends We can recast the z-scores as heatmaps. On the left is smoothed 💜 and on the right monthly 🍊 confirmed. Vertical ordering is intensity of decline in recent months (negative z-scores). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/zscore-heatmap-smoothed.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/02/zscore-heatmap-month.png) Source [(code)](https://github.com/opioiddatalab/overdosedata/blob/main/z-score%20heatmaps.ipynb): UNC Opioid Data Lab using CDC NVSS and WONDER data In the 🍊 data on the right you can clearly see the run of dark red blocks in half of states representing the instant spike in May 2020 at the onset of COVID. But that spike is erased from the smoothed graph on left. On the right you can see the effect of CDC data suppression rules (less than 5 deaths that month) that leave white holes in data for NE, ND, SD, WY, MT, HI. There is no chance for deductive disclosure here, and this antiquated rule needs to go. New Jersey, Pennsylvania, Maryland, Ohio, Massachusetts, and New Hampshire stand out as having had the steepest declines in the first half of 2024\. While these are places where fentanyl emerged earliest (red on top left of smoothed graph), that emergence happened before 2017 (according to Zoorob et al.), yet the worst period in these states came years later. On the bottom right of either plot are \~10 states where fentanyl established itself late. In between the top 10 and bottom 10, there are 30 states where the geographic pattern of a east-to-west spread gets thoroughly jumbled. Texas and New York started their declines late, putting a serious damper on a simple east-to-west narrative. While the narrative may hold for parts of New England/Mid-Atlantic and the west coast, for millions of us not living in those regions, the fentanyl sweep explanation doesn't hold. Neither does the idea of attrition (depletion of susceptibles) through death. --- ## Implications for Analysts Also news organizations Historically our shorthand for the rise and fall of national drug crises distilled down to dangerously simple explanations, see the "[crack babies](https://pmc.ncbi.nlm.nih.gov/articles/PMC1681748)" fiasco. Years later when data became available, scientists refuted or added color (ha!), revising our collective understanding. Directly impacted people and service providers did not benefit from insights, calling into question the importance of the "research" enterprise. Is the current blowback against academia any surprise? The slow pace of inference was further removed from the public by being hidden behind paywalls. In the meantime, a dominant public narrative flourished based on anecdotes and reinforced by our mental expectations. This is the first major drug crisis that has emerged and appears to be peaking🤞🏾in the era of modern empirical data. It’s time we use more advanced methods and publish our results quicker. (We see you instrumental variables, ARIMA, and counterfactual models!) We showed how localized measurement of interventions is doable with secondary data [a decade ago](https://injuryprevention.bmj.com/content/24/1/48), continuing now with [CORE NC](https://ncopioidsettlement.org/) tracking opioid settlement spending. If public health hadn’t been so fixated on the narrative of inexorable increase (“fentanyl potency explains everything!”), we could be carrying better tools now to assess causes for the downturn. Like hiking poles more useful hiking down the mountain than the climb up, we need different tools to understand inflection points and declines. A few years ago we participated in a national seasonal influenza [forecasting competition](https://www.cdc.gov/flu-forecasting/about/index.htm). The best models were excellent at predicting upwards and downwards slope trajectories once they had begun. But they all sucked at predicting changes of direction, and failed to pinpoint the week in which flu would peak. The same cognitive and mathematical biases operate with overdose prediction. Here's our recommendations for analysts: - **Sensitivity analysis required.** We urge utmost caution using pre-smoothed 12-month cumulative provisional data in time series analysis. At a minimum, sensitivity analyses should adjust back the date to the midpoint of the range, shifting 12-month smoothed values back in time by 6 months. Whenever possible, use confirmed data by month. - **Cross-check national trends using state dashboards.** [Here's a list](https://cchi.web.unc.edu/opioid-dashboards/). Encourage your state Tableau heroes to update dashboards quickly and make the data downloadable. - **Test assumptions.** When doing interrupted time series or changepoint (segmented) regression, be sure to test assumptions of linearity. Two-peak states may require modeling techniques like splines. - **Pay attention to outliers**. There are many states that don't follow expected east-to-west or fentanyl emergence patterns. We aren't just flyover states. - **Embrace modern modeling.** Go beyond the flawed comfort zone of logistic regression, and simplistic pre-/post- frameworks. Testing single-cause hypotheses without multivariable adjustment for competing causes is unlikely to be scientifically valid. (We're also talking to you, Journal Editors.) - **Allow for changes in direction in predictive models.** Using historical data around the time of peak ascent and descent will be challenging. - **Gather data on interventions**. Look around for secondary sources. Don't burden community programs with onerous data collection, and they deserve to be compensated for their data. - **Make your work accessible now.** Publish open access with plain language and graphical summaries. Short videos? ## What do we do now? For policymakers and direct service providers In closing, here are the main actions: 1. **Don't let up**. Tens of thousands of people keep dying. Keep going with the interventions that are based in scientific evidence. 2. **Be critical - not all interventions are created equal**. Use opioid settlement funds wisely. A must-read study reveals that continuing to use drugs is [less risky](https://www.sciencedirect.com/science/article/pii/S0376871623012784) than forced abstinence "treatment." 🤯 3. **Ask who is being left behind**. Gains in reducing overdose are not experienced uniformly. Some community efforts are addressing this directly. But we should constantly be making sure nobody gets left behind. 4. **Address other drug-related harms**. Skin wounds, hepatitis, endocarditis, etc. all stem from an unregulated drug supply. Stimulants and sedatives are also in the mix. A solitary focus on overdose prevention or OUD or fentanyl is shortsighted. 5. **Properly resource medical examiners**. Whether redirecting opioid settlement funds or setting new state allocations, medical examiners need more support to address the caseload for autopsies. --- # Your Turn In our next post we hope to delve into theories why ODs are declining, with data. Leave us comments below on what you think is behind the improvements. Thanks for reading! > Even a single death means something. To those who care, and even to those who don’t. Even a single death makes a demand on us all. > \-Vaseem Khan --- # Suggested Citation & Code This post, code, data, and infographic files have been stored on Carolina Digital Repository. This work can be cited using DOI [10.17615/fr0z-be38](https://doi.org/10.17615/fr0z-be38). See accompanying [GitHub repository](https://github.com/opioiddatalab/overdosedata/tree/main) for data, code, and files. Thanks to Paula Gildner for proofreading! ## Get our next analysis in your inbox. We hope you'll join us! Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### 👑 Gold Seal 🦭 URL: https://www.opioiddata.org/gold-seal-2/ Last updated: 2025-02-24T18:44:36.000Z Erin Tracy & Jalice Manso If we continue our journey from the sample inlet downward (see last month's post diving into the injection port), the next part of the instrument is the gold seal. This little disk is tiny, but important. Big picture orientation – once the drug samples arrive at the lab, we transfer them to smaller glass vials that go onto the GCMS instrument tray. One microliter of the liquid is pulled up via an automated syringe and injected into the instrument port. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/01/image-32.png) Image from: Agilent.com The gold seal follows the septum and liner in the injection port. The disk creates a seal between the liner in the inlet and the column in the oven. A high-quality gold-plated septum provides a leak-free environment: - Increasing system sensitivity - Reducing column bleeding - Preventing loss of analytes during the injection process The replacement part costs about $50 and it only takes us about two hours to do it ourselves. This maintenance is done about every six months. With any high throughput machine, things get dirty, things wear out. We're prepared to tackle routine maintenance and troubleshoot instrument issues to keep your sample analysis trucking! ### LA Wildfire Donations URL: https://www.opioiddata.org/la-wildfire-donations/ Last updated: 2025-02-25T21:51:24.000Z **L.A. County** **AADAP** [**Health Intervention Program**](https://aadapinc.org/health-intervention-program-hip/)(Inglewood) - Contact: [treynolds@aadapinc.org](mailto:treynolds@aadapinc.org) - [aadapinc.org/ways-to-give/](https://aadapinc.org/ways-to-give/) ***\*Highly impacted with active response*** --- **Being Alive** [**Harm Reduction Program**](https://beingalivela.org/our-programs/syringe-services/) - [givebutter.com/BA\_Annual\_Fund](https://givebutter.com/BA%5FAnnual%5FFund) --- **Bienestar** [**Harm Reduction Center**](https://www.bienestar.org/community/harm-reduction/)(East L.A., Long Beach and Pomona) - Contact: [ejalayer@bienestar.org](mailto:ejalayer@bienestar.org) - [bienestar.org/donate/](https://www.bienestar.org/donate/) ***\*Highly impacted with active response*** --- [**Los Angeles**](https://www.chpla.org/) [**Community Health Project** ](https://www.chpla.org/) - [chpla.org/donate](https://www.chpla.org/donate) --- **Communidad en Outreach for Resiliency and Awareness (CORA)** (Lincoln Heights, Highland Park South, East Downtown, Pico Union, El Monte, Boyle Heights**)** - To Donate via Zelle contact: [admin@corala.org](mailto:admin@corala.org) --- [**Healthcare in Action L.A**](https://www.healthcareinaction.org/)**.** - [healthcareinaction.org/](https://www.healthcareinaction.org/) --- [**Homeless Health Care Los Angeles**](https://www.hhcla.org/programs) - [hhcla.org/donate](https://www.hhcla.org/donate) --- **Homeless Outreach Program Integrated Care System (OPICS)** [**Street-Based Engagement**](https://www.hopics.org/streetbasedengagement) - [hopics.org/support-us](https://www.hopics.org/support-us) --- [**Melanin Angels (mutual aid)**](http://melaninangels.org/) - Contact: [LatoniaMister@MelaninAngels.org](mailto:LatoniaMister@MelaninAngels.org)[](http://melaninangels.org/) --- [**Sidewalk Project**](https://www.thesidewalkproject.org/) - [thesidewalkproject.org/support-1](https://www.thesidewalkproject.org/support-1) ***\*Highly impacted with active response*** --- [**SUDIS**](https://www.sudisla.org/harm-reduction)(Substance Use Disorder Integrated Services) (Whittier) - [sudisla.org/monetary-donations](https://www.sudisla.org/monetary-donations) - [.sudisla.org/resource-donations](https://www.sudisla.org/resource-donations) --- [**Velnonart**](https://velnonart.org/) **Transformative Health** - [velnonart.org/](https://velnonart.org/) - [To Donate](https://www.paypal.com/donate?token=ovIdPJqYM0Rq0-flqJA26pNStjLjO4nIU7cpPnW2-v4yH4rVLMndmGqv2uVeFBOFrh6HMj3v6iw7A%5Fta) ***\*Highly impacted with active response*** --- **Venice Family Clinic** [**Common Ground**](https://venicefamilyclinic.org/programs-and-services/community-wellness/common-ground/) - Contact: [**DOmalley@mednet.ucla.edu**](mailto:DOmalley@mednet.ucla.edu) - To donate, visit: [**DOmalley@mednet.ucla.edu**](mailto:DOmalley@mednet.ucla.edu). For in-person donations, ask for Arron. ***\*Highly impacted with active response*** --- **Tarzana Treatment Centers** - [tarzanatc.org/](https://www.tarzanatc.org/) --- **Riverside** [**Inland Empire Harm Reduction**](https://www.ieharmreduction.org/) - Instagram: [linktr.ee/iehr (accepts Venmo and Paypal)](https://l.instagram.com/?u=https%3A%2F%2Flinktr.ee%2Fiehr%3Ffbclid%3DPAZXh0bgNhZW0CMTEAAabP8Lsusj5b7X4%5FlTOJnewE7MGz5C0IkK6kCS198Ju7aVlVco-m-U9jgCk%5Faem%5FBYTaLI0uz8zkjq4dH9Scdg&e=AT3oue4GtnMwk26agTrLANac9%5Farzs0qYcWGskwM6CrEYo6sGY0W00zQymFm8nsB6am-d-Xn2X63d6FlEXNEbKag2pUcEzevQTCdtj93UNaTS6LjDRNC-w) --- **Santa Barbara** [**Pacific Pride Foundation**](https://pacificpridefoundation.org/ssp/) - [pacificpridefoundation.org/donate/](https://pacificpridefoundation.org/donate/) ### December Newsletter URL: https://www.opioiddata.org/december-newsletter/ Last updated: 2025-02-27T13:57:46.000Z As the year winds down, we want to take a moment to send you warmth, love, and gratitude for all the incredible work you do. Whether you're gearing up for a well-deserved break or holding it down for your community during the holidays, we hope this little slice of connection brightens your day! Let’s remember to care for ourselves and each other, and showing up for those who need extra support this time of year. Thank you for being part of this vibrant, compassionate network—we’re so lucky to share this journey with you. See you next year! --- # 〽️Service Stats & Updates As of Wednesday December 18, 2024. **9,632** samples analyzed Serving **160** harm reduction programs Reaching **228** counties in **39** states **365** unique substances identified **Reminder that we will be closed December 20th to January 5th.** Kit shipment and lab services will resume immediately 1/6/25\. ICYMI, we also want to draw your attention to the [upcoming changes to our data collection card](https://www.opioiddata.org/upcoming-data-changes/), based on your feedback. No changes to our Watchlist, but click below to see Live Reports on cafentanil, (dex)medetomidine, nitazenes, BTMPS and more. [UNC Watchlist](https://www.opioiddata.org/unc-watchlist/) --- # 👩🏽‍🔬Newly Detected Substances In November, we saw 8 substances that were new-to-us. That's right in the middle of the [normal range](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823) of new substances monthly. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-2.png) We heard you on shortening the newsletter. So, we'll be putting monthly new detections out as a separate post each month. Here's the first one: [Recent Detections by UNC Street Drug Lab November 2024N-cyclohexyl butylone; desalkylquazepam; sertraline; tryptamine; chlorcyclizine; desalkylgidazepam; ethyl 4-anilinopiperidine-1-carboxylate; deoxymethoxetamine; brorphine![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-17.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/nabarund_A_chemistry_lab_with_a_woman_and_a_lab_coat_holding_up_b93d7a42-81ca-4222-8de0-75fd4ccbf8a3-1-1.PNG)](https://www.opioiddata.org/recent-drugs-nov-24/) Here's the November list: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-3.png) [Source](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823) --- # 🔬 BTMPS Update More results from the amazing XP Huang at UNC. There had been some older papers suggesting that BTMPS had antagonist properties at nicotinic acetylcholine receptors (nAChRs). Using modern assays, XP now reports **no binding activity whatsoever of BTMPS to nACHRs**. So, think twice before making broad claims about molecular properties of BTMPS based on old papers who's findings were never reproduced. We've analyzed over [700 samples containing BTMPS](https://deepnote.com/app/opioiddatalab/bis2266-tetramethyl-4-piperidyl-sebacate-57aada26-47f7-4095-a52e-f6f334b086e8?%5F%5Fembedded=true&ref=opioiddatalab.ghost.io) from 14 states. This nasty chemical sure seems like it's entrenched in the supply in some cities. For example, in Pittsburgh the last couple of weeks, BTMPS has been seen [by itself](https://www.streetsafe.supply/results/p/602642) (by GCMS detection) and in a [mix with just lidocaine](https://www.streetsafe.supply/results/p/602652) (no psychoactive substances). --- # 💫 Reversal Agents See new expert statement from **60** health providers in North Carolina. [Expert Statement Regarding High-Dose Naloxone and Long-Acting Opioid Overdose Reversal Formulations in North CarolinaExpert Statement Regarding High-Dose Naloxone and Long-Acting Opioid Overdose Reversal Formulations in North Carolina![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-545d11a84432819b25149c67d4e2aa95f3bee9e815f20b9bfbf105e836d70ff5-2.ico)Carolina Digital RepositorySaucier, Roxanne, and Nabarun Dasgupta.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/jm215421k-1)](https://cdr.lib.unc.edu/concern/journals/wp989125x?locale=en) Over 17 years, successful overdose reversals with naloxone have needed on average only 1.6 doses. Severe withdrawal from high doses of naloxone leads to more immediate re-dosing of opioids and using alone. Risk of subsequent overdose increases. Nalmefene nasal spray has never been tested in the current North Carolina drug supply or on people using opioids. Its real-world effectiveness is unknown. There is no urgency to switch to pharmaceuticals that are untested. Overdose rates in North Carolina are stabilizing with continued distribution. 😵‍💫 If you're on the receiving end of overtly aggressive pharma marketing, FDA wants to hear about it. All you have to do is ****forward pharma emails to BadAd@fda.gov**. Or call 855-Rx-BADAD (855-792-2323). You don't have to fact check the blizzard of claims. Forward on even if it's from a consulting firm and not the company itself. If we get enough examples to FDA, it will launch an investigation. --- # 🐯 Drugs In The Wild To close out the year, here's a little something to remind you that drugs in the real world are as *quirky* and *ironic* as **dolphins on fentanyl** and a bag labeled "NOT a Bag Full of Drugs" (*spoiler: it totally was*). 🤣 [Bag Labeled “Not a Bag Full of Drugs” Definitely Was Full of Drugs, Cops SayPortland couple arrested after police find drugs in bag ironically labeled “Not a Bag Full of Drugs” during traffic stop.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-site-icon-1.png)VICELuis Prada![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/definitely-not-a-bag-full-of-drugs.jpg)](https://www.vice.com/en/article/definitely-not-a-bag-full-of-drugs-bust-portland/) [Sharks in Brazil test positive for cocaine, say scientists | CNNSharks living off the coast of Brazil have tested positive for cocaine, according to new research, the first time that the drug has been detected in free-ranging sharks.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-9.png)CNNJack Guy![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-2024-07-19-12-54-42-2.jpg)](https://www.cnn.com/2024/07/23/science/cocaine-sharks-brazil-scli-intl-scn/index.html) [Several drugs, including fentanyl, found in bottlenose dolphins in Gulf of Mexico, scientists sayScientists have detected fentanyl and other drugs in dozens of dolphins from the Gulf of Mexico, which could have large implications on the overall health of the oceans.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-7.ico)ABC NewsABC News![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/Dolphins-fentanyl-2-gty-jm-241206_1733507303360_hpMain_16x9.jpg)](https://abcnews.go.com/International/drugs-including-fentanyl-found-bottleneck-dolphins-gulf-mexico/story?id=116523978) Also we really should be talking more about the environmental consequences of drugs, both unregulated and pharmaceutical. --- # 🤗 Opportunities for Impact Job postings, conferences, proposals, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. **Request for Proposal** Got a bright idea to improve drug supply communication and boost health outcomes for people who use drugs? Pitch your proposal to NASTAD and help create smarter, safer solutions for thriving communities! [Click here to learn more!](https://nastad.org/requests-proposals-phic-improving-communication-about-drug-supply-improve-health-outcomes-among) **Job Postings** Join the NCDHHS team as a Data Abstractor and play a key role in collecting and analyzing health data to support public health initiatives across North Carolina. This full-time position in Raleigh, NC. [Apply here](https://www.governmentjobs.com/careers/northcarolina/jobs/4763711-0/data-abstractor) by 1/7/2025! **NIDA Council for people with lived experience** Stemming from our productive discussion with Director Nora Volkow at the DPA conference in Phoenix, NIDA just announced a working group to the [National Advisory Council on Drug Abuse (NACDA) ](https://nida.nih.gov/about-nida/advisory-boards-review-groups/national-advisory-council-drug-abuse-nacda)made up of people with lived or living experience (PWLLE) with drug use. Applications to be part of this are easy – video is fine. [Apply here](https://nida.nih.gov/about-nida/advisory-boards-groups/national-advisory-council-drug-abuse-nacda/council-workgroups) by January 10, 2025. --- # ✈️ Out and About Nab was honored to be the keynote speaker ([slides](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/3x8171965?locale=en)) at the [HIT Hot Topics Conference](https://hit.org.uk/events/) in Liverpool, England last month. [Here's the recap](https://www.talkingdrugs.org/hit-conference-2024-resisting-the-state-and-keeping-communities-alive/) from the conference organizers about the amazing cohort of speakers. "Hands down the best harm reduction conference. Meticulously curated, they covered all the ground in one awe-inspiring day. Also, sandwiched by rocking social events. You should go!" Shout out to Lucy and Maddie O'Hare for putting on the best show! Photos by Nigel 💖 who we adore. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/DSC00704.jpg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/DSC00461.jpg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/DSC00203.jpg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/DSC01405.jpg) Photos by the legendary [Nigel Brundson](https://nigelbrunsdon.com/) (who you should definitely hire for your events) --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! - Al Jazeera: [What will happen to al-Assad's Captagon empire now?](https://www.aljazeera.com/features/2024/12/18/what-will-happen-to-al-assads-captagon-empire-now) Explores the implications of regime change in Syria and the hugely popular [counterfeit stimulant](https://www.aljazeera.com/news/2023/5/9/what-is-captagon-the-addictive-drug-mass-produced-in-syria) - KFF Health News: [Opioid Settlement Funds Tracked in New Database](https://kffhealthnews.org/news/article/opioid-settlement-funds-detailed-database-state-county-city-spending/) Details how states, counties, and cities allocate billions from opioid lawsuit settlements to address the crisis. - NY Times: [Fraud Allegations at Acadia Methadone Clinics.](https://www.nytimes.com/2024/12/07/health/acadia-methadone-clinics-fraud.html?smid=nytcore-ios-share&referringSource=articleShare) Examines concerns of financial mismanagement and patient care at some of the largest methadone chains. Sad. - NYC Health: [Drug Checking Program Implementation Guide](https://www.nyc.gov/assets/doh/downloads/pdf/basas/drug-checking-program-implementation-guide.pdf) Provides comprehensive strategies for establishing and managing drug checking services to enhance harm reduction efforts. 💪🏾💖 Yarelix!! - The Guardian: [Majority of Americans Support Treating Drug Possession as a Health Issue](https://www.theguardian.com/us-news/2024/dec/06/substance-use-drug-possession-felony-health-issue-poll) Highlights shifting public opinion favoring decriminalization and health-focused approaches to substance use. ### 🤓 Scientific Literature Earlier this month we did a deep dive on the only predictive model that correctly predicted the current drop in overdoses nationally. [The model that predicted the current overdose dropMeet the model that predicted the current drop in overdose deaths. 📉 Modeling the evolution of the US opioid crisis for national policy development![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-18.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/pnas.2115714119fig01.jpg)](https://www.opioiddata.org/the-model-that-predicted-od-drop/) And, you don't want to miss Maya Doe-Simkins and Eliza Wheeler discussing the first 2 years of [Remedy Alliance naloxone distribution data](https://ajph.aphapublications.org/doi/10.2105/AJPH.2024.307893) over in the *American Journal of Public Health*. The [supplemental table](https://ajph.aphapublications.org/doi/suppl/10.2105/AJPH.2024.307893?role=tab) to their article is critical reading – it shows state-by-state where the greatest need for naloxone is. Here's a visual of that table. Each dot in the graph below is a state. Vertical axis is total naloxone (free and purchased). The horizontal axis is % of doses that were sent at no cost. The color is number of free doses – yes, you're reading that right. Tens of thousands of free doses of naloxone to big orange dots are states receiving the most no-cost ("free") naloxone: Minnesota and **North Carolina**. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-24-1.png) Despite best intentions, our state's official government naloxone distribution infrastructure has not been able to keep up with the demand for the antidote by harm reduction programs. 😔 And so, Remedy has shipped pallets full of free naloxone to NC to keep our neighbors alive. Also, NC IVPB has a [new website for overdose stats](https://www.dph.ncdhhs.gov/programs/chronic-disease-and-injury/injury-and-violence-prevention-branch/north-carolina-overdose-epidemic-data#monthly-reports) that you'll want to bookmark. From the monthly summary, ED visits for opioid overdose are down -35% since this time last year. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-25.png) NC DHHS --- # 📣 Team Voices Check out monthly blog posts from members of our team! [Septum and LinerBehind the Scenes: Maintaining Precision in Drug Sample Analysis Ever wondered what happens behind the scenes when you send a drug sample to our lab? Let’s pull back the curtain and talk about something that might sound tiny but is actually a big deal: injection port maintenance. Your Sample’s Grand![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-16.png)Opioid Data LabErin Tracy![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image-16-1-1.png)](https://www.opioiddata.org/septum-and-liner/) --- # 👋 Meet our Team Members Each month will feature different team members 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image--2--1.png) ## Adams Sibley Our postdoctoral researcher, interventionist, stigma expert, dog dad, and human husband. --- # 💝 Helping Out With a Donation As you think about end-of-the year donations, please remember our North Carolina harm reduction programs that will be rebuilding from Hurricane Helene for a long time to come. You can find a [list of worthy programs here](https://www.opioiddata.org/how-to-help-asheville-nc-now/). --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/IMG_0384.jpg) ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ### Recent Drugs Nov '24 URL: https://www.opioiddata.org/recent-drugs-nov-24/ Last updated: 2024-12-20T18:36:29.000Z We detected 9 new-to-us substances in November 2024, amidst 130 unique substances we saw in the drug supply this month. 💡 We're switching to a consolidated format for our monthly new detection summary, which will be [archived here](https://www.opioiddata.org/tag/new-detections/). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-10.png) [![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-11.png)](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823?utm%5Fcontent=2f2c3288-10a7-4e03-a6c2-57bb006b5823&ref=opioiddatalab.ghost.io) [clickable link](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823?utm%5Fcontent=2f2c3288-10a7-4e03-a6c2-57bb006b5823&ref=opioiddatalab.ghost.io) ## Monthly New Detections Report Sign up to get this monthly digest in your inbox free. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. --- # desalkylgidazepam des-al-kyl-gid-az-e-pam This novel benzo, desalkylgidazepam ([PubChem](https://pubchem.ncbi.nlm.nih.gov/compound/117065425)) that is not scheduled. Among the known molecules, it seems most similar to [nordiazepam](https://en.wikipedia.org/wiki/Nordazepam)/nordazepam, which is a long-lasting benzo. You can see just the chlorine is substituted with a bromine molecule. There isn't much in the way of human studies on desalkylgidazepam, but we would be looking out for long-acting effects. The [index sample](https://www.streetsafe.supply/results/p/806597), from New York, was expected to be a benzodiazepine, and also contained bromazolam, xylazine, and (dex)medetomidine, but not fentanyl. This particular sample only contained in desalkylgidazepam in trace abundance. CSFRE [reported detection](https://www.cfsre.org/nps-discovery/monographs/desalkylgidazepam) in December 2022\. You can see the molecular similarities here: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-14-1-1.png) new detection: desalkylgidazepam ([source](https://en.wikipedia.org/wiki/Gidazepam)) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-13-1-1.png) known medication: nordiazepam ([source](https://en.wikipedia.org/wiki/Nordazepam)) And, you can see Br (bromine) and Cl (chlorine) are adjacent in the column known as halogens. This is *generally* a sign that effects may be similar when substituted for one another. For example, sodium chloride (NaCl) is regular table salt, whereas and sodium bromide (NaBr) is the active ingredient in the old school headache and antacid [Bromo-Seltzer](https://en.wikipedia.org/wiki/Bromo-Seltzer). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-21-1-1.png) Source: PubChem For the sake of completeness, it's worth nothing that desalkylgidazepam is the downstream active metabolite of the prodrug gidazepam/hydazepam ([PubChem](https://pubchem.ncbi.nlm.nih.gov/compound/121919)). 💡 ****prodrug** A substance that gets unpackaged and activated (metabolized) inside your body, kinda like a security tag getting taken off to activate a gadget. Enzymes from the liver are usually responsible for the unpacking and activation. Classic examples include codeine as a prodrug of morphine, and lisdexamfetamine becoming d-amphetamine. --- # desalkylquazepam Another novel benzodiazepine in trace abundance, with minimal human information. CSFRE [picked this up](https://www.cfsre.org/nps-discovery/monographs/desalkylquazepam) in May 2024 in a solid drug sample via the Canton-Stark County Crime Lab in Ohio. Our [index sample](https://www.streetsafe.supply/results/p/807961) came from Michigan, collected at the end of October. That particular sample was an outlier, containing 19 (nineteen) unique substances, including cannabinoids, a nitazene, heroin, fentanyl and analogue, xylazine, and OTC medications. The dealkylquazepam was only detected in trace abundance. You can see dealkylquazepam ([PubChem](https://pubchem.ncbi.nlm.nih.gov/compound/3081966)) has a family resemblance to desalkylgidazepam and nordiazepam above, but the addition of sulfur and fluorine in different positions is certain to change how it acts in the human body, relative to the two benzos described above. But that means it should be easier to distinguish on FTIR and mass spec. You can see sulfur (S) below oxygen (O) in the Periodic Table, again placing them in the same vertical chemical family. Walking down the columns of the Periodic Table is a classic way for new drugs to be synthesized by the pharmaceutical industry and clandestine manufacture. Nothing surprising here. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-22-1.png) dealkylquazepamSource: Chemdoodle using PubChem SMILES At this point, we aren't drawing a connecting line between these two "desalkyl..." new-to-us benzodiazepines. It may just be coincidence that we saw them in the same month, albeit in different US states. But in general, we expect novel benzos to continue diversifying. --- # ethyl 4-anilinopiperidine-1-carboxylate A known fentanyl precursor. [DEA](https://www.oas.org/en/sms/cicad/chemical-substances/2022/docs/experts-group/1-Estados%5FUnidos.pdf) noticed it and made it a controlled substance in 2020, and it was identified in British Columbia, [Canada](https://www.canada.ca/content/dam/hc-sc/documents/services/publications/healthy-living/new-psychoactive-substances-canada-2023/new-psychoactive-substances-canada-2023-en.pdf) in July 2023\. The usual cat and mouse game. The [index sample](https://www.streetsafe.supply/results/p/807973) was mostly caffeine, lidocaine, and diphenhydramine. --- # deoxymethoxetamine Deoxymethoxetamine is also called DMXE or 3D-MXE ([wikipedia](https://en.wikipedia.org/wiki/Deoxymethoxetamine)). First identification was in Denmark in 2021\. No human data at this time, but [this chemical simulation *in silico* study](https://www.sciencedirect.com/science/article/pii/S134786132200072X) showed that methoxetamine (MXE) derivatives also block [NMDA receptors](https://en.wikipedia.org/wiki/NMDA%5Freceptor%5Fantagonist#:~:text=Some%20NMDA%20receptor%20antagonists%2C%20such,are%20classified%20as%20dissociative%20drugs.). Not much of a surprise here; MXE is well-known among the psychonauts. In our [index sample](https://www.streetsafe.supply/results/p/808023), deoxymethoxetamine was in trace abundance, and contained 3-HO-PCP and deschloroketamine, with a touch of 2-fluoro-2-oxo-PCE. So a combo probably intended for an experienced user. --- # brorphine Oooh, this is an interesting one. Brophine (Wikipedia) is an opioid alternative that was discovered in the 2010s “with the intention of finding safer analgesics that produce less respiratory depression than typical opioids... Its safety profile in any animal model has never been established. Despite the lack of safety information on the compound, brorphine has been sold as a designer drug since mid-2019, initially being identified in the US Midwest, though it has since been found in 2020 in Belgium.” ![](https://media.tenor.com/i1CYaklqYGQAAAAC/snes.gif) For the youngs This sample from Michigan contained 17 unique substances, including BTMPS, tylenol, xylazine, fentanyl, metonitazene, bromazolam, benadryl, heroin, and caffeine. A messy brew indeed. --- # N-cyclohexyl butylone This is another novel, rare stimulant derived from the khat plant. It is in the class of molecules known as substituted cathinones, which can be identified with the “-ylone” suffix. [DrugsData/Erowid Center](https://www.drugsdata.org/view.php?id=12347) saw this in March 2022, and [CSFRE](https://www.cfsre.org/nps-discovery/monographs/n-cyclohexyl-butylone) picked this up in June 2022, and [other labs](https://www.aegislabs.com/clinical-update/mar23a/) in August of that year. [Energy Control](https://energycontrol-international.org/) also identified N-cyclohexyl butylone and worked with labs in Spain and the Netherlands to characterize it; [computer modeling](https://www.sciencedirect.com/science/article/pii/S0026265X23001959?via%3Dihub) of predicted effects conducted in the wake of the 2022 emergence suggest effects similar to MDMA. > Samples were submitted by anonymous Spanish users to Energy Control’s drop-in service for their analysis. The format of these samples was the following: two samples were yellow pills with the logo of Snapchat (also containing caffeine), one brown crystal sample was containing also MDMA and finally two were in white crystal form. All of them were acquired as MDMA. This was expected to be a fentanyl fake M30, and it did contain a trace of fentanyl. But imagine the surprise when you get an upper instead of a downer! Luckily it had not been consumed before it was sent to us; a wise decision and glad folks are trusting their instincts. Our [index sample](https://www.streetsafe.supply/results/p/602543) came from the Charlotte, North Carolina area, and was also a yellow pill. Coincidence? We reached out to the site and they reported that the pill was poorly made. And that it did not have indicia; contrast that with the snapchat pill that was sold as XTC. 🙊 We don't publicly identify program names unless they specifically ask us to. But we also believe in giving credit to the folks on the frontlines doing the hard work of caring for our people. So, in any of our blog posts or newsletters, if you want us to mention you or your organization by name, just drop us an email and we can update the site. We reached out to CSFRE, Kykeon and looked at DrugsData.org – none of these major labs reported having seen N-cyclohexyl butylone recently. We are left pondering if our index sample is something emergent or maybe just something old. We might could rule out leftovers from 2022 because of the presence of BTMPS, but then again it was only in trace abundance. We also note that trace detections from pill samples could also be from handling and contaminated surfaces. For example 1,4-butanediol detection is unusual for a pill (usually liquid), and another sample from the same site at the same time was just 1,4-BD — so its presence in the GCMS detection at a tiny tiny level is very likely contamination by proximity or handling before it came to the lab. No shade y’all, we get that drugs in the real world are messy. --- # sertraline [This sample](https://www.streetsafe.supply/results/p/807009) was expected to be tusi, in the form of a light pink powder. Sertraline is the anti-depressant Zoloft. The sample also contained the cough medicine guaifenesin ([which we see sporadically](https://www.streetsafe.supply/search?q=guaifenesin)). And heroin. Here we speculate: The sample was collected on October 24\. We point out that this was just 3 days after *The New York Times* published their [gratuitously alarmist article](https://www.nytimes.com/2024/10/21/well/what-is-pink-cocaine.html) (pink powder and razor blades!) about "pink cocaine" – which is supposed to be tusi, which is a loose term referring to ketamine + meth + MDMA mixes in the nightlife scene. And we note that Robi*tussi*n often contains guaifenesin. This is pure coincidence, right? Right? We've pointed out that news reporting volume about certain drugs can be directly tired to overdose rates \~4 months later. Increases and decreases. [Breaking the News or Fueling the Epidemic? Temporal Association between News Media Report Volume and Opioid-Related Mortality - PMCHistorical studies of news media have suggested an association between reporting and increased drug abuse. Period effects for substance use have been documented for different classes of legal and illicit substances, with the suspicion that media…![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-7.png)PMC home page![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/pone.0007758.g001.jpg)](https://pmc.ncbi.nlm.nih.gov/articles/PMC2771898/) We also note that we routinely see mental health medications in the drug supply: [quetiapine](https://www.streetsafe.supply/search?q=quetiapine&ref=opioiddatalab.ghost.io) (schizophrenia and bipolar disorder), [trazodone](https://www.streetsafe.supply/search?q=trazodone&ref=opioiddatalab.ghost.io) (anti-depressant), and [fluoxetine](https://www.streetsafe.supply/search?q=fluoxetine) (anti-depressant). --- # tryptamine We know about Foxy and DMT and other "tryptamine psychedelics" or hallucinogens like AMT, 5-MeO-DIPT, 5-MeO-DMT, etc. But in [this sample](https://www.streetsafe.supply/results/p/805301) we only saw regular old tryptamine, not psychedelic combo per se, but just the metabolite of the amino acid tryptophan. The tryptamine was only in trace abundance in a heroin/fent sample from the Bronx which contained fentanyl, caffeine, procaine (typical for NY), and (dex)medetomidine. Tryptamine can turn on the dopamine system, and in larger doses cause hallucinations, but also sweating, nausea, and other unpleasantness ([wikipedia](https://en.wikipedia.org/wiki/Tryptamine#:~:text=In%20a%20published%20clinical%20study,heart%20rate%20or%20respiratory%20rate.)). Regardless, the trace abundance here doesn't say much about what the experience may have been like. Erowid's legendary [Experience Vaults](https://www.erowid.org/search.php?exclude=&q=tryptamine&x=0&y=0) have plenty of reports on tryptamines. Tryptamine isn't something we would normally expect with fent. The tan powder in the index sample was described as "normal" and "nice." Given those sensations (even in the presence of (dex)medetomidine!), we would speculate that the trace tryptamine didn't do much here. Which is a good reminder why the sensation info is so important, and that new detections aren't automatically a cause for concern. But it also reinforces that an unregulated drug supply is inherently unpredictable. --- # chlorcyclizine Old school anti-histamine, still sold as a medication in the US and elsewhere. In the US it's usually found with [other cold meds](https://www.drugs.com/ingredient/chlorcyclizine.html) and decongestants; but we didn't see any of those in the lab. This sample was [a pink pill](https://www.streetsafe.supply/results/p/807981), that was a groundscore, so no expectations. We looked up visual pill ID resources and could find any chlorcyclizine that would fit the pink pill description, at least not any single-entity pharmaceutical formulations. 👨‍🦳 ****groundscore** Excitement over an object found on the ground, usually in outdoor public spaces. (You're welcome, Boomer.) We also detected methamphetamine and delta-9-THC with it (in primary abundance) – which may be contamination? We see other anti-histamines, [specifically diphenhydramine](https://www.streetsafe.supply/search?q=diphenhydramine), routinely in the drug supply. And we don't see weed and meth mixed together so often. And something that was a groundscore, well, things could be messy. So can't conclude too much for this one based on the results. It's kind of an outlier, but handling and circumstances could explain. ### Septum and Liner URL: https://www.opioiddata.org/septum-and-liner/ Last updated: 2024-12-20T13:56:17.000Z ## Behind the Scenes: Maintaining Precision in Drug Sample Analysis Ever wondered what happens behind the scenes when you send a drug sample to our lab? Let's pull back the curtain and talk about something that might sound tiny but is actually a big deal: injection port maintenance. ## Your Sample's Grand Entrance: The Injection Port Imagine the injection port as the entry point for your drug sample into the world of chemical analysis. It's like a carefully designed doorway that must be pristine to ensure the sample enters the instrument without contamination. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-16-1.png) Injection Port ### The Septum: Your Sample's First Threshold The septum is a small, round seal typically made of silicone or another polymer. Its job is crucial: - Creates an airtight seal when the sample needle punctures it - Keeps unwanted air and contaminants out - Maintains the pressurized environment inside the instrument ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-20-1.png) Septum Over time the septum degrades. It can: - Develop micro-tears from repeated needle injections - Start leaking (and nobody wants a leaky seal, or a soggy bottom) ### The Liner: Guiding Your Sample's Journey The liner is a small glass tube inside the injection port. Think of it as a funnel that: - Turns your liquid sample into a vapor - Spreads the sample evenly (no sample left behind!) - Transfers the sample to the column for separation ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-18-1.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-19-1-1.png) Over time the liner gets dirty leading to: - Poor peak shape in the chromatogram - Increased potential for contaminants ## Why Routine Maintenance Matters Routine maintenance ensures reliable, precise sample analysis. And changing the septum and liner takes less than an hour! ### Our Maintenance Protocol We recommend changing the septum and liner: - At least once a week - Immediately if there is any visual degradation - During preventative maintenance schedules ### The Replacement Process Our technicians follow a standard process that's as easy as 1, 2, 3: 1. Carefully remove the old septum and liner 2. Install a new, high-quality septum 3. Insert a clean, appropriate liner *Pro tip: This is all happening behind the scenes, so you can focus on the results that keep communities safe.* ## Ensuring Your Results' Reliability By maintaining these small but critical components, every drug sample you send receives the most accurate, reliable analysis possible. Every tiny detail matters when you're analyzing substances that could impact people's health and safety. ### November Newsletter URL: https://www.opioiddata.org/november-newsletter/ Last updated: 2024-12-20T16:58:50.000Z 🍂 Happy Fall thanks for popping by to the [****UNC Street Drug Analysis Lab**](https://streetsafe.supply)****'s Newsletter!** Check out [our blog site](https://www.opioiddata.org/) and [data apps](https://uncopioid.atlassian.net/wiki/external/ZTk5NGQ0YWE3NDA1NGEwZGIxZjhiMDUyNGQ1ZWJiY2M) for frequent updates. # 〽️ Service Stats As of Friday November 22, 2024. **9,122** samples analyzed Serving **158** harm reduction programs Reaching **228** counties in **39** states **356** unique substances identified --- # 🚨 Upcoming Card & Data Changes We will be shipping card version 9 in kits sometime starting in January 2025\. The [last update](https://cdr.lib.unc.edu/concern/multimeds/5d86p887m?locale=en&ref=opioiddatalab.ghost.io) was in June 2023; we don't like changing this often. Based on your feedback and our detailed analysis of missingness, we made 3 substantial changes: - Added nitazene and carfentanil to list of expected drugs - Added stimulant / opioid type to OD panel - Added test strip results for benzos, fent, xylazine, and meth Click the link below to see all the smaller changes and data implications. [Upcoming data card changes📊Updated cards will be mailed with kits starting in late January 2025\. We have received a lot of great feedback from programs on how to improve the data collections elements on the card. We have noted these over the last months, and are ready to make changes. (The card was![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-12.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/Screenshot-2024-11-26-at-9.09.08-AM.png)](https://www.opioiddata.org/upcoming-data-changes/) --- # 🕵🏼‍♀️ Solved! BTMPS FTIR Spectra Mystery solved! A national team of experts has figured out why street samples and library FTIR spectra were not matching fully for BTMPS. If you're a FTIR tech, you'll want to read the blog post linked below. This is us, as a harm reduction community, doing the science to answer the questions that matter most to us. An excellent reminder that nobody is going to save us but ourselves. [BTMPS Explainer: The Effect of ProtonationVikrant Jandev and Marya Lieberman, UND Blake Joachim (Outside In) and Cole Altomare-Jarczyk and Ivy Sabal (MADDS) What’s up with the IR spectrum of BTMPS? How come the literature spectrum doesn’t fit what we are seeing in drug samples? The literature IR spectrum of BTMPS is the free![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-11.png)Opioid Data LabMarya Lieberman![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1650978810641-6610f4b6d15a-1.jpeg)](https://www.opioiddata.org/btmps-explainer-the-effect-of-protonation/) For the noobs, [catch up here on all things BTMPS](https://www.opioiddata.org/mystery-substance-summer-2024/) (also known as: bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate). The investigative team was Vikrant Jandev and Marya Liberman from Univ. of Notre Dame in Indiana, Blake Joachim from Outside In in Oregon, Ivy Sabal and Cole Altomare-Jarczyk from Brandeis University in Massachusetts. Y'all are great! 💞 --- # 👀 UNC Watchlist Here are the [trends in the drug supply](https://www.opioiddata.org/unc-watchlist/) we are keeping an eye on this month. - [**BTMPS**](https://www.opioiddata.org/unc-watchlist/#btmps) \- industrial chemical added to plastics. See note above about new findings for FTIR spectra. - [**Xylazine & (dex)medetomidine**](https://www.opioiddata.org/unc-watchlist/#xylazine-dexmedetomidine) \- strong sedatives mixed with fentanyl. We have a [new tracker](https://deepnote.com/app/opioiddatalab/dexmedetomidine-Tracker-a401c37e-5255-4d15-87a1-252ee09f360d) for these showing the uptick of (dex)medetomidine starting in June 2024\. We're seeing a parallel increase in xylazine among our fentanyl samples too. [(dex)medetomidine TrackerData apps for data scientists and data analysts.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-4.png)DeepnoteOpioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/social-image-1)](https://deepnote.com/app/opioiddatalab/dexmedetomidine-Tracker-a401c37e-5255-4d15-87a1-252ee09f360d) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-9.png) - [**Carfentanil**](https://www.opioiddata.org/unc-watchlist/#carfentanil) \- powerful opioid reemerges in a new way. We've seen carfentanil in samples from 7 states: FL, WI, NY, MI, WA, CA and NM - [**Nitazenes**](https://www.opioiddata.org/unc-watchlist/#nitazenes) \- new-ish class of synthetic opioids. We have analyzed 112 samples containing nitazenes, from 14 states. The most common of these "benzimidazole opioids" we have see are [protonitazene](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3?selected%5Fsubstance=protonitazene) and [metonitazene](https://deepnote.com/app/opioiddatalab/What-else-and-where-69f2c61d-8ba3-4df8-92fe-a6cae8d145a3?selected%5Fsubstance=metonitazene). Fentanyl is also found in about half the nitazene samples, and about the same for xylazine. These combos can be really sedating. On the other hand, nitazenes may find favor among those with big established fent habits. Nitazenes are the synthetic opioid most common in Europe (not fentanyl). Nitazenes have been in the US for years, for example in [Wisconsin and Illinois](https://pmc.ncbi.nlm.nih.gov/articles/PMC8141068/) in 2020 and [Tennessee](https://www.cdc.gov/mmwr/volumes/71/wr/mm7137a5.htm) in 2019. - [**2-fluoro-2-oxo-PCE + fentanyl**](https://www.opioiddata.org/unc-watchlist/#2-fluoro-2-oxo-pce) \- international club drug mixed unexpectedly with fentanyl and others - [**Shift to smoking**](https://www.opioiddata.org/unc-watchlist/#shift-to-smoking) \- broad trend with implications for overdose prevention - [**Decline in overdoses**](https://www.opioiddata.org/are-overdoses-down-and-why/) \- it's happening, but why? We also [retired](https://www.opioiddata.org/unc-watchlist/#retired-watchlist) acetamiprid from the Watchlist. As our friend Eliza always reminds us, **it's important to have expirations on drug alerts to prevent panic and distraction after the situation changes**. 👏🏾 --- # 👩🏽‍🔬 New Substances Detected We have a [new live report app](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823) that shows which new-to-us substances detected recently. This app auto-updates the first of each month. We detected **13 new substances** in the drug supply in October 2024\. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/Screenshot-2024-11-26-at-9.29.05-AM.png) Source: [Live report with clickable links](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823?utm%5Fcontent=2f2c3288-10a7-4e03-a6c2-57bb006b5823) Many of these samples came from FTIR-based programs. These front line folks have way more local context and are the true experts. We make some speculations below based on our scientific and street knowledge. We're connecting dots nationally, but fully defer to the local programs. Let us know if we missed the mark at opioiddatalab@unc.edu. ### Descriptions - **spironolactone** and **canrenone** \- Spironolactone is a second line medication for heart failure, and not a controlled substance. ([Other medical uses](https://www.mayoclinic.org/drugs-supplements/spironolactone-oral-route/description/drg-20071534).) Canrenone is a metabolic byproduct of spironolactone, so we hypothesize that this was a GCMS breakdown substance, or the pill may be old, or there could be some instability from pharma manufacturing. [The index sample](https://www.streetsafe.supply/results/p/806726) was a light yellow pill, assumed to be amphetamine. Allow us to *speculate*. There are pharmaceutical versions [matching this description](https://www.drugs.com/imprints/ad-26050.html), and we can't help but notice the "AD" indicia may misdirect folks looking for amphetamine (aka [Adderall](https://www.drugs.com/adderall.html)). This sample was brought in before consumption, so kudos on trusting that spidey sense. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-2.png) spironolactone ([image source](https://www.drugs.com/imprints/ad-26050.html)) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-1.png) Adderall ([image source](https://www.drugs.com/imprints/ad-30-1123.html)) (HT: thanks to Dr. Ben Howell for the correction of what spirinolactone was prescribed for... not primarily for gout apparently, tho that may be for a few patients.) - **cyfluthrin** \- A [common insecticide](https://en.wikipedia.org/wiki/Cyfluthrin) in the pyethroid family of chemicals, with limited toxicity to humans. At room temperature it has a "yellow-brown mass of oily to paste-like consistency" ([source](https://www.fao.org/4/w8338e/w8338e06.htm)), which may explain the reported tan color of the [sample](https://www.streetsafe.supply/results/p/806899). ([PubChem](https://pubchem.ncbi.nlm.nih.gov/compound/104926)) The sample also contained first-time-detected **acetyl tributyl citrate** (aka ATBC, tributyl acetylcitrate, [PubChem](https://pubchem.ncbi.nlm.nih.gov/compound/6505)), a nail polish additive, pharmaceutical [pill coating](https://pmc.ncbi.nlm.nih.gov/articles/PMC6320780/#:~:text=Acetyl%20tributyl%20citrate%20%28ATBC%29%20is,as%20coated%20tablets%20or%20capsules.), plasticizer, and fragrance that evoked thoughts of [BTMPS](https://www.opioiddata.org/mystery-substance-summer-2024/). This sample was supposed to be heroin, and came to us from a used cotton. It was reported to cause a burning sensation, and did not provide a high. The sample also contained plenty of phenacetin, a OTC analgesic not sold in the USA. Could ATBC have come from the coating of the pill? Maybe, but we couldn't find an international excipient database that could definitively say so. Could the cyfluthrin have come from an insecticide used while growing the cotton? Possibly, but cyfluthrin isn't widely used in agriculture, was not in trace abundance, and the color of the sample suggests that the amount of the substance was non-trivial. How and why it ended up in this sample is a mystery. And could the recent emergence and publicity about BTMPS have led to experimentation with adding ATBC to the drug supply? Let's be clear, just by looking at molecules, we can't determine intentionality. We try to be objective scientists and not judgmental, but this sample is pretty fucked up. - **fluoxetine** \- Common SSRI anti-depressant Prozac (or generic). [This sample](https://www.streetsafe.supply/results/p/801441) was just a white powder, supposed to be a fentanyl, which turned out to be cocaine. There was a trace amount of fentanyl in it. Okay, so none of this is all that surprising given the time and place, and we don't know the full backstory. The sample had other common contaminants or breakdown products of cocaine: tropacocaine, levamisole, and methyl ecgonidine (MED), which makes us feel more confident that this was primarily a cocaine sample. But it was the fluoxetine that landed it on this list. Sometimes Rx medications get passed off as street-desirable pills, like the gout med above. In this case fluoxetine only shows up in trace abundance. Perhaps this was intentional, but just as likely to have been accidental. Part of a broader trend, we've detected other mental health meds in the drug supply: [quetiapine](https://www.streetsafe.supply/search?q=quetiapine) (schizophrenia and bipolar disorder) and [trazodone](https://www.streetsafe.supply/search?q=trazodone) (anti-depressant), among others. - **atropine** \- an old pharmaceutical medicine with [multiple uses](https://en.wikipedia.org/wiki/Atropine), and not known to be psychoactive. It is on the WHO's List of Essential Medicines, and also occurs naturally in plants. [In this sample](https://www.streetsafe.supply/results/p/804342), it only shows up in trace abundance. Like the fluoxetine sample above, these aren't substances that consistently produce an immediate euphoric high. So contamination is always the simplest possibility. Then again, if you've got crushed Rx tablets floating around when bagging up, maybe there's something else going on. - ***N*\-desalkylflurazepam -** (also called [**norfludiazepam**](https://pubchem.ncbi.nlm.nih.gov/compound/4540))Infrequently seen benzo that's usually a metabolite of other benzos. Not [much](https://www.opioiddata.org/btmps-explainer-the-effect-of-protonation/) known about it in street drugs. - **etodesnitazene** (also called **etazene**) - In the newer class of synthetic opioids called nitazenes. This particular one has been [advertised in online forums](https://pubmed.ncbi.nlm.nih.gov/34091156/) with claims of relative safety. CSFRE [reports](https://journals.lww.com/amjforensicmedicine/abstract/2022/12000/proliferation%5Fof%5Fnovel%5Fsynthetic%5Fopioids%5Fin.4.aspx) "etodesnitazene was first reported in a case from Iowa collected in May 2021, with subsequent cases reported from Louisiana, West Virginia, and Iowa (n = 1)." The [index sample](https://www.streetsafe.supply/results/p/806268) we received was a messy brew that had fent, Benadryl, BTMPS, dex(medetomidine), gabapentin, and heroin, as well as trace xylazine and caffeine (and other substances). If that combo wasn't expected, we would expect this to be rather sedating. While the index sample was a white powder, [WHO reports](https://cdn.who.int/media/docs/default-source/controlled-substances/45th-ecdd/etazene%5Fdraft.pdf?sfvrsn=cc970e16%5F1) it has also been found in fake M30 pills. Etazene is expected to be more potent at the mu opioid receptor than the more historically common etonitazene. - **phenazolam** (also called **clobromazolam**) **\-** Another benzo, that [CSFRE first saw](https://www.cfsre.org/images/monographs/Phenazolam-120622-CFSRE-Toxicology-Report.pdf) in November 2022\. It's been known in Sweden, Serbia, and [Australia](https://academic.oup.com/jat/article-abstract/48/5/273/7624899). It has some published [lab papers](https://academic.oup.com/jat/article/45/9/1014/5922474), but not a ton is officially known. 🤔 ****What's in a chemical name?** The last 3 examples above show is how chemical naming conventions have a big impact on our ability to retrieve additional health information. Current search engines are not nuanced enough to pick up on these chemical synonyms. And candidly, we wouldn't want to trust machines to do the name matching without human (chemist) oversight. Take the example of ****etodesnitazene** vs. ****etazene**. At the lab detection level, chemists often pick the name of a molecule given by the reference standard manufacturer because it is the most technically defensible; in the United States much of that is driven by [Cayman Chemical](https://www.caymanchem.com/product/29916/etodesnitazene-%28citrate%29). But, other labs in other countries will use other vendors, who may choose (completely legit) to name it differently. So, our job at the Street Drug Analysis Lab is to figure how to report out chemicals with multiple names in a way that returns the most useful clearweb search. If you search the scientific literature for "etodesnitazene" you'll get few hits. But, searching for "etazene" unlocks dozens of international studies and reports. So, in this case, we should probably switch to using "etazene." Before we do so, we will take time to verify that the chemical formula, and molecular structures and weights are the same. This is a careful process that will eventually become part of our (long-promised, but slow-going) Chemical Dictionary. - **pyrazolam** \- Established benzo in fake pills in Europe. May have less sedating properties than etizolam or bromazolam; there is a belief that pyrazolam may be helpful in reducing anxiety without as much of a hypnotic effect. The [index sample](https://www.streetsafe.supply/results/p/806114) was described as being a fine, tan power by itself, but the literature describes it more often in pill form. This [interesting "netographic analysis](https://pmc.ncbi.nlm.nih.gov/articles/PMC10801481/)" describes how pyrazolam is preferentially discussed on certain social media sites (but not others), and who's discussion volume is declining over time. - **delta-4(8)-iso-THC** \- impurity of synthetic THC production when being made from CBD. We don't know much about it's specific pharmacology ([Wikipedia](https://en.wikipedia.org/wiki/Isotetrahydrocannabinol)), but it's common in weed processing. The [index sample](https://www.streetsafe.supply/results/p/805028) had CBD, delta-8 and delta-9 THC, as well as cannabidiol, and was a brown oil/wax. Overall, this one is not a surprising find, but just new-to-us because we don't test a lot of weed. - **AB-MDMSBA** \- A less common synthetic cannabinoid. The [index sample](https://www.streetsafe.supply/results/p/806100) was expected to be a benzo, as a fine white powder, but wasn't. We are confident about the identification, but don't know much about this one. If anyone wants to enlighten us, we'd be happy to update this entry. The [PubChem](https://pubchem.ncbi.nlm.nih.gov/compound/156588929) entry was only created in late 2021, so this is likely a newer syncann. - **N-(1-phenethyl-4-piperidyl)-N-benzylpropanamide** \- A fentanyl synthesis byproduct. ([PubChem](https://pubchem.ncbi.nlm.nih.gov/compound/156588929)) We are expecting to see more of these novel impurities as production method shifts happen, driven by DTO infighting in Mexico, enforcement against [precursors in China](https://www.npr.org/2024/08/29/nx-s1-5089978/fentanyl-china-precursors), and US-led trade wars. Stay tuned. ## Watchlist Updates Want our Watchlist and New Substances sent your inbox every month? Sign up below for this newsletter. No password needed. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. --- # 🦸🏽 Harm Reduction Heroes Everyday heroes don’t always wear capes.” The truth is, the real champions are those rolling up their sleeves and making a difference on the ground daily. Their dedication and impact rival any superhero storyline—deserving all the spotlight and appreciation! Learn more about these local heroes by clicking the links below! ## **National Black Harm Reduction Network** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/IMG_3885-2-1.jpg) Illyana pictured with NBHRN director and board members Joy Rucker, Shreeta Waldon, and Bre Azanedo at the Florida harm Reduction Conference, October 2024. The National Black Harm Reduction Network is a powerful coalition dedicated to advancing health equity and justice for Black communities disproportionately impacted by systemic inequities. Rooted in the legacy of Black-led movements, the Network focuses on advocacy, mentorship, and building Black-centered harm reduction initiatives. [Advocacy & Action: The National Black Harm Reduction NetworkNational black harm reduction![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-7.png)Opioid Data LabIllyana Massey![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/IMG_3882-2-1-1-1.jpg)](https://www.opioiddata.org/advocacy-action-the-national-black-harm-reduction-network/) --- # ❤️‍🩹 Hurricane Update Hurricane Helene’s aftermath has left harm reduction programs in western North Carolina stretched to their limits. Communities are continuing to face housing instability, rising overdose rates, all while essential supplies and stability vanishes overnight. Harm reduction workers are delivering aid in the hardest-hit areas, even on horseback, but the needs continue to far outweigh the resources. This is a *critical* moment for **solidarity** and **action**. [Click here to learn how you can support these life-saving programs and help rebuild hope in WNC](https://www.wyff4.com/article/western-north-carolina-hurricane-helene-opioid-overdose/62854238). --- # 📖 Reading Room A place for things that taught us something new and maybe you will learn something too! When cities sweep homeless encampments, it’s not just tents and trash that are lost—it’s life-saving supplies like medications, IDs, and harm reduction tools. These sweeps devastate already vulnerable people, forcing them to start over with nothing. This cycle of displacement fuels instability and puts lives at greater risk. Learn how these policies impact communities and what can be done to support those most affected. [Read more about this here from ProPublica.](https://projects.propublica.org/homeless-encampment-sweeps-taken-belongings/) - North Carolina News: [Attorney General Josh Stein Finalizes $1.37 Billion Opioid Settlement with Kroger](https://ncdoj.gov/attorney-general-josh-stein-finalizes-1-37-billion-opioid-settlement-with-kroger/) - NY Times: [What's Behind the Remarkable Drop in US Overdose Deaths](https://www.nytimes.com/2024/11/21/health/overdose-deaths-decline-drug-supply.html) (with one of our own quoted☺️) - NY Times: [Where Some See Taboos, They See Opportunity](https://www.nytimes.com/2024/10/30/style/overdrive-defense-test-kits-fentanyl.html?smid=nytcore-ios-share&referringSource=articleShare) Explores how overdose defense is revolutionizing harm reduction - Drugs+Hip-Hop: [Slideshow: Opioid Advertisements From the Height Of the Crisis](https://benwesthoff.substack.com/p/slideshow-opioid-advertisements-from?utm%5Fsource=substack&publication%5Fid=44183&post%5Fid=150941282&utm%5Fmedium=email&utm%5Fcontent=share&utm%5Fcampaign=email-share&triggerShare=true&isFreemail=true&r=av0k0&triedRedirect=true) - PAGroundhogs: [PAG Surpasses 500 Samples Tested; Launches SAFER SMOKING Campaign](https://pagroundhogs.org/news/f/pag-surpasses-500-samples-tested-launches-safer-smoking-campaign?blogcategory=Funding) - KFF: [12 States Promised To Open the Books on Their Opioid Settlement Funds. We Checked Up on Them.](https://kffhealthnews.org/news/article/state-opioid-settlement-funds-transparency-update/) - Johns Hopkins blog: [10 Impactful ways to spend small opioid settlement allocations](https://opioidprinciples.jhsph.edu/impactful-ways-to-spend-small-opioid-settlement-allocations/), check out Roxanne Saucier's handy list (with evidence) ### 🤓 Scientific Literature The easiest way to get access to paywalled articles is to email the corresponding (or first) author. - Coney L, et al. [Comparison of strength and adulteration between illicit drugs obtained from cryptomarkets versus off-line](https://onlinelibrary.wiley.com/doi/10.1111/add.16665). *Addiction.* 2024\. \[open access\] - Langford AV, Lin CC, Nielsen S. [Global perspectives on opioid use: shifting the conversation from deprescribing to quality use of medicines.](https://qualitysafety.bmj.com/content/early/2024/11/07/bmjqs-2024-017657) *BMJ Quality & Safety*. 2024 \[open access\] - Lima, T. Y., et al. [Temporal and spatial trends of fentanyl co-occurrence in the illicit drug supply in the United States: A serial cross-sectional analysis.](https://www.thelancet.com/journals/lanam/article/PIIS2667-193X%2824%2900225-4/fulltext) *The Lancet Regional Health – Americas, 24*, Article 00225\. 2024 \[open access\] - Vivolo-Kantor, A. M., et al. [Notes from the Field: Ketamine Detection and Involvement in Drug Overdose Deaths — United States, July 2019–June 2023\. ](https://www.cdc.gov/mmwr/volumes/73/wr/mm7344a4.htm)*MMWR Morbidity and Mortality Weekly Report,* 73(44), 1010–1012**.** 2024\. \[open access\] - Wilson P, et al. [Safer supply and political interference in medical practice: Alberta's Narcotics Transition Services.](https://www.sciencedirect.com/science/article/pii/S0955395924002846) *International Journal of Drug Policy.* 2024 \[open access\] --- # 🤗 Opportunities for Impact Job postings, conferences, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. **Fireside Chat** Philomena Kebec, J.D., Economic Development Coordinator, Bad River Band of Lake Superior Chippewa invites you to the Brookings Institution launch of a major research initiative exploring the fentanyl epidemic in North America and globally: > Wednesday, December 4 from 9 AM to 12:30 PM EST, with in-person and virtual participation. I will be presenting at 9:50-10:35 with Peter Reuter and Beau Kilmer on domestic implications, sharing my research on the impact of fentanyl on American Indian and Alaska Native communities. More information and a link to register is available [here](https://www.brookings.edu/events/the-fentanyl-epidemic-in-north-america-and-the-global-reach-of-synthetic-opioids/). **Panel Discussion** Watch a recap of ["White faces, Black and Brown Lives: Racial Disparities in the OD Crisis."](https://www.youtube.com/watch?v=vrnuc4xr2PY) panel discussion last month. **Pain Patients as Casualties: Webinar** On December 3rd, join to [explore how pain patients have become unintended casualties in the ongoing war on drugs and discuss compassionate solutions.](https://www.cato.org/events/pain-refugees-collateral-damage-war-drugs) **Call For Abstracts** Health Affairs is calling for abstracts on research and policy insights about the opioid crisis for a thematic issue to be published in September 2025\. Submit your abstract by December 2, 2024, to contribute to this critical discussion and help shape future opioid policies. [Click here to learn more.](https://www.healthaffairs.org/request-for-abstracts/2025-opioids) --- # 📣 Team Voices Check out monthly blog posts from members of our team! [GCMS Filament EI source replacement @ UNC Street Drug LabReplacing the filament of the EI source in our GCMS to support street drug analysis. Electron ionization filament replacement visualized![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-8.png)Opioid Data LabErin Tracy![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/IMG_CF411ADC0801-1-3-1.jpeg)](https://www.opioiddata.org/filament/) [On the Road AgainAdams and Colin were back on the road this month, visiting with partners at Prevention Point in Pittsburgh, Pennsylvania. The two spent time with 27 people who use drugs, learning more about naloxone use and overdose response strategies, xylazine trends, and a potential mystery substance some are calling “trippy dope,![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-10.png)Opioid Data LabAdams Sibley![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/image--1--1-1.png)](https://www.opioiddata.org/on-the-road-again/) --- # 🪩 Out and About See what our team has been up to in the community! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/IMG_9798.jpg) Left to right: Cole Altomare-Jarczyk (Brandeis University), Jalice Manso (UNC), Joshua DeBord (CFSRE), Alex Krotulski (CFSRE), Erin Tracy (UNC), Karen McDonald (Toronto Drug Checking Service) at the 2024 Novel Synthetic Drug Threat Symposium in Philadelphia, PA. [Click here to read more about the event!](https://www.opioiddata.org/2024-novel-synthetic-drug-threat-symposium/) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/IMG_4063-1-1.jpg) Illyana presenting at the North Carolina Community Health Center Association's 2024 Clinical Conference on Quality and Chronic Disease this month. [Click here to learn more about the conference and association!](https://www.ncchca.org/event/2024-clinical-conference/) --- # 👋 Meet our Team Members Each month will feature different team members 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/IMG_1982-1.jpg) ## Colin Miller Having joined the team in 2022, our Community Liaison Colin Miller brings a range of skill and lived and living experience from community organizing, to research, and to non-profit management. Colin is co-founder and initial Executive Director of Twin City Harm Reduction Collective in Winston-Salem and communicates with the animals in his spare time. --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/IMG_0224-1.jpg) --- ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ### BTMPS Explainer: The Effect of Protonation URL: https://www.opioiddata.org/btmps-explainer-the-effect-of-protonation/ Last updated: 2024-12-20T20:04:58.000Z **Vikrant Jandev and Marya Lieberman, UND** **Blake Joachim (Outside In) and Cole Altomare-Jarczyk and Ivy Sabal (MADDS)** *What’s up with the IR spectrum of BTMPS? How come the literature spectrum doesn’t fit what we are seeing in drug samples?* The literature IR spectrum of BTMPS is the free base, which is the form that is used as a plastics additive. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-18.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-19.png) Figure-1 IR spectra of free base BTMPS (Vikrant Jandev took this spectrum of our free base BTMPS material). That teeny little peak at about 3300 cm\-1 is probably the N-H stretching mode, the bands from 3000 to 2850 are various C-H stretching modes, the strong peak at 1717 cm\-1 is the C=O stretch. The red spectrum at the top here is the literature BTMPS spectrum, the blue spectrum at the bottom is the IR that is obtained when you subtract out the “known” components of a sample that has a lot of BTMPS, verified by GCMS. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-20.png) Figure-2 Mystery IR spectrum The chemical form found in the drug supply appears to be the hydrochloride salt. Why? The hydrochloride salt of BTMPS is quite soluble in water. The free base of BTMPS is not soluble in water at all, so it would not “work” as a component of an injectable drug. (I have no clue why anyone would add it to drugs in the first place) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-17.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-21.png) Figure-3 IR spectra of BTMPS\*2HCl (Vikrant Jandev took this spectrum too). The symmetric and antisymmetric NH2 stretching modes are at 3392 and 3321 cm\-1, there is a broad envelope of NH combinations and overtones in the 2800-2450 cm\-1 range (partially on top of the CH stretching modes), the C=O stretch is at 1729 cm\-1, and there’s a band at 1604 that is probably an NH2 scissoring mode. This OPUS spectrum is available for download *here*, in the Remedy Alliance slack channel and has been shared with MADDS, BCCSU, and Kykeon. **Synthesis:** BTMPS is a “free base” meaning that the 2 nitrogen atoms in the piperidine rings are available for protonation. Addition of 2 molar equivalents of a strong acid gives the doubly protonated form of the molecule. The parent BTMPS is soluble in methanol and acetone, but insoluble in water. The hydrochloride salt is soluble in methanol and water, but not in acetone. So if you make the salt in acetone, it crashes out of solution. 1.25 g bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS, CAS 52829-07-9, Tinuvin 770, Sigma-Aldrich #535834, 480.7 g/mol, 2.60 mmol) was dissolved in 7.5 mL acetone at room temperature giving a clear solution. 2.0 mL of 3M HCl in isopropyl alcohol was added slowly with swirling (6 mmol, 2.3 eq). The cloudy solution was refrigerated for 30 min, during which time copious white solid precipitated. The precipitate remained after warming the solution to room temperature. The solid was isolated by vacuum filtration and rinsed with 2x5 mL of RT acetone, then was dried to constant weight (1.4182 g, 98.5% assuming product is the dihydrochloride with formula C28H54N2O4Cl2, 553.65 g/mol). Per Sigma: acetone: 19 % (w/w) at 20 °C, ethyl acetate: 24 % (w/w) at 20 °C, methanol: 38 % (w/w) at 20 °C, chloroform: 45 % (w/w) at 20 °C, methylene chloride: 56 % (w/w) at 20 °C, H2O: insoluble <6 ppm at 20 °C While the parent BTMPS gave a sharp melting point (82.7-84.3C, compare with 82-85 °C (lit.)) the hydrochloride salt appeared to melt in several stages starting at about 118C and with solid still visible until it decomposed to a brown material at 255 C. (Catherine O’Donnell and Marya Lieberman both checked this) The infrared spectra were obtained on a Bruker Alpha II ATR-IR with 4 cm\-1 resolution and 16 scans. **More resources:** 1) Here is a good online tutorial about the impact of protonation on amine IR spectra: 2) This free IR modeling site is fun to play with: [Infrared spectra prediction](https://www.cheminfo.org/flavor/structuralAnalysis/IR/IR%5Fspectra%5Fprediction/index.html) To use the IR modeling software, you’ll need to draw the molecule. The easiest way is to import the SMILES string. The BTMPS SMILES string is: CC1(C)CC(CC(C)(C)N1)OC(=O)CCCCCCCCC(=O)OC2CC(C)(C)NC(C)(C)C2 Once you’ve imported the string, the structure of the molecule should pop up on the screen. The program is not powerful enough to model the entire molecule, so just erase half of the atoms (pick the left or right side, it doesn’t matter which). The IR spectrum of that half molecule will be very similar to the IR spectrum of the full molecule. Next, draw in the extra N-H bond (and add a + charge) and model the IR spectrum for the cation. Once you’ve modeled the spectrum, you can pick an IR mode and the software will then show you a movie of the corresponding bond stretches and wiggles. [TINUVIN 2HCLTINUVIN 2HCL.040 KBdownload-circle](https://www.opioiddata.org/content/files/2024/11/TINUVIN-2HCL.0 "Download") ### The model that predicted OD drop URL: https://www.opioiddata.org/the-model-that-predicted-od-drop/ Last updated: 2026-05-11T15:46:28.000Z In the aftermath of a presidential election, there is a lot of navel gazing about the reliability of prediction models. The lesson is clear: It takes immense skill (and a touch of good fortune) to model complex human and social phenomena with mathematics. And so, predicting big trends in overdose takes some panache. Cynically, the scientific literature is replete with mediocre predictive models who's big conclusion is *shockingly* that previous history of overdose is predictive of future overdose. Meh. But there is just one model that I've come to trust, after watching [Mo Jalali of Harvard Medical School](https://mj-lab.mgh.harvard.edu/) present at the [RADARS Annual Meeting](https://www.radars.org/annual-meetings-a.html) in May 2023\. [His presentation](https://www.radars.org/system/events/RADARS%20System%202023%20Annual%20Meeting%5FJalali%20-%20Application%20of%20Systems%20Science%20in%20Opiod.pdf.tmp) is based on [**this paper**](https://www.pnas.org/doi/10.1073/pnas.2115714119) (and [supporting information](https://www.pnas.org/doi/suppl/10.1073/pnas.2115714119)) published in PNAS, with Tse Yang Lim as first author. (The research was funded by the US Food and Drug Administration, which also funds science at the Opioid Data Lab.) It's a dream team of modelers in this space; Stringfellow and especially Wakeland have been doing opioid systems modeling for a very long time. These authors are solidly credentialed. [![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/Screenshot-2024-11-22-at-9.20.23-AM.png)](https://www.pnas.org/doi/10.1073/pnas.2115714119) [Source](https://www.pnas.org/doi/10.1073/pnas.2115714119) Read on for our take on the model and what they got right, and what didn't pan out. We promise we won't get into the Greek-letter equations 😉 but the lengthy [supporting information](https://www.pnas.org/doi/suppl/10.1073/pnas.2115714119) is worth a closer look. 🤓 Read on below the break. ## Sign up for Opioid Data Lab Like this analysis? Subscribe (free!) to get our latest takes on drugs in America. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. --- # Timeline First, let's get the timeline right. They submitted the paper in August 2021, and used data through 2020\. They predicted the trajectory of the overdose epidemic going forward to **2033**. Think back. This is before COVID vaccines, and we were still isolated. Overdoses were [skyrocketing](https://www.sciencedirect.com/science/article/pii/S0376871620303410?casa%5Ftoken=JiFC3vfbVEsAAAAA:Zq%5FsflfQ6leGR34o-B9tXkpp7-ppm4nz2e1K3-3PBqyRN90YCCCAiXxReo0bDt5SaFsFXHPR). This was a moment of grave public pessimism. Into that breach, Lim et al. stepped forward with **predictive modeling suggesting that overdose deaths would start to decrease nationally in 2023.** ![](https://media.tenor.com/HpBRbrenM7kAAAAC/del-griffith-oh-sure-sure.gif) ## But they were right! The [current decline in overdoses](https://www.opioiddata.org/are-overdoses-down-and-why/) arrived when it was predicted. And moreover, the rate of decline (slope or downward trajectory) aligns remarkably well with what is happening today. I've used a modified and simplified version of their predictive model output in [my slides](https://cdr.lib.unc.edu/collections/9880w316p?locale=en) for the last year. In those talks, my rhetorical point has been that we have a full decade ahead of us where there are more than 50,000 overdose deaths per year, even if we do everything right. (By comparison, all of Scotland, England and Wales has 5,000 OD deaths per year. Regardless of population denominators, the sheer public health magnitude of what we face in the US is staggering.) In my talks I exhort us to take better care of the people providing front line services, because the accumulating grief is a tangible threat to public health capacity. And it's gonna be around a long time. Putting aside immense societal grief for a moment, let's look at what Lim et al. predicted: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/Screenshot-2024-11-22-at-9.37.59-AM.png) Modified and annotated from Figure 5 of [Lim et al](https://www.pnas.org/doi/suppl/10.1073/pnas.2115714119). Black vertical line represents 3Q2023 when ODs started declining in the USA. ![](https://media.tenor.com/XbRb8JJmT10AAAAC/nailed-it.gif) Okay okay, I get it. Academic exuberance when there are so many people dying is unseemly. Those are my friends lives that accreted into that blue line. Here's one of them, Tony Givens, who passed in 2004\. Miss you, brother. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/image-8.png) RIP Anthony Givens But let's see what worked so we can get a sense of how to get these stubborn numbers to stay down. (The last person to say "[bend the curve](https://www.nejm.org/doi/abs/10.1056/NEJMe2406359)" buys the next round of drinks. For Tony that would have been a Rusty Nail, eww gross.) --- # What's under the hood We can think of the model in 3 parts: 1. [Historical information](https://www.opioiddata.org/the-model-that-predicted-od-drop#historical-information) 2. [Mathematical functions](https://www.opioiddata.org/the-model-that-predicted-od-drop#mathematical-functions) 3. [Predictions based on scenarios](https://www.opioiddata.org/the-model-that-predicted-od-drop#predictions-based-on-scenarios) --- ## Historical information The historical information they used is store in something they call SOURCE for "Simulation of Opioid Use, Response, Consequences, and Effects." (Strong acronym work there.) They used \~15 different national datasets measuring different aspects of opioid use/problems to replicate (blue line) what really happened (grey dots) from 1999 to 2020. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/Screenshot-2024-11-22-at-10.01.24-AM.png) From Supplemental Material of [Lim et al](https://www.pnas.org/doi/suppl/10.1073/pnas.2115714119) page 58 **Pause here, youngins.** Starting around 2012, we shifted from Rx opioid overdoses to heroin, and back when the model was being conceptualized (like 2019 or so), heroin was more common than fentanyl. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/1-s2.0-S0376871614018675-gr1_lrg.jpg) North Carolina data from [Dasgupta et al.](https://doi.org/10.1016/j.drugalcdep.2014.10.005) The transition to heroin was well under way by 2019, so reading this model in almost-2025, it feels anachronistic to have such an emphasis on the transitions from Rx opioids analgesics. And I will point out to my beloved community of folks living with chronic pain: This model largely ignores your plight. And yet it still accurately predicts the decline in overdose today. Why? Because by the middle of the first decade of the 2000s, it was not patients in chronic pain who were dying from overdoses on their prescriptions, that rate was [0.022%](https://academic.oup.com/painmedicine/article/17/1/85/1752837) as we've shown. (Sadly in recent years, [suicide among long-term opioid patients](https://academic.oup.com/aje/advance-article-abstract/doi/10.1093/aje/kwae394/7815653) who were abruptly discontinued is horrific.) Rather, the Lim et al. model is looking at people who who were using both heroin and Rx opioids. What is important though is the concept of new initiates. Which brings us to transitions and flows at the individual level... --- ## Mathematical functions The simplified take of the complex math is that 1) individuals can change, and 2) external factors have impacts. ### Individual flows The basic concept here is that individuals who are using drugs, as well as service providers will change "states" over time. In the graphic below, the top half are people with OUD, and the bottom half are clinicians prescribing buprenorphine. So the modeling process really got into the weeds. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/Screenshot-2024-11-22-at-10.55.44-AM.png) Here are patient level flows in more detail. Even though the thickness of the arrows is the same in the figure, each arrow is specified independently and can be set to have different effect sizes. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/Screenshot-2024-11-22-at-11.02.47-AM.png) Again, starting with Rx opioids as the incoming funnel will be uncomfortable, as if the whole problem is being blamed, yet again, on pain patients. Optics of the graphic aside, let's look at the actual numbers used. They used the IQVIA (neé IMS) outpatient pharmacy dispensing number for *all* opioid analgesics, from 1999-2020\. So, if you got a Rx for wisdom teeth extraction, you're represented in here. Effectively, this is like 20% of the *entire* population. The starting point is important, but it's also so big that "People with Rx opioid" should not be construed to mean chronic pain patients. Capiche? I speculate there is also some bureaucracy that influenced the model. The emphasis on *prescribing* is likely an artifact of FDA's funding and involvement in the study, because the Feds in the early 2020s had an uneasy entente: Division of responsibility was split between FDA (Rx opioids), DEA (street drugs), SAMHSA (treatment), and CDC (overdose). A lot of these boundaries have eased now, but I can see the imprint of the bureaucracy on the science. ### External factors These are the factors they looked at: - Barriers to treatment, including transportation - Treatment capacity (including bup, methadone, and Vivitrol) - Treatment duration - Rate of remission from OUD - Abuse-deterrent formulations - Street prices (from [StreetRx.com](https://streetrx.com/)) - Heroin prices - Fentanyl market penetration - Naloxone kit distribution (including OSNN Buyers Club) - Probability of witnessing an OD - COVID As an example, here's their thinking on how they disentangled COVID effects. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/Screenshot-2024-11-22-at-9.52.41-AM.png) [Jalali](https://www.radars.org/system/events/RADARS%20System%202023%20Annual%20Meeting%5FJalali%20-%20Application%20of%20Systems%20Science%20in%20Opiod.pdf.tmp) at RADARS Annual Meeting They also model things dynamically based on changes in public perception of risks of drug use. > Two key endogenous processes in the model are social influence, whereby existing users of a substance can increase initiation rates or accelerate use disorder development, and risk perception, whereby overdoses, especially overdose deaths, increase the perceived risk associated with prescription opioid or heroin use and discourage initiation. The model also endogenously represents the dynamics of demand for and availability of prescription opioids for misuse, which influence initiation and use disorder development. Combined together, these "states" end up looking like this: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-5.png) **(A–E) Changes in key transitions (flows) over time (Top, blue), distinguishing effects of changes in transition hazard rates (Middle, red), and source populations (Bottom, green). Bands are 95% CrIs. Source populations and hazard rates are normalized to their initial values. HUD, heroin use disorder; Rx, prescription opioid; Rx OUD, prescription opioid use disorder.*[source](https://www.pnas.org/doi/10.1073/pnas.2115714119) --- ## Predictions based on scenarios The last component of the model are hypothetical scenarios. These are intended to convey a range of possibilities of interventions and changes in street supply. For example, they show what ODs would look like if fentanyl hadn't replaced heroin (red lines below), or without naloxone distribution (green). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-6.png) [Source](https://www.pnas.org/doi/10.1073/pnas.2115714119) The naloxone distribution is interesting. They show a modest effect, which is fair for the time at which the model was made. And they are mostly looking at *pharmacy dispensed* naloxone. Actual community-based naloxone distribution ramped waaaaaaaaaay up in 2021, so the actual impact of naloxone distribution is probably more impactful than the model expects. Back to the model. They present scenarios. First one is a scenario cleverly called exogenous trends continue (ETC) – meaning things continuing along the trajectory as was known in 2020 before the emergence of illicitly manufactured fentanyl. And there are two other "optimistic" and "pessimistic" scenarios. > here we present three scenarios: an “exogenous trends continue” (ETC) scenario, where SOURCE’s exogenous inputs are assumed to continue their present trends at decelerating rates, stabilizing at plausible levels by 2032, as well as two variants of this scenario with more “optimistic” and “pessimistic” outcomes ([Table 1](https://www.pnas.org/doi/10.1073/pnas.2115714119#t01)). The optimistic case assumes lower IMF prevalence, higher naloxone and MOUD availability, and greater reductions in opioid prescribing than the ETC case, while the pessimistic case is the reverse. These scenarios should not be considered precise forecasts nor analyses of any particular policy interventions, but instead plausible future trajectories for the evolving crisis. --- # Putting it all together So, putting those 3 components together we have 3 sets of graphs. Top is heroin or Rx opioid initiation. Middle is OUD. And bottom is overdose. Left of the red dotted line is actually observed data, and to the right are the model predictions. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-7.png) **Simulated historical and projected trajectories for selected variables, under three sets of assumptions: ETC (blue), optimistic (orange), and pessimistic (green). Bands are 95% CrIs for estimated underlying values (historical portion, before 2020) and for projected reported data (after 2020); CrIs for projected reported values account for measurement noise, and hence are wider. Full results are in*[**SI Appendix*, section S5](https://www.pnas.org/doi/10.1073/pnas.2115714119#supplementary-materials)**.*[Source](https://www.pnas.org/doi/10.1073/pnas.2115714119) The top panels do give us reason to suspect the "[depletion of susceptibles](https://www.opioiddata.org/are-overdoses-down-and-why/#5-depletion-of-susceptibles)" hypothesis may have some truth. The number of new initiates has been dropping for a decade. Let's zoom in and focus on the bottom row for overdoses: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/12/image-8.png) [Source](https://www.pnas.org/doi/10.1073/pnas.2115714119) Figure 5 First, note the left panel. Deaths from Rx opioids are MUCH lower than deaths from illicitly manufactured fentanyl (right panel). This jives with what has actually happened. ## Worst of the worst Now, on the right, we see the model predicting that ODs from street fentanyl and heroin. Sorry y'all, the pessimistic scenario is the most accurate one in green. The bold green line is the core model's prediction, and the light green represents different possible ways that dark green could like based on simulations. In other words, the top of the light green region is pretty close to what actually happened. I'll say that again: Our collective in the last few years was the worst case simulation using the most pessimistic model. Yeah, remember what we were saying about grief? It's what we've lived through. The worst of the worst scenario. Despite that, the model *still* predicted that ODs were to start dropping in 2023 or 2024\. And that's where we are today. Some states started dropping in late 2023, and most states show declines in OD into 2024. --- # Summary So in summary, I don't always trust models, but this one I do. [via GIPHY](https://giphy.com/gifs/tokkingheads-6GyRTM4xJNoW1WFsOs) To my knowledge, this was the only group of mathematical modelers who got this right. (Let me know if I'm wrong! opioiddatalab@unc.edu) For many of us, the sudden drop in overdose deaths over the past year has come as a surprise. It's hard to believe it, after all these decades of grief. We are inured to optimism. So, it gives us some hope to know that the most sophisticated prediction of our current state accurately portrays what much of the country has recently experienced. ## Sign up for Opioid Data Lab Welcome to the Street Drug Analysis Lab @ UNC, a public service of the University of North Carolina at Chapel Hill. We provide analytical chemistry services and information for public health. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### Advocacy & Action: The National Black Harm Reduction Network URL: https://www.opioiddata.org/advocacy-action-the-national-black-harm-reduction-network/ Last updated: 2024-11-21T19:56:01.000Z At the Florida Harm Reduction Conference (October 2024), Illyana had the pleasure of meeting a few of the board members from NBHRN. The National Black Harm Reduction Network (NBHRN) is a groundbreaking organization rooted in the rich legacy of Black-led movements for freedom, equity, and self-determination. As a leader in harm reduction, the Network reimagines a future where Black communities are no longer disproportionately impacted by systemic inequities in public health, criminal justice, and drug policies. With an unwavering commitment to dismantling structural racism, NBHRN strives to eliminate harm—not merely reduce it—through advocacy, education, and action that centers Black voices and experiences. Through its work, NBHRN serves as a national advocate for Black-centered policies that promote health equity and justice, providing technical assistance and mentorship to community organizations and government entities alike. It builds robust networks of Black-led and Black-centered harm reduction initiatives, creating a platform for collaboration, innovation, and transformation. With a focus on preserving the history of Black harm reduction work while shaping its future, NBHRN inspires action and challenges systems of oppression with a vision of true liberation. To learn more about their impactful work, connect, or get involved in advancing harm reduction for Black communities, visit their website! Explore their blog, access resources, and discover opportunities to join this movement for justice and equity. The **National Black Harm Reduction Network** is an undeniable force for change and a source of *inspiration* for ***all*** who seek to build a more just and equitable future. [National Black Harm Reduction Network (NBHRN)The National Black Harm Reduction Network (NBHRN) is committed to promoting harm reduction strategies that improve the health and well-being of Black communities. These communities are disproportionately impacted by harmful drug policies, the criminal justice system, and public health inequities.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-6.ico)National Black Harm Reduction Network (NBHRN)0![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/BILLBOARD-01---Horizontal--Cropped-.png)](https://www.nbhrn.org/) ### On the Road Again URL: https://www.opioiddata.org/on-the-road-again/ Last updated: 2024-11-25T16:16:52.000Z Adams and Colin were back on the road this month, visiting with partners at Prevention Point in Pittsburgh, Pennsylvania. The two spent time with 27 people who use drugs, learning more about naloxone use and overdose response strategies, xylazine trends, and a potential mystery substance some are calling "trippy dope," which seems to cause mild hallucinations. Adams and Colin will take a break from traveling for the holidays before resuming data collection in Sacramento in the new year. ### 2024 Novel Synthetic Drug Threat Symposium URL: https://www.opioiddata.org/2024-novel-synthetic-drug-threat-symposium/ Last updated: 2024-11-26T16:51:32.000Z The goal is to bring together international thought leaders and scientists, policy makers, health professionals, public health and public safety stakeholders working in or impacted by Novel Synthetic Drugs Crisis. The program will have a focus on global impacts of NPS. Professionals from across the world will share current knowledge on NPS trends and emerging threats, review of tools and workflows that have developed over recent years and will work together to imagine and anticipate some of the challenges in NPS in the years ahead. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/IMG_9798-1.jpg) Cole Altomare-Jarczyk (Brandeis University), Jalice, Joshua DeBord (CFSRE), Alex Krotulski (CFSRE), Erin, Karen McDonald (Toronto Drug Checking Service) ### Filament URL: https://www.opioiddata.org/filament/ Last updated: 2025-03-25T15:36:20.000Z ## The Unsung Hero of Our GC-MS: Maintaining the Electron Ionization Filament Let's be honest - when you get data back from the lab, the last thing you're thinking about is the inner workings of the instrument used to generate it. But one tiny, unheralded component plays a huge role in making sure your analytical results are accurate: the electron ionization (EI) filament. ***By: Erin Tracy and Jalice Manso*** --- ### What the Heck is Electron Ionization? Before we get to the filament, let's quickly cover the basics of EI. It's the secret sauce that powers a lot of modern mass spectrometers, including the GC-MS instrument we use to analyze your samples. The EI process is pretty straightforward - a beam of high-energy electrons blasts apart the molecules in your sample, creating a cloud of positively charged ions. These ions then get accelerated and sorted by the mass spectrometer, allowing us to identify the compounds present. It's like breaking a puzzle into pieces and reassembling them. ### The Filament That Fuels the Flame At the heart of the EI source is a thin wire called the filament. When electricity runs through it, the filament heats up and emits the electrons that do the ionization. But over time, all that heat takes a toll, causing the filament to wear down and eventually burn out. Below you can see the spiral coil that should remind you of an incandescent bulb 💡. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/IMG_6E80E5D87325-1-1.jpeg) Spent filament on the left, new replacement on right. As you can see, a tired, worn-out filament (on the left) looks pretty beat up compared to a fresh, new one (on the right). If it's not replaced in time, this physical deterioration can impact the instrument's performance, leading to: - Weaker signals and poorer detection of your target compounds - Higher background noise that can make your data harder to interpret - Potential damage to other sensitive parts of the mass spec ### Keeping Our Instrument Running Strong Our Agilent GCMS was purchased by the North Carolina General Assembly via the [NC Collaboratory](https://collaboratory.unc.edu/) using opioid settlement funds. We are grateful and feel it is our duty to keep the instrument running strong. The good news is that replacing the EI filament is a routine maintenance task that's pretty straightforward. And we can do it ourselves! We typically anticipate swapping it out every 5-8 months to keep our GC-MS running at peak performance. After the replacement, the vacuum re-pressurization in the chamber takes about half a day. So, expect us to to be down for about a day every 6 months to do this maintenance. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/11/IMG_4529834F42C4-1-1.jpeg) Move over IKEA! Filament is #7 So the next time you get data from the lab, give a silent thank-you to the unsung hero of the GC-MS - the hardworking EI filament that makes it all possible. We are on top of taking care of the equipment that powers our science. ### Upcoming data card changes URL: https://www.opioiddata.org/upcoming-data-changes/ Last updated: 2024-12-22T22:29:41.000Z 📊 Updated cards will be mailed with kits starting in late January 2025\. We have received a lot of great feedback from programs on how to improve the data collections elements on the card. We have noted these over the last months, and are ready to make changes. (The card was last updated in June 2023.) We're giving analysts 2 months lead time to get ready. Given all the analysis implications listed below, we do not want to make another card change for a long time! We will update this page with the final version prior to launch. [Instruction and data card, v9Shipping in kits from January 2025Instruction and data card, v9.pdf932 KBdownload-circle](https://www.opioiddata.org/content/files/2024/11/Instruction-and-data-card--v9-1.pdf "Download") You can find an [archive of previous card versions](https://cdr.lib.unc.edu/concern/multimeds/5d86p887m?locale=en) and launch dates at the UNC institutional repository. For this round of changes, we did a data analysis of 8,311 samples analyzed by October 2024 to see patterns of missingness and see if we could make circle choices for common write-in notes for sensations, texture and expected drugs. The [current codebook](https://github.com/opioiddatalab/drugchecking/blob/main/datasets/unc%5Fdruchecking%5Fcodebook.txt) may be helpful in understanding the analysis implications. The codebook will be updated in January in advance of the launch. The following changes are expected to roll-out in mid-to-late January 2025, as card version 9\. Card version numbers are noted in the bottom left of the card. ## Subscribe to stay current. We will notify everyone of the launch date via our January newsletter. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. --- # Card Changes ## Big Things - Added nitazene and carfentanil to list of expected drugs - Added stimulant / opioid type to OD panel - Added test strip results for benzos, fent, xylazine, and meth ## Little Things - Changed scoop visual for collection method to be scoop and not spatula - Added “important!” to collection method to get more completion (this is very important for the lab to know how to analyze the sample, such as needing to concentrate residue samples) - Added “fine” to texture (common write-in) - Added “rock” to texture (common write-in) - Changed “weird” to “unusual” in sensations because the former was considered pejorative by some participants - Changed “unusual taste” to “odd smell" and "odd taste” in sensations to differentiate it from "unusual" above - Removed “fake pill” and kept “pill” - Changed “normal” to “typical” in sensations --- # **Analysis Implications** *These are some anticipated downstream implications of the card changes on data.* Analyzing sensations, datasets will be retrospectively processed to aggregate “unusual” or “weird” to be "unusual" only. Analyzing sensations, "smell" and "taste" can be disaggregated in **sensations**. Analyzing sensations, “normal” or “typical” will be aggregated. We will update datasets to replace all “normal” with “typical” retrospectively in variable **sen\_strength** and **sensations**. Variable **sen\_weird** will be renamed to **sen\_unusual**. In sensations, “more down” and “sedating” were redundant, so only “sedating” was kept to make room on the card. Variable **sen\_down** will remain as it is but will include both “more down” and “sedating” responses. Variable **overdose** will stay the same, but **od\_type** will be added to distinguish stimulant, opioid, and no response. Analyzing texture, “rock” was commonly listed as a write-in “other” category, and now will be in the main description text of **sensations**. This will be automated retrospectively to make it consistent with earlier datasets so no additional analysis to search free text (variable **texture\_notes**) . Same with “fine.” Test strip results will be a new set of 4 verbatim variables for **test\_benzos**, **test\_fent**, **test\_meth**, and **test\_xylazine**. The variables will take values of -1 for circled negative, 1 for circled positive, missing if not specified. --- We hope these changes will help our participants describe their experiences better, reduce hassle for staff filling out the cards, and provide analysts with tools for more nuanced analysis. ### October Newsletter URL: https://www.opioiddata.org/october-2024-newsletter/ Last updated: 2024-11-26T22:55:50.000Z 👻 Happy Spooky Season and welcome to [****UNC Street Drug Analysis Lab**](https://streetsafe.supply)****'s Newsletter!** We're excited to bring you the latest from our team, including must-read articles, insightful blog posts, cutting-edge research, behind-the-scenes updates from the lab, and more! Whether you're here to learn about drug checking or catch up on what we're up to, we’ve got something for everyone. And if you can’t wait till next month, [our blog site](https://www.opioiddata.org/) will get regular updates. Dive in, stay informed, and let’s keep building safer, smarter communities together! # 〽️ Service Stats As of Monday, October 28, 2024: 8,591 samples analyzed Serving 154 harm reduction programs Reaching 223 counties in 39 states 346 unique substances identified --- # 👀 Watchlist Here are the [trends in the drug supply](https://www.opioiddata.org/unc-watchlist/) we are keeping an eye on this month. For our local audience, here are slides for [the NC Drug Landscape Update](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/cv43pb594?locale=en) we provided at the Governors Institute Addiction Essentials course in October. [Acetamiprid](https://www.opioiddata.org/unc-watchlist/#insecticide-acetamiprid) \- insecticide we were about to take off the list and then it popped up [BTMPS](https://www.opioiddata.org/unc-watchlist/#btmps) \- industrial chemical added to plastics. New finding: XP Huang at our partner lab at UNC has established that it has no direct binding to any of the \~350 brain/body receptors that known drugs activate. Meaning, this is not likely a psychoactive substance, and so subjective effects may be due to other properties (e.g., calcium channel blocker??). [Xylazine & (dex)medetomidine](https://www.opioiddata.org/unc-watchlist/#xylazine-dexmedetomidine) \- sedatives mixed with fentanyl [Carfentanil](https://www.opioiddata.org/unc-watchlist/#carfentanil) \- powerful opioid reemerges in a new way [2-fluoro-2-oxo-PCE + fentanyl](https://www.opioiddata.org/unc-watchlist/#2-fluoro-2-oxo-pce) \- international club drug mixed unexpectedly with fentanyl and others [Shift to smoking](https://www.opioiddata.org/unc-watchlist/#shift-to-smoking) \- broad trend with implications for overdose prevention We talk about declines on overdose rates further down. --- # 👩🏽‍🔬 New Substances Detected We have a [new live report app](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823) that shows which new substances have been detected recently. This app auto-updates on the first day of each month. ([all the other live report apps](https://uncopioid.atlassian.net/wiki/external/ZTk5NGQ0YWE3NDA1NGEwZGIxZjhiMDUyNGQ1ZWJiY2M#2.-Live-Reports)) We detected **6 new substances** in the drug supply in September 2024\. Well, new-to-us at least. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/image-5.png) [clickable version here](https://deepnote.com/app/opioiddatalab/Newly-Detected-Substances-2f2c3288-10a7-4e03-a6c2-57bb006b5823) ### Descriptions - **7-hydroxymitragynine** \- part of kratom plant. Occurs naturally, one of many alkaloids. - **N-propionitrile chlorphine** \- novel synthetic opioid of questionable potency ([CSFRE](https://www.cfsre.org/nps-discovery/trend-reports/nps-opioids)). We'll have more to say about this later. We have concerns. - **niacin** \- vitamin B3, causes body flushing ([wikipedia](https://en.wikipedia.org/wiki/Niacin)). This would normally be an underisrable thing, in fact, back in the day [Pfizer was trying](https://www.jpain.org/article/S1526-5900%2811%2900325-7/fulltext) to make a oxycodone + niacin tablet that would cause a severe flushing reaction if crushed and snorted/injected. It never made it to approval because it caused the same type of problem in patients when taken in orally intact. We've sporadically seen [compounds related to niacin](https://www.streetsafe.supply/results/p/300757) in NC, but the [recent niacin sample](https://www.streetsafe.supply/results/p/805140) came from Washington. - **PMK ethyl glycidate** \- precursor for MDMA, already scheduled. Not much surprise here. Maybe synthesis methods are evolving, or could be a one-off. - **hydromorphone** \- classic pharmaceutical opioid similar in effect to heroin ([wikipedia](https://en.wikipedia.org/wiki/Hydromorphone)). It is unusual to see this typically-prescription opioid in a street sample. [This sample](https://www.streetsafe.supply/results/p/806745) was a white pill that also contained fentanyl and 4-ANPP. There are no fentanyl+hydromorphone Rx opioids on the market anywhere in the world, and the presence of 4-ANPP suggests clandestine manufacture of the fentanyl. So, it begs the question if the hydromorphone is of pharmaceutical origin (Dilaudid and generics) or being synthesized in unregulated labs. Hydromorphone has a lower OD risk profile than fentanyl, and is subjectively the Rx opioid most preferred on the street historically. - **3,4-Methylenedioxy-α-Propylaminobutiophenone** (MDPPP) - designer stimulant in fake Ecstasy ([wikipedia](https://en.wikipedia.org/wiki/3%27,4%27-Methylenedioxy-%CE%B1-pyrrolidinopropiophenone)). There are other similar molecules we have detected, for example, [this sample](https://www.streetsafe.supply/results/p/802600) from NY and this [one from](https://www.streetsafe.supply/results/p/400136) TN were supposed to be Molly, but were not. ## Watchlist Updates Want our Watchlist and New Substances sent your inbox every month? Sign up below for this newsletter. No password needed. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. --- # ❤️‍🩹 Hurricane Update A month after Hurricane Helene our thoughts remain with our beloved harm reduction programs in western North Carolina. Coincidentally, in between Hurricanes Helena and Milton, the paper below was published after being under review for 17 months. Using data going back to 1930, this sophisticated econometric analysis found was that impact of hurricanes (“tropical cyclones” or TCs) are felt over generations. While direct immediate mortality numbers may be in the dozens, unexplained excess mortality is 7,000 to 11,000 ***per storm***. The figure at the top of this newsletter and quote below are from [the paper](https://www.nature.com/articles/s41586-024-07945-5) by Rachel Young & Solomon Hsiang: > impacts of TCs might affect human health through complex chains of events that separate the cause (cyclone) from the delayed effect (mortality) so much that affected individuals are themselves unaware that a TC influenced their own health outcome. For example, individuals may use retirement savings to repair damage, reducing future healthcare spending to compensate; family members might move away, removing critical support when something unexpected occurs years later; or public budgets may change to meet the immediate post-TC needs of a community, reducing investments that would otherwise support long-run health. We also learned that “tropical cyclones” = hurricanes + tropical storms. But in the South we just call 'em *storms.* [Mortality caused by tropical cyclones in the United States - NatureA large-scale evaluation of the long-term effects of tropical cyclones on human mortality in the contiguous United States estimates that the average tropical cyclone results in 7,000–11,000 excess deaths, far exceeding previous estimates.![](https://www.nature.com/static/images/favicons/nature/apple-touch-icon-f39cb19454.png)NatureRachel Young![](https://media.springernature.com/m685/springer-static/image/art%3A10.1038%2Fs41586-024-07945-5/MediaObjects/41586_2024_7945_Fig1_HTML.png)](https://www.nature.com/articles/s41586-024-07945-5) What are the implications for us right now? A monthly pledge to donate is more important than material donations and immediate cash. Harm reduction has always been underfunded, and the depth of devastation reflects this lack of investment. 📽️ Wanna hear directly from affected programs? [This recorded webinar](https://us06web.zoom.us/rec/play/UrdtRjiDZeKKkVbUqFeCrDgWXkieBlsBxJ4qP6Vre00m7Lwjr%5FL69cYCpXuP-ar84bKx7HiXUlb2AVED.6%5FLAcoxA2etrHb1u?canPlayFromShare=true&from=share%5Frecording%5Fdetail&continueMode=true&componentName=rec-play&originRequestUrl=https%3A%2F%2Fus06web.zoom.us%2Frec%2Fshare%2FNJmBDqq7Ko7wDtcKigARvZ4IOOMltIeiClB9PAD-KUl8jfx0YdWYmoWn2QrDlJqP.I-GCC7xsKpf2ERtF) hosted by [CEG](https://communityeducationgroup.org/) had most of the WNC harm reduction and assisting programs. Program staff have been doing so much to help their participants!! Programs need grant-level financial support to pay for overtime, which won’t even cover the actual hours people are putting in. Everyone is exhausted, patience wears thin, because *trauma*. Healthy boundaries get blurred at the expense of service, especially with Gen Z and Millennial workers putting in long physically grueling hours. Everything feels expensive right now, as programs replace sundries like fire extinguishers and clothes and furniture and basic hardware. Supplies are still being delivered and recovery operations conducted on horseback! SO, link below to donate. Do a monthly pledge. Please. [How to help Asheville, NC, SC, TN nowHurricane Helene disaster help needed for western North Carolina harm reduction programs.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://images.unsplash.com/photo-1669742596169-d0d8b92e1f40?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wxMTc3M3wwfDF8c2VhcmNofDE5fHxBc2hldmlsbGV8ZW58MHx8fHwxNzI3ODQ0MDQ5fDA&ixlib=rb-4.0.3&q=80&w=2000)](https://www.opioiddata.org/how-to-help-asheville-nc-now/) And if any of y’all know what could help in Ashe, Avery, Mitchell and Watagua counties, please tell us. The northern NC part of the Blue Ridge Mountains (hours north of Asheville) was extra-devastated, but there is still very little contact. We respect their privacy and stoicism and self-sufficiency and grief. But we know it's bad in spots up there. If y'all need anything, holler at us. --- # 🎃 Fentanyl in Candy This comes up every year about this time... and we [discussed this on NPR](https://www.npr.org/2022/10/11/1127168627/is-rainbow-fentanyl-a-threat-to-your-kids-this-halloween-experts-say-no) in 2023\. There have been no verified reports of fentanyl in Halloween candy. Why? This sticker says it all: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/image-3-1-1.png) Sticker from Claire Zagorski's [Etsy shop](https://www.etsy.com/listing/1297850843/drugs-are-expensive-sticker) There are things you can **actually do** to protect your children: - Reflective strips and lights on costumes to be visible on streets - Don't eat unwrapped candy, because, gross. - Looking over your kid's candy together offers opportunity for conversation - Put a one-night sugar binge in the context of healthy diet habits - Trunk-or-treats are an option, if that's your thing - Brushing teeth at the end of the night - Be thankful we are better off now, remembering Halloween was cancelled this time 4 years ago --- # 🙏🏽 Need ur help: Naloxone petition Following the examples of New Mexico and California, advocates in North Carolina have assembled a compelling petition that awaits your signature. Due to extremely aggressive marketing by two specific pharma companies, NC harm reduction programs and government officials are being pressured to switch to expensive, untested overdose reversal antidotes. ✍️ ****Health and allied professionals in North Carolina** ****should** [****sign this petition**](https://docs.google.com/forms/d/e/1FAIpQLSerIhBmoezLpA%5FVeVDSAgMC1AocWGKDmp2pzSaryCD2fiJE5w/viewform)[****.**](https://docs.google.com/forms/d/e/1FAIpQLSerIhBmoezLpA%5FVeVDSAgMC1AocWGKDmp2pzSaryCD2fiJE5w/viewform) This is expert opinion, not legislative advocacy, so you can sign with university affiliations. Read the [full statement with citations](https://drive.google.com/file/d/11FLunK5n-DZiPkSx3tMUi4xCrrBjdHy9/view). There is a [second petition](https://www.change.org/p/give-us-access-to-standard-naloxone-products-for-compassionate-response-to-overdose?recruiter=972864289&recruited%5Fby%5Fid=fce70f30-90f1-11e9-8544-79ea32b86c8d&utm%5Fsource=share%5Fpetition&utm%5Fcampaign=share%5Fpetition&utm%5Fmedium=copylink&utm%5Fcontent=cl%5Fsharecopy%5F490257304%5Fen-US%3A9) for community members. [Expert Statement Regarding High-Dose Naloxone and Long-Acting Opioid Overdose Reversal Formulations in North CarolinaPharmaceutical companies that make stronger naloxone formulations have been exerting immense pressure on purchasers to buy their products. They often insist that stronger or longer-acting products are necessary to counter compounds like fentanyl in the illicit drug supply. But we know that these assertions are not backed by science, and that these products increase the risk of dangerous withdrawal symptoms. Just as experts have done in New Mexico and California, North Carolina overdose prevention experts are pushing back against this aggressive marketing. We invite you to read the “Expert Statement Regarding High-Dose Naloxone and Long-Acting Opioid Overdose Reversal Formulations in North Carolina” here and to sign on below. The deadline for sign-ons is October 31\. Please share this sign-on with colleagues in North Carolina who you think might be supportive. \*Your signature represents expert opinion and does not influence legislation, so is not subject to lobbying restrictions.\* Thank you.![](https://ssl.gstatic.com/docs/forms/device_home/android_192.png)Google Docs![](https://lh4.googleusercontent.com/gz23_oxF_JPGa9kR1D5_mffHTxpwUD-_m-p5VQIFIlLH0GdDspcvytSUJ9vCslrZfJwlZM-ScLw=w1200-h630-p)](https://docs.google.com/forms/d/e/1FAIpQLSerIhBmoezLpA%5FVeVDSAgMC1AocWGKDmp2pzSaryCD2fiJE5w/viewform) **The marketing of high-dose naloxone is a historical and global anomaly.** The average dose of naloxone per reversal did not change during the fentanyl era. **Severe Withdrawal Increases Risk for Repeated Overdose.** Legit question: If saving a life is what's important, can't they just put up with withdrawal? We just learned about this: Severe withdrawal can lead to immediate and repeated re-dosing with dope. In the weeks that follow, negative withdrawal experiences may lead to using drugs alone. Both of these outcomes increase the chance of a subsequent overdose! Ohhhh, maybe that's why pharma is pushing these products so hard. 🤔 On the other, while public health folks have been saying that fentanyl re-dosing after reversal is risky for OD, it is also an ubiquitous behavior, and there aren’t strong data showing that it’s all that risky. **Nalmefene nasal spray has never been tested in the real-world.** How can you trust an overdose reversal drug that wasn't even tested with people who use drugs!? Oh yeah, also never tested on smokers. **Stick with what is proven: There is no urgency to switch to untested medications.** 😵‍💫 If you're on the receiving end of overtly aggressive pharma marketing, FDA wants to hear about it. All you have to do is ****forward pharma emails to BadAd@fda.gov**. Or call 855-Rx-BADAD (855-792-2323). You don't have to fact check the blizzard of claims that pharma is pushing. Folks have started doing this, but government investigations are more likely with critical mass. --- # 🦸 Harm Reduction Heroes You know the saying, “Not all heroes wear capes”? Well, the real heroes—those on the ground putting in work everyday—deserve just as much recognition as any Marvel or DC character, if not more! Learn more about these local heroes by clicking the links below! **Edgecombe County (NC) Emergency Services** (EMS) and substance treatment clinical care providers are true rockstars, transforming their community. With their drug checking service, they’re diving deep into the causes of overdoses and keeping their community informed. Savannah Junkins and Dalton Barrett share what drug checking has done for EMS and treatment providers. [How Edgecombe EMS does Drug Checking 😍By: Dalton Barrett, CP-C and Savannah Junkins, PA-C Access to drug checking services has revolutionized the way we are able to counsel and treat our patients in Edgecombe County. We were able to identify the presence of xylazine for the first time in our county when it was previously only![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabSavannah Junkins![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w1200/2024/10/IMG_0106-1.png)](https://www.opioiddata.org/how-edgecombe-ems-does-drug-checking/) The **Carolina Harm Reduction Union** is one of those collegiate organizations that actually provides services to people who use drugs. Riley Sullivan writes about a recent event at the White House. [White House Challenge to Save Lives from Overdose EventOn October 8, the Office of National Drug Control Policy and the Domestic Policy Council hosted the White House Challenge to Save Lives from Overdose, bringing together stakeholders nationwide to showcase their overdose prevention efforts. I was honored to represent the Carolina Harm Reduction Union, a peer-to-peer collegiate harm reduction![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabRiley Sullivan![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w1200/2024/10/IMG_0313-1-1.jpg)](https://www.opioiddata.org/white-house-challenge-to-save-lives-from-overdose-event/) --- # 📣 Team Voices Check out monthly blog posts from members of our team! [Team Building & Why It Is Important?Recently, our UNC team participated in a fun team-building activity at Bull City Escape Room in Durham, NC. We had 60 minutes to work together to find clues and solve puzzles, ultimately discovering the four-digit code required to escape the room. We managed to escape with 2 minutes left on![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-3.png)Opioid Data LabNatalie Sutton![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/IMG_6319-1.jpg)](https://www.opioiddata.org/team-building-why-it-is-important/) [⚾️ Field WorkIn October, Adams and Colin traveled to Grand Rapids, MI to visit the Red Project, a harm reduction program and one of three partners in our multi-state study on naloxone utilization. Adams and Colin interviewed 25 people who use drugs about their experiences reversing overdoses. These findings will inform recommendations![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabAdams Sibley![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w1200/2024/10/1000025250-1.jpg)](https://www.opioiddata.org/field-work/) [Community Conversation on Overdose PreventionOn September 26, 2024, at Transfer Food Hall in Raleigh, NC the community gathered to discuss the overdose crisis in Wake County, highlight the signs of an overdose and how to use naloxone, emphasize the importance of reducing stigma around substance use, and offer a chance to assess naloxone needs![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabIllyana Massey![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w1200/2024/10/IMG_9384-2-1.jpg)](https://www.opioiddata.org/community-conversation-on-overdose-prevention/) --- # 📖 Reading Room The response to our [blog post](https://www.opioiddata.org/are-overdoses-down-and-why/) on the decline in overdose rates has been astounding. In the meantime, we suggest that the discussion can be boiled down to these two questions: What's working? Who's being left behind? **1\. What's working?** We are gathering the alternative hypotheses that have been shared with us and will put those out soon in another blog post ([subscribe for free](https://www.opioiddata.org/signup/)). Among the keenest and longest observers, an amorphous consensus centers around changes in the *drug supply*. But which changes exactly? Xylazine? but that's been around for awhile. Return of heroin? but not everywhere. Reduction in fentanyl % weight/volume? Show us the data. Border interdiction with the [Multi-energy portal](https://www.medrxiv.org/content/10.1101/2024.10.16.24315583v1)? But the fluctuations. Less [total volume](https://www.npr.org/2024/09/30/nx-s1-5124997/fentanyl-overdose-opioid-btmps-drug-cartel-xylazine-tranq-mexico-china) of fentanyl? Not on the east coast, buddy. And there are behavioral changes and policy effects that have been put forward too. Stay tuned. **2\. Who's being left behind?** One of the most puzzling aspects of the decline in overdose is that rates by racial group are different by state. In some places, ODs among Black Americans are dropping *faster* than for White in tandem. In others, overdoses among Black men and Native Americans rise as White ODs fall. As usual, no simple narrative about race and drugs holds. These four articles did a good job going into the details: - Salon: Drug overdose deaths may be decreasing — but [not for everyone](https://www.salon.com/2024/10/05/overdose-may-be-decreasing--but-not-for-everyone/) - The Guardian: ‘Unprecedented’ decline in US drug overdose deaths [gives experts hope](https://www.theguardian.com/us-news/2024/oct/04/overdose-deaths-decline) - NY Times: [Fatal Drug Overdoses Drop, Though Racial Disparities Tell a Different Story](https://www.nytimes.com/2024/10/25/us/drug-overdoses-opioids-fentanyl.html) \[paywall\] - KFF: [Opioid Deaths Fell in Mid-2023, But Progress Is Uneven and Future Trends are Uncertain](https://www.kff.org/mental-health/issue-brief/opioid-deaths-fell-in-mid-2023-but-progress-is-uneven-and-future-trends-are-uncertain/) ### 🤓 Scientific Literature The easiest way to get access to paywalled articles is to email the corresponding (or first) author. - Payne ER, et al. [Development, Evaluation, and Initial Findings of New York State Department of Health Community Drug Checking Pilot Programs](https://journals.lww.com/jphmp/fulltext/9900/development,%5Fevaluation,%5Fand%5Finitial%5Ffindings%5Fof.348.aspx). *Journal of Public Health Management and Practice*. 2024:10-97\. \[open access\] - Alam IZ, et al. [Association Between Rapid Opioid Reduction or Discontinuation and Self-Harm, Suicide Attempt, and Suicide Death Among High-Dose Long-Term Opioid Therapy Patients in North Carolina, 2006-2018](https://academic.oup.com/aje/advance-article-abstract/doi/10.1093/aje/kwae394/7815653). *American Journal of Epidemiology*. 2024 Oct 8:kwae394\. \[paywall\] - Zibbell JE, et. al. [Use of fentanyl test strips by people who inject drugs: Baseline findings from the South Atlantic Fentanyl Test Strip Study](https://www.sciencedirect.com/science/article/pii/S095539592400272X) (SAFTSS). *International Journal of Drug Policy*. 2024 Nov 1;133:104588\. \[open access\] - Cooper HLF, et al. [The War on Drugs, Racialized Capitalism, and Health Care Utilization Among White People Who Use Drugs in 22 Rural Appalachian Counties](https://ajph.aphapublications.org/doi/10.2105/AJPH.2024.307744). *Am J Public Health*. 2024 Oct;114(10):1086-1096\. doi: 10.2105/AJPH.2024.307744\. PMID: 39231413; PMCID: PMC11375347\. \[paywall\] - Rushing J, Brewington E, Sachdeva N. [The North Carolina model for opioid settlements: partnering to equip local governments’ overdose response](https://ncmedicaljournal.com/article/123269-the-north-carolina-model-for-opioid-settlements-partnering-to-equip-local-governments-overdose-response). *North Carolina Medical Journal*. 2024 Sep 17;85(5). \[open access\] --- # 🤗 Opportunities for Impact Job postings, conferences, and other events for you harm reduction baddies! If you have a job posting or event you'd like us to highlight, please be in touch. ### Job Postings from our Friends University of Missouri St. Louis's Missouri Institute of Mental Health is hiring for TWO leadership roles! Assistant Research Professor and Director of Improving Systems! [Join Our Team — MIMH Addiction Science![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-5.ico)MIMH Addiction Science0![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/UMSL_Addiction-Science-Team_1-line_200-BLKA.png)](https://mimhaddisci.org/join-our-team) Queen City Harm Reduction SSP, Charlotte, NC is looking for a bilingual outreach specialist to join their team! [Job Announcement (final) Outreach\_Worker\_Meck 9-18-24 (002)Full-time Harm Reduction Outreach Specialist-Mecklenburg Co, NCJob Announcement (final) Outreach\_Worker\_Meck 9-18-24 (002).pdf178 KBdownload-circle](https://www.opioiddata.org/content/files/2024/10/Job-Announcement--final--Outreach%5FWorker%5FMeck-9-18-24--002-.pdf "Download") ### Upcoming Webinar Join harm reduction trailblazers for a panel discussion- "White faces, Black and Brown Lives: Racial Disparities in the OD Crisis." [Tracie M. Gardner on LinkedIn: Excited to be co-sponsoring this with Drug Policy Alliance AIDS United…Excited to be co-sponsoring this with Drug Policy Alliance AIDS United NASTAD Human Impact Partners (HIP) and National Harm Reduction Coalition Register here:…![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/al2o9zrvru7aqj8e1x2rzsrca)LinkedInTracie M. Gardner![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/1728065050458)](https://www.linkedin.com/posts/traciemgardner%5Fexcited-to-be-co-sponsoring-this-with-drug-activity-7248030156756254721-sfIq/?utm%5Fsource=share&utm%5Fmedium=member%5Fios) ### 🧑🏼‍🏫 Pharmacist CE for OUD Our friends at the University of Kentucky School of Pharmacy just launched this great site for all you pharmacists to get continuing education (CE) credits. Led by Trish Freeman and Doug Oyler, this is a set of courses by pharmacists for pharmacists. [Continuing Education | UK College of Pharmacy![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon.ico)UK College of Pharmacy | University of Kentucky![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/adobestock_239101217.jpeg)](https://p2p.uky.edu/cpe) ### $50 Survey The [Reagan-Udall Foundation](https://reaganudall.org/) for the FDA is conducting a research project about preventing pediatric unintended exposures to medications for opioid use disorder. They are conducting interviews with people who take medications that contain methadone or buprenorphine (including branded medications such as Suboxone or Zubsolv). If selected, participants who complete a 30–45-minute interview will receive a $50 Amazon gift card. Specifically, the Foundation is looking for people who meet the following criteria: - Individuals with children under 6 years old living in the house (full or part time) - Individuals currently or formerly taking medication for opioid use disorder - Individuals in households with a person taking medication for opioid use disorder Email Joy Eckert (jeckert@reaganudall.org) and check out the flyer below to learn more. [Interviews about Medication Storage\_FlyerThe Reagan-Udall Foundation for the FDA is conducting a research project about preventing pediatric Interviews about Medication Storage\_Flyer.pdf157 KBdownload-circle](https://www.opioiddata.org/content/files/2024/10/Interviews-about-Medication-Storage%5FFlyer.pdf "Download") --- # 👋 Meet our Team Members Each month will feature different team members 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/thumbnail_IMG_5666.jpg) ## Natalie Sutton Our research project manager, who joined the team in 2024\. She has experience in clinical, public health, and laboratory research. --- # 🪩 Out and About ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/1000025254-3-1-1-1.jpg) Colin hanging out with Gabe and the rest of the incredible staff at the [Red Project](https://www.redproject.org/), Grand Rapids, MI. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/03D14FBC-F9BC-41D1-9E69-76F0809CF52C_1_102-1.jpeg) Nab with New York State FTIR technicians Carolina Diaz, Amanda Serrano, Steve Spendle, Kusuma Anand at the [New York State Harm Reduction Association Conference](https://www.opioiddata.org/nyshra-conference/). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/IMG_9382-1-1.jpg) Erin Tracy (far left) and Freida MacDonald, Ainsley Worrell, Justin Garrity speaking at the Wake County (NC) [Community Conversation on Overdose Prevention](https://www.opioiddata.org/community-conversation-on-overdose-prevention/). --- # 🥼 Lab Visits We were delighted to host [Rep. Jarrod Lowery](https://www.ncleg.gov/Members/Biography/H/807) (R-Robeson NC-47) in our lab this month. Check out more [photos and details](https://www.opioiddata.org/rep-jarrod-lowery/) about the visit. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/image-7.png) We discussed drug trends and samples in Robeson County. We all share a common goal to keep our neighbors safe. We love visitors! Check out who's [come to see us recently](https://www.opioiddata.org/tag/site-visits/). Let us know if y'all would like to stop by. For NC General Assembly members, [Amy McConkey](https://publicaffairs.unc.edu/staff/#chapter-3) can arrange your visit. --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/image-1-1.png) --- # 🫶🏽 Funders In October we wrapped up a 2-year engagement with the [Foundation for Opioid Response Efforts](https://forefdn.org/?ref=opioiddatalab.ghost.io). FORE was our first funder major in drug checking, and the first randomized messaging trial on drug alerts, led by Allison Lazard. We are supremely grateful for them taking a risk on us! (We also appreciate all our [other funders](https://www.opioiddata.org/funders/) too.) [FORE Appreciation postIn October we wrapped up a 2-year engagement with the Foundation for Opioid Response Efforts. FORE was our first funder major in drug checking, and the first randomized messaging trial on drug alerts. We are supremely grateful for them taking a risk on us... drug checking was barely happening in![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w1200/2024/10/IMG_6838-1.jpeg)](https://www.opioiddata.org/fore-appreciation-post/) --- ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ## Like what you read? Heyo, sign up to get this newsletter in your inbox every month. Stay on top of new developments from our team. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### FORE Appreciation post URL: https://www.opioiddata.org/fore-appreciation-post/ Last updated: 2024-10-30T01:52:09.000Z In October we wrapped up a 2-year engagement with the [Foundation for Opioid Response Efforts](https://forefdn.org/). FORE was our first funder major in drug checking, and the first randomized messaging trial on drug alerts. We are supremely grateful for them taking a risk on us... drug checking was barely happening in the US when we started. They have been a very easy funder to work with, and we recommend them. Some of the key deliverables were: - Drug Checking results site [streetsafe.supply](https://www.streetsafe.supply/) - This [blog](https://www.opioiddata.org/) - [Live Reports](https://uncopioid.atlassian.net/wiki/external/ZTk5NGQ0YWE3NDA1NGEwZGIxZjhiMDUyNGQ1ZWJiY2M#2.-Live-Reports) are data displays that answer specific questions of our drug checking data - [zerostigma.art](https://www.zerostigma.art/) is an open source resource for hand-drawn images related to pain management, harm reduction, and drugs - [Drug Alert Templates](https://cdr.lib.unc.edu/concern/multimeds/70795m43k?locale=en) for Public Health and Public Safety includes a style guide and have resources in PowerPoint, Illustrator, and InDesign - [Slides](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/h415pm28f?locale=en) from our [presentations](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/df65vp73k?locale=en) at the FORE grantee meeting In the hope that y'all get to work with FORE, we are posting the text of our original proposal. Feel free to reuse, be inspired, take creative license with the material. [FORE proposal share - shortFORE proposal share - short.pdf464 KBdownload-circle](https://www.opioiddata.org/content/files/2024/10/FORE-proposal-share---short.pdf "Download") In looking back, we were able to accomplish way more than we expected. We appreciate the entire FORE team!! And the grantee meetings are a blast. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/18835097-7f56-4f2f-b4a1-fe2a6c219de0-1.jpeg) Dr. Rafi Torruella from Intercambios Puerto Rico and Dr. Eddie Suarez from IDEA Exchange in Miami are also FORE grantees ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/IMG_6836-1.jpeg) Long-time harm reduction badass and enabler Alissa Sadler joined FORE recently ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/IMG_6826-1.jpeg) Glad that Holler HR is a grantee too! ### NYSHRA URL: https://www.opioiddata.org/nyshra-conference/ Last updated: 2024-10-29T17:59:17.000Z Nab was delighted to spend a couple of days in Binghampton giving the keynote at the New York State Harm Reduction Association Conference. Slides from the talk are here: [\[NYHRA\] Making Our Work Meaningful through Community Engagement\[NYHRA\] Making Our Work Meaningful through Community Engagement![](https://cdr.lib.unc.edu/assets/favicon-545d11a84432819b25149c67d4e2aa95f3bee9e815f20b9bfbf105e836d70ff5.ico)Carolina Digital RepositoryDaasgupta, Nabarun.![](http://cdr.lib.unc.edu/downloads/js956w50c)](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/x633ff221?locale=en) It was great to see folks we've been doing drug checking with but never met IRL, an re-unite with old friends. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/F039743A-25AC-42F5-B1D5-7B5B743794EB_1_105_c-1-1.jpeg) Matt Fallico from NY State AIDS Institute ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/03D02A7F-DFA7-4872-B134-C5FD91235A2C_1_105_c-1.jpeg) Tracie Gardner of the National Black Harm Reduction Network Southern Tier NYS in the fall puts on a stunning leaf peeping show! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/65D827A3-CC7D-44BA-9F55-A6F7C85C6829_1_105_c-1.jpeg) Flying into Syracuse ### Rep. Jarrod Lowery URL: https://www.opioiddata.org/rep-jarrod-lowery/ Last updated: 2024-10-29T17:30:54.000Z We were delighted to host [Rep. Jarrod Lowery](https://www.ncleg.gov/Members/Biography/H/807) (R-Robeson) in our lab this month. We are very grateful to the NC General Assembly for providing the funds for purchasing our dedicated GCMS instrument via the [NC Collaboratory](https://collaboratory.unc.edu/). This instrument allows us to keep track of what is in the NC drug supply in real time. Rep. Lowery, Nab, and Erin discussed the many samples from Robeson County that we have analyzed. We all share a common goal to keep our neighbors safe. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/IMG_1118.jpeg) 🚪 Let us know if you'd like to come for a visit too! ### White House Challenge to Save Lives from Overdose Event URL: https://www.opioiddata.org/white-house-challenge-to-save-lives-from-overdose-event/ Last updated: 2024-10-29T16:56:29.000Z On October 8, the Office of National Drug Control Policy and the Domestic Policy Council hosted the White House Challenge to Save Lives from Overdose, bringing together stakeholders nationwide to showcase their overdose prevention efforts. I was honored to represent the [Carolina Harm Reduction Union](https://www.instagram.com/chru%5Fnc/), a [peer-to-peer](https://www.npr.org/2023/10/16/1206207367/naloxone-on-college-campuses-saves-lives) collegiate harm reduction program I co-founded and currently lead as executive director. The event, in line with the Biden-Harris administration's call for a whole-of-society approach to the overdose epidemic, featured three panels exploring how communities, workplaces, and entertainment venues can play a role in prevention. While the ONDCP highlighted many organizations' commitments in a [fact sheet](https://www.whitehouse.gov/briefing-room/statements-releases/2024/10/08/fact-sheet-biden-harris-administration-announces-over-250-organizations-made-voluntary-commitments-to-white-house-challenge-to-save-lives-from-overdose/), the event underscored the diverse strategies groups across different sectors employ to tackle this issue. One of my highlights was hearing from Donna Parks Hill, who traveled from our home state of North Carolina to represent the North Carolina Council of Churches (NCCC). The NCCC has been working with faith communities across the state to bridge faith, health, and justice, including overdose prevention. I also appreciated the focus on how unions and companies can collaborate to create safer workplaces. The [Washington Post](https://www.washingtonpost.com/business/2023/10/06/jobs-likely-to-overdose/) reported that 1 in 5 people who died from an overdose in 2020 worked in construction or the restaurant industry. TheSan Francisco Entertainment Commission, International Union of Painters & Allied Trades (IUPAT) District Council 35, and the Association of Flight Attendants-CWA (AFA) demonstrated how organizations can take proactive steps to integrate harm reduction practices and protect their members from the risks of overdose in their respective industries. Reflecting on the event, one of my biggest takeaways is how much the conversation around naloxone, overdose prevention, and harm reduction has shifted in recent years. As a kid, I remember hearing about so-called "Narcan parties," where people were supposedly gathering to intentionally overdose—an idea as fictitious as it was harmful. To now see the White House hosting an event centered on naloxone, with speakers from the MLB discussing how their teams travel with it, and video messages from Samuel L. Jackson and Robert De Niro endorsing its use, shows just how much things have changed. But that change has come as we’ve lived through the deadliest days of the overdose epidemic. As a 22-year-old, I’ve never known a time before this crisis—only times when it worsened. For many of us in this work, the growing statistics represent our loved ones. Despite a recent 10% decrease in overdose deaths, this trend isn’t universal, and rates continue to rise among Indigenous, Black, and Hispanic communities. This serves as a stark reminder that while overall trends may be improving, our work is far from done. The conversation around naloxone and harm reduction has evolved, but we must continue pushing for equitable access to these life-saving tools and ensure that no community is left behind. The fight to save lives is ongoing, and it’s up to all of us to maintain this momentum and ensure that progress reaches everyone. ### How Edgecombe EMS does Drug Checking 😍 URL: https://www.opioiddata.org/how-edgecombe-ems-does-drug-checking/ Last updated: 2024-11-02T02:41:55.000Z **By: Dalton Barrett, CP-C and Savannah Junkins, PA-C** Access to drug checking services has revolutionized the way we are able to counsel and treat our patients in Edgecombe County. We were able to identify the presence of xylazine for the first time in our county when it was previously only a rumor. We proved to patients that many of their stimulant supplies contained fentanyl, which encouraged the use of fentanyl testing strips that they originally thought they didn’t need. The results of drug checking samples are shared in printed format, with the name and picture of the stamp included, so that drug users can easily link the stamp they’ve often seen to its actual contents. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/D55E9904-74C9-47E8-A826-CEF8F7791B83_1_105_c.jpeg) Watching sample prep during a visit to the UNC lab. In the office treatment setting, patients are grateful for the knowledge gained from drug checking results, and the acknowledgment that we are more concerned about their individual safety above all else. This is often the place where patients feel they can’t be honest about their use or ask the important things they need to know, for fear of disappointment or repercussion from their health care providers. This is one way we can demonstrate that we truly practice a harm reduction approach, in addition to offering syringe service program supplies as part of the treatment plan. In the community space, the impact of a paramedic who is willing to gather and submit samples to make drug users safer has opened so many doors we never imagined. Community members who aren’t well informed about substance use are genuinely surprised and interested in the results when shared in local presentations and meetings. Drug users who are rightfully suspicious of first responders based on their past experiences are able to develop a trusting relationship instead, and are given a chance to help their own communities by contributing meaningful information about the drug supply. Combining this service with mobile syringe supplies further strengthens these relationships. We are beyond grateful to have this valuable opportunity to help our community in a way that’s never been done before in Edgecombe County. The trust, communication, and relationships we’ve developed with drug users as a result has made our respective programs more effective than ever. This is how we go beyond saying that we meet patients where they are, to proving it. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/F71B1FBA-1D3F-4C97-A429-97C9C5D7C5F3_1_105_c.jpeg) Behind the scenes! # Edgecombe in the News We've had great local TV coverage from WRAL (Raleigh) on our collaboration. These three 2-minute videos tell a lot of the story in a very compelling manner. Here's an overview of the work in Edgecombe County: [Edgecombe County investigation finds 22 hidden substances in street drugsThere have been 22 hidden substances found in street drugs in Edgecombe County since September such as caffeine and fentanyl. A new program is helping fight the problem.![](https://wwwcache.wral.com/favicons/favicon-48x48.png)WRALWRAL![](https://wwwcache.wral.com/asset/news/local/2016/05/16/15708734/OPIOIDS_3-DMID1-5sawhriuv-640x480.jpg)](https://www.wral.com/video/edgecombe-county-investigation-finds-22-hidden-substances-in-street-drugs/21271152/) This one shows us working together to find out what caused fatal overdoses ([youtube](https://www.youtube.com/watch?v=HIWljr-a0Io)): [Drugs sold as fentanyl in Goldsboro, Edgecombe overdoses contained 8 different substancesXylazine, Benzatropine, a hallucinogen and another kind of designer chemical among drugs detected in sample linked to dozens of eastern North Carolina overdoses.![](https://wwwcache.wral.com/favicons/favicon-48x48.png)WRALWRAL![](https://images.wral.com/asset/news/local/2024/05/23/21447569/fentanyl-DMID1-631i5nrt3-640x480.jpg)](https://www.wral.com/story/drugs-sold-as-fentanyl-in-goldsboro-edgecombe-overdoses-contained-8-different-substances/21447445/) And the most recent one shows how we collaborate to identify new emerging substances [like BTMPS](https://www.opioiddata.org/mystery-substance-summer-2024/): [Public health officials warn about rare and dangerous substance discovered in eastern North CarolinaA rare and dangerous substance has been discovered in eastern North Carolina for the first time.![](https://wwwcache.wral.com/favicons/favicon-48x48.png)WRALHeidi Kirk, WRAL eastern North Carolina reporter![](https://images.wral.com/9585435d-fdc3-4238-80bc-80d16996fb74?w=1200&h=630)](https://www.wral.com/news/state/dangerous-substance-discovered-eastern-north-carolina-oct-2023/) ### Community Conversation on Overdose Prevention URL: https://www.opioiddata.org/community-conversation-on-overdose-prevention/ Last updated: 2024-10-18T18:49:32.000Z On September 26, 2024, at Transfer Food Hall in Raleigh, NC the community gathered to discuss the overdose crisis in Wake County, highlight the signs of an overdose and how to use naloxone, emphasize the importance of reducing stigma around substance use, and offer a chance to assess naloxone needs within the community. This was a great event and proved to be very informative to everyone who attended! Our chemist Erin and others spoke at the event 🤗 ### ⚾️ Field Work URL: https://www.opioiddata.org/field-work/ Last updated: 2024-10-18T18:11:30.000Z In October, Adams and Colin traveled to Grand Rapids, MI to visit the Red Project, a harm reduction program and one of three partners in our multi-state study on naloxone utilization. Adams and Colin interviewed 25 people who use drugs about their experiences reversing overdoses. These findings will inform recommendations for harm reduction practitioners, policymakers, and device manufacturers. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/10/1000025254-1.jpg) Hanging out with Gabe and the rest of the incredible staff at the Red Project, Grand Rapids, MI. ### Team Building & Why It Is Important? URL: https://www.opioiddata.org/team-building-why-it-is-important/ Last updated: 2024-10-14T23:16:44.000Z *Recently, our UNC team participated in a fun team-building activity at Bull City Escape Room in Durham, NC. We had 60 minutes to work together to find clues and solve puzzles, ultimately discovering the four-digit code required to escape the room. We managed to escape with 2 minutes left on the clock!* **What is team building?* Team building allows team members to effectively work together to complete a shared goal, task, or process. It helps to identify and celebrate strengths among team members and discover areas where the team can provide support to one another.* **What are team building activities?* Team building activities don’t have to be an escape room or a ropes course. They can be any activity that promotes collaboration and cooperation among the team.Some examples include a scavenger hunt, a trivia game or a volunteer activity.The lasting effects of these activities can aid in successful project completion and ongoing program development by translating these experiences into everyday work.* *What are your favorite team building activities?* ### How to help Asheville, NC, SC, TN now URL: https://www.opioiddata.org/how-to-help-asheville-nc-now/ Last updated: 2024-12-22T22:28:33.000Z Asheville is beloved. We are gutted to see the destruction. The storm affected a very large area, multiple counties in NC, SC, TN. Right now Asheville is getting attention, but it is critical to spread donations into the rural counties too. Here’s how to help. 😮‍💨 ****Monday update.** All 27 Opioid Treatment programs in the affected region are open. Most SSPs are open but operating on alternative schedules (check their socials). ****HR program staff are** ***exhausted** **. How can we show them some love?** Please be considerate on sending supplies: There have been numerous go-gooder caravans showing up uninvited with non-essential supplies, creating **more* burden. One SSP need is finding biohazard disposal, as some of the landfills have been destroyed; no easy solution. Water service in Asheville may not be restored for weeks, and in other areas there is a backlog of bottled water. ****The best thing you can do right now is to donate generously, and consider a monthly commitment.** ## Immediate Needs Day-to-day needs, shopping lists, and caravans are being discussed on the NC Harm Reduction Advocacy listserv. If you intend to join this community long-term, let us know and we can tell you how. ## In the area? Tyler Yates at NC DHHS is maintaining a list of evolving SSP operating hours. We haven't heard from Sunrise at the Buncombe health department directly, but do know their supplies were hard to access. Other SSPs are operating locally. **Ensuring those affected by, and those assisting with, Hurricane Helene have the Behavioral Health resources they need:** - Working with all shelters to provide Behavioral Health clinicians and mental health services. - 988 and the Peer Warm Line (1-855-PEERS NC; 1-855-733-7762) are ready for increased call volume. - NCDHHS will deploy mobile mental health units into the community as soon as we are able to, in coordination with NC Emergency Management. HT: Annie Vasquez Residents of affected areas fortunate enough to have wifi/cell reception can browse this resource for basic needs from Democracy NC. > *Our partners on the ground in Western NC have developed a* [*living document*](https://click.everyaction.com/k/94131939/502604110/1314809601?nvep=ew0KICAiVGVuYW50VXJpIjogIm5ncHZhbjovL3Zhbi9BVi9ERU1OQy8xLzEzOTYzIiwNCiAgIkRpc3RyaWJ1dGlvblVuaXF1ZUlkIjogIjcwN2YyYzg0LWYwODAtZWYxMS04NDc0LTYwNDViZGE4YWFlOSIsDQogICJFbWFpbEFkZHJlc3MiOiAiTGF1cmVuLktlc3RuZXIzNEBnbWFpbC5jb20iDQp9&hmac=GDayaegot8veoQCY0YY0XvZdDYlOH4LDF%5FFCIZKq5bM=&emci=53c3d9ab-2a80-ef11-8474-6045bda8aae9&emdi=707f2c84-f080-ef11-8474-6045bda8aae9&ceid=109264) *with county-specific information, which is being updated daily.* HT: Lauren Kestner --- ## Donations These are the organizations we have heard from directly and have an idea of needs. We will update as we hear from the Eastern Band of Cherokee of the Qualla Boundary. We haven’t heard much from the northeast due to continuing phone and electricity outages: Ashe, Avery, Watagua, Mitchell, and Surry counties. Jen Carroll reports on October 7th from her trip over the weekend: > The biggest update that seems worth sharing is that folks are beyond exhausted. It may be fair to say what's obvious, but the level of exhaustion that harm reductionists and outreach workers are experiencing is just unreal. Between working sun up to sun down (and then some) for their programs and then also dealing with no cell signal, lines for gasoline, broken generators at home, going days without showering, etc, it just looks kind of brutal. Things are improving, and everyone is grateful for support, but short term memory, bandwidth to communicate, brain synapses, and patience are all pretty thin. Below are the harm reduction organizations who have been most directly involved in recovery efforts in the southern part of the Blue Ridge. STEADY in Asheville and [Smoky Mountain HR](https://www.facebook.com/SmokyMountainHarmReduction/) in Macon County are the most financially vulnerable. NCHRC has a mutual aid pool. NCHRC-Haywood has an excellently placed pre-existing program to provide cash and services to PWUD in an adjacent, accessible county; that fund is in need of replenishment. Faith in Harm Reduction is diligently serving some of the more rural areas away from Asheville. WNCAP is a comprehensive care provider for folks with HIV and SSP provider to an older generation, with fixed site and mobile. Holler HR in Madison County is resilient and likely the most effective at the current moment, with remaining infrastructure. Their [Insta](https://www.instagram.com/hollerharmreduction?igsh=c3gyMm56bnU5bW01) and [FB](https://www.facebook.com/hollerharmreduction/) have updates. **All of then could use your help. Now, and in the months ahead**. Here are vetted links for donations, by county. These are all orgs who we have spoken with directly. Thanks, y’all! ### NC Harm Reduction Coalition They have a short-term mutual aid pool via PayPayl for all HR orgs in the area, as well as specific NCHRC-**Haywood County** capabilities to help locally immediately. [Donate to North Carolina Harm Reduction CoalitionHelp support North Carolina Harm Reduction Coalition by donating or sharing with your friends.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/pp196.png)![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/file.JPG)](https://www.paypal.com/donate/?hosted%5Fbutton%5Fid=8HUY2Z3FEM8XL) ### Western NC AIDS Project Please consider a monthly donation as the impact will reverberate for years. **Buncombe County** (Asheville) and **Macon County**. [Home - WNCAPAsheville, NC![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-wncap_BrandMark_RGB-270x270.png)WNCAP - Asheville, NC![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/end-stigma-homepage-cover.jpg)](https://wncap.org/?form=unrestricted) ### STEADY Collective Core SSP in **Buncombe County** (Asheville), serving unhoused folks. [Donate or Volunteer — The Steady Collective![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/default-favicon.ico)The Steady Collective![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/ae3d0a8c9a874ffd9d82715e1e961e39.jpg)](https://www.thesteadycollective.org/donate-or-volunteer) ### Holler Harm Reduction Monthly donations accepted. Also Venmo. Holler has asked that immediate mutual aid donations be routed through [Rural Organizing and Resiliency](https://ruralorganizing.wordpress.com/) mutual aid pool for **Madison County**, which provides immediate access to cash. [ROAR's Insta](https://www.instagram.com/%5Froar%5Fwnc/) is regularly updated with needs lists. Also highly recommend signing up for a [monthly donation with Holler](https://www.hollerharmreduction.org/get-involved). Holler's updated [service delivery times](https://www.instagram.com/hollerharmreduction/?hl=en) are on their Insta. [Rural Organizing And Resilience![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/webclip.png)Rural Organizing And Resilienceruralorganizing![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/blank.jpg)](https://ruralorganizing.wordpress.com) ## Faith in Harm Reduction Hill Brown is the Southern regional coordinator for this national org. They are arranging on the ground supply distribution in **Mitchell and Yancey Counties**. Make note in comment to earmark for storm recovery. [Donate — Faith in Harm Reduction![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-4.ico)Faith in Harm Reduction![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/faithinhr-logos_vertical-color.jpg)](https://faithinharmreduction.org/donate) ## Virginia Harm Reduction Coalition Danny at VHRC has been making deliveries into western NC, including by kayak. Supporting them to continue this lifeline would be excellent. [Virginia Harm Reduction Coalition – We love you. Be safe. Carry Naloxone.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-2-270x270-3.png)Virginia Harm Reduction Coalition![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/82110276_3411765988897120_1321723176857632768_o-1-1024x915-1.jpg)](https://carrynaloxone.org) --- ### Programs in SC and TN [Challenges, Inc.](https://challengesinc.org/) is a well-established program outside of the most dire zone, but definitely affected by flooding and taking care of displaced people. We haven't been in touch with them, and don't know them from before the storm, but are being told by intermediaries that [Community Defense of Eastern TN](https://www.cdetpush.org/) does good work in **Green County** Tennessee. Another we haven't connected directly with is [Choice Health Network](https://choicehealthnetwork.org/donate), but hear they do mobile outreach in hard-hit **Cocke County** TN. --- ## Buprenorphine Access **There are 5 buprenorphine clinics in Asheville accepting new patients right now.** Contact Anna Stanley at the SOTA for details. The NC State Opioid Treatment Authority (SOTA) is helping with getting buprenorphine scripts transferred to operational pharmacies. Contact Pam Morrison or Anna Stanley at the SOTA. Let us know if you need their contact info. Shelter staff should obtain the following information from each patient who needs continuation of medication for opioid use disorder: - Name - Date of Birth - Medication and dose - Name of patient’s current home clinic (or prescribing physician and medical practice, if receiving OBOT/office-based/prescription-based services) --- ## Pain Patients We hear reports of pain patients near the end of refills getting nervous about meds. If there are orgs in the area helping out, let us know and we will update here. List of operating pharmacies: [EmergencyOperatingPharmaciesHelene![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-2.png)North Carolina Board of Pharmacy![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/NCBOP_Logo_small-2-1.png)](https://ncbop.org/emergencyoperatingpharmacieshelene.html) NC Board of Pharmacy has [emergency loosening of restrictions](https://www.ncbop.org/heleneaftermath.html) posted for Helene already. And NC Medicaid has [similar new flexibilities](https://medicaid.ncdhhs.gov/blog/2024/09/26/nc-medicaid-temporary-flexibilities-due-hurricane-helene). It’s a start. Below applies to buprenorphine (Suboxone) as well as pain meds. > **CONTROLLED SUBSTANCE PRESCRIPTION FORMATS.** The North Carolina STOP Act requires that prescriptions for “targeted controlled substances” to be transmitted electronically unless an exception applies. One exception is “technical failure or other circumstance preventing electronic transmission.” For obvious reasons, transmission or receipt of electronic prescriptions in Helene-affected counties is likely to be problematic. Accordingly, the STOP Act’s electronic transmission provisions are not a reason to decline filling a controlled substance prescription issued for a legitimate medical purpose in the ordinary course of medical practice. [NC Board of Pharmacy](https://ncbop.org/heleneaftermath.html) HT: Trish Freeman for the pharmacy resources. Kristen Leloudis at the UNC School of Government has this excellent blog post breaking down the specifics of all the emergency prescribing rules in NC. Worth a read. Useful also for patient advocates. Covers emergency refills, early refills, non-patient pickups, out-of-state waivers, and controlled substances. [Access to Pharmacies and Prescription Refills after Hurricane Helene - Coates’ Canons NC Local Government LawPublic Health![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/ss_img_unc_favicon-1.ico)Coates’ Canons NC Local Government LawKirsten Leloudis![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/20a3442a69df757956a104c5ba6a1a69)](https://canons.sog.unc.edu/2024/10/hurricane-helene-rx/) --- ## Bigger Picture We have [previously written](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5846593/) about natural disasters and pain and substance use. > It has been observed that people somaticize social disasters into physical pain. Subjective economic hardship was associated with new onset low back pain following the Great East Japan Earthquake. Intensifying substance use may be a normal societal response to mass traumatic events, especially when experienced by people in lower socioeconomic strata. Increased alcohol use and binge drinking were noted after Hurricanes Katrina and Rita, with the greatest compensatory drinking among those with lower lifetime income trajectories. Women experiencing work stressors after September 11, 2001, were more likely to have increased alcohol use. Yet, some communities’ protective family and social structures generate resilience that mitigates negative impacts from the collision of economic hardship, substance use, and depression. ## Sign up for Opioid Data Lab Welcome to the Street Drug Analysis Lab @ UNC, a public service of the University of North Carolina at Chapel Hill. We provide analytical chemistry services and information for public health. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### Reasons for the decline in drug overdoses: perspective from Kentucky's pharmacy students URL: https://www.opioiddata.org/reasons-for-the-decline-in-drug-overdoses-perspective-from-kentuckys-pharmacy-students/ Last updated: 2024-09-26T14:16:15.000Z ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/small_OpioidDataLab_portraits_Jan2021__ChrisDelcher-3-1-1-1.jpg) by Chris Delcher, PhD Director of the [Institute for Pharmaceutical Outcomes & Policy (IPOP)](https://pharmacy.uky.edu/office-research-operations/cornerstones/research-centers/ipop), University of Kentucky I warn the 2nd year pharmacy students taking my policy course that the world of drug policy can change quickly. In other words, expect the unexpected. That's *exactly* what happened this past week when news broke of the sharp declines in drug overdoses nationally and (adeptly) triangulated to the state and local levels by the [Opioid Data Lab](https://www.opioiddata.org/are-overdoses-down-and-why/?ref=unc-street-drug-analysis-lab-newsletter) team. Their team's analysis even echoed recent conversations I had with an online group of forensic epidemiologists (the people working in medical examiner and coroner offices to get this data out there) organized by the [Council for State and Territorial Epidemiologists](https://www.cste.org/page/AppliedForensic). They were cross-validating observations showing declines in fatal fentanyl poisonings in each of their jurisdictions. The IPOP team weighed in on this conversation by providing the trends below from our [repository](https://github.com/UK-IPOP/open-data-pipeline) of 5 additional jurisdictions with public data available on drug overdoses. The downturn from late 2023 to early 2024 is clear. Note: the Opioid Data Lab already warned of the lag time problem and cautioned against over-interpreting the later 2024 trend because cases are not finalized and added to the datasets. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/opioid-overall.png) The Opioid Data Lab team offered eight hypotheses for the downturn in drug overdoses: 1. Removing barriers to drug treatment 2. Increased distribution of naloxone 3. Law enforcement operations at US-Mexico border 4. Cartel arrests and fentanyl shipment restriction 5. Depletion of susceptibles 6. Marijuana legalization 7. Xylazine reducing overdose severity 8. Transition to smoking & price We all know the true answer to this question: it is a mix of these interventions and that these aren't all the possibilities and I am always looking to poll my PharmD students to get the pharmacist's view of the world. Many of my students are working in Kentucky's pharmacies so they naturally have a patient-level perspective that I lack as an epidemiologist. So, the morning that the story broke (and I'm fairly certain they had no knowledge of the story prior to the poll), I asked them (n=93): Which of these hypotheses is the **primary** driver? ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Pharmacy_poll.png) Their answers surprised me. Their training and the messaging that we provide at the University of Kentucky's [College of Pharmacy](https://pharmacy.uky.edu/) around the value of naloxone for saving lives comes through in the poll (49% chose this one). This is good news for naloxone education in a state located in the historic epicenter of the opioid crisis. The next most frequent answer was marijuana legalization (20%). (Only medical cannabis is [legal in Kentucky](https://kymedcan.ky.gov/Pages/index.aspx) effective Jan. 1\. 2025 in case you are wondering). This isn't a scientific analysis nor even a well-phrased survey question (medical versus recreational cannabis would have been a nice distinction for me to make) but I was a little surprised that "removal of barriers to drug treatment" fell behind in this crowd of future pharmacists. Are they seeing first-hand that barriers still exist in pharmacies? For example, our faculty [reported](https://jamanetwork.com/journals/jama-health-forum/fullarticle/2818723) that one of the medications for opioid use disorder, buprenorphine, was inaccessible to Medicaid recipients in up to 20% of pharmacies authorized to dispense it. Along those lines, I have [written](https://ajph.aphapublications.org/doi/10.2105/AJPH.2024.307649) about the flattening of buprenorphine prescribing trends despite federal efforts to increase access. Maybe they are even starting to hear from patients that cross our border with Ohio about their experiences with recreational cannabis (Ohio just opened their [first dispensaries](https://com.ohio.gov/about-us/media-center/news/ohioans-urged-to-be-cautious-and-responsible-if-using-cannabis) on Aug. 6 2024). The poll will certainly spark several interesting class discussions in the weeks ahead. One thing is clear from the poll: I have already made it a note to recruit the 1 respondent who answered "depletion of susceptibles" into our [PhD program](https://www.uky.edu/academics/doctoral/college-pharmacy/pharmaceutical-sciences-graduate) for their apparent epidemiologic know-how. ### Are overdoses down and why? URL: https://www.opioiddata.org/are-overdoses-down-and-why/ Last updated: 2026-05-20T16:22:13.000Z 📣 This blog post was covered by [National Public Radio](https://www.npr.org/2024/09/18/nx-s1-5107417/overdose-fatal-fentanyl-death-opioid) (NPR) on September 18, 2024\. By: [Nabarun Dasgupta](https://www.opioiddata.org/author/nabarun/), [Colin Miller](https://www.opioiddata.org/author/colin/), [Adams Sibley](https://www.opioiddata.org/author/adams/) A good analogy is inflation: It's hard to trust official numbers unless we feel it in our wallets. Or in this case, our hearts. Are we going to fewer funerals? Donating to fewer memorial funds? Getting fewer dreaded late night phone calls? Maybe. But we've been here before. Excitement about dips in overdose indicators end up being transient or explained away by data artifacts. So pardon our skepticism. Let's be clear: **Too many people we love are still dying from overdose.** Any decrease is too late for them. Yet, -15% to -20% decreases in overdose would be **unprecedented**. To our knowledge, no public health intervention in the United States has ever achieved this benchmark. For example, NIDA spent [$343.7 million](https://heal.nih.gov/research/research-to-practice/healing-communities#:~:text=With%20support%20from%20the%20NIH,and%20research%20in%20four%20states.) (!) to show that it was possible to [reduce overdoses by 9% in four states](https://www.nejm.org/doi/full/10.1056/NEJMoa2401177) in one year. A reduction of this magnitude across the *entire countr*y translates to a very strong acting force. Something has changed. And that this is happening without central coordination is a big deal. It has major implications for the way we think about overdose prevention interventions. And everybody we talked to had a different explanation why this could be happening. Most started off by saying any decrease was due to whatever they themselves were working on. Great that so many people find meaning in their work. But we have a job to do in establishing some truths and get the conversation started. And for the love of us all, **do not ease up** on whatever it is you are doing! --- # Motivating Example We set out on this investigation when we heard that fentanyl overdoses were down 31% from May of last year in North Carolina: 1,008 this year, compared to 1,458 the same time in 2023\. We had also been hearing from community and harm reduction providers that things had "chilled out" a bit since the height of overdoses during the COVID years. Judging by these data, **there are still twice as many overdoses as before the pandemic** (585 in 2019). Dark blue is year-to-date for the same month the previous year, and light blue is the total for that year. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-83.png) [Source](https://injuryfreenc.dph.ncdhhs.gov/DataSurveillance/StatewideOverdoseSurveillanceReports/OpioidOverdoseEDVisitsMonthlyReports/OCMEMonthlySuspectedOD%5FReport-Jul24.pdf): NC DHHS & OCME And then we looked up the [national numbers](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) and saw what appeared to be a -10% decline in overdose mortality. It was enough to dig deeper, but we were jaded. --- # Our Investigation First, we looked at state health department dashboards nationwide, across a range of overdose metrics, to understand if state data were confirming the aggregate national trend. Do the pieces add up to the whole? Second, we probed possible causes for a decline. We gathered a range of competing hypotheses: naloxone distribution, contaminants in the drug supply, border security, availability of drug treatment, and more. We looked at when the dips started, and what was happening around the same time. We examined patterns in geography. ****Skip ahead**. [Are overdoses down?](#overdose-mortality) [Why are overdoses down?](#eight-hypotheses-why) Spoiler: We concluded that non-fatal overdoses are down -15% to -20%. We also noticed a trend that the improvements spread across the continental from east-to-west. --- # Technical Matters Why don't we have more timely data on overdose deaths? At the heart of the matter is the [lag time](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2021.306332) between a death, its final cause being determined by autopsy, and those data getting reported to the national level. Crude overdose death counts are plagued by always appearing to go down in the past \~6-10 months because of the lag. We can see the lag in the North Carolina data, the light grey bars are pending (or "provisional") cases. Our medical examiners have an incredibly important and difficult job, and the division is chronically underfunded. 😦 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-81.png) [Source](https://injuryfreenc.dph.ncdhhs.gov/DataSurveillance/StatewideOverdoseSurveillanceReports/OpioidOverdoseEDVisitsMonthlyReports/OCMEMonthlySuspectedOD%5FReport-Jul24.pdf): NC DHHS There are [sophisticated](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2021.306256) [methods](https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2794462) for accounting for this. Still, we are cautious when we see the Centers for Disease Control and Prevention (CDC) reporting a 10.0% decline in overdose deaths between April 2023 and April 2024\. Also, sweater weather is around the corner and springtime statistics feel a bit stale. [Deep Dive: Overdose Death Data ProcessOverview of how overdose deaths are counted.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://images.unsplash.com/photo-1531851243379-1524c00c0545?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wxMTc3M3wwfDF8c2VhcmNofDE5fHxlbXB0eSUyMGNoYWlyfGVufDB8fHx8MTcyNjYxNjUwNHww&ixlib=rb-4.0.3&q=80&w=2000)](https://www.opioiddata.org/deep-dive-overdose-death-data-process/) We think the term "CDC data" is a misnomer. It obfuscates the fact that these data are *aggregated* by CDC (by longstanding Congressional mandate), but they actually [originate locally](https://www.ncbi.nlm.nih.gov/books/NBK219870/). So, if we are skeptical, we should **go to source**. Compared to national CDC-aggregated data, dashboards maintained by state health departments are more timely. They trade national representativeness for timeliness. Put another way, standardizing across a large nation requires data to be simplified. When simplified data are aggregated, [strange things can happen](https://en.wikipedia.org/wiki/Simpson%27s%5Fparadox). Simpson's Paradox describes a scenario where *individual state* numbers can all be going up, but the *national aggregate* will appear to be going down, because different states started at different baselines. Imagine each state as a different color in the hypothetical data below, and then being aggregated into the black dots nationally. The "korrelation" numbers above are R-squared values, all of which are statistically valid. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Simpsons_paradox_-_animation.gif) Simpson' Paradox illustrated using demonstration data. Source: [Wikipedia](https://commons.wikimedia.org/wiki/File:Simpsons%5Fparadox%5F-%5Fanimation.gif) This mind-bending scenario occurs when states with lower overdose rate influence the national average more heavily, hiding the increases happening in smaller individual states.​​​​​​​​​​​​​​​​ So, we need to first see if the national trend holds at the state level. And if there are legitimate declines, then we want to know why. --- # Backstory Overdoses had been holding steady or just starting to dip before the onset of COVID restrictions in 2020\. Immediately after things shut down, overdoses went up. Overdose indicators at the [county](https://link.springer.com/article/10.1007/s11524-022-00610-0) and [state](https://doi.org/10.1016/j.drugalcdep.2020.108176) level document the early COVID-era increase very clearly, but the national *mortality* numbers show a [less prominent pattern](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10414597/). Not surprisingly, as medical examiners dealt with a major increase in the absolute numbers of deaths, overdose fatalities during 2020-21 were undercounted. Here's the takeaway: National OD mortality numbers can be buffeted by other societal forces. So, it is worth digging deeper into any apparent national change in overdose rates before we draw conclusions. --- # Our Methods We investigated overdose metrics on state dashboards using [this list](https://cchi.web.unc.edu/opioid-dashboards/) maintained by the Carolina Center for Health Informatics at the University of North Carolina. (We were not involved in the compilation.) ### Metrics We looked at overdose deaths, hospital emergency department (ED) visits, and calls to emergency medical services (EMS; aka ambulance runs). The generation of overdose death data is intentionally deliberative. It takes a lot of time because each case is reviewed by multiple medical experts, supported by chemical and other forensic analysis. In contrast, the sources we are using for hospital emergency data are nimble, and can be aggregated to state level within hours. However, the data are thin. It is literally one line of information (imagine one row on a spreadsheet with a dozen columns for date, age, gender, and “chief complaint”). It is that last field that differentiates a car crash from an overdose. It’s based on quick clinical observation, often by nurses. Sometimes the data row gets updated after lab tests. And then it gets assigned an alphanumeric code that is uniform across hospitals. This early warning system is also used for infectious disease outbreaks, bioterrorism events, extreme heat/cold related issues, etc. Finally, EMS data are published even faster. These data can be noisy. But they offer a handy national snapshot. These are usually non-fatal overdoses. These three data systems are independent. Taken together, if a consistent trend appears in all three, we would have a lot more confidence that declines in overdose are real. If emergency care goes up and overdose deaths go down, we could interpret that discordance as more people getting care for a potentially life-threatening condition successfully. On the other hand, if emergency care *and* deaths go down at the same time, they are likely measuring an actual change in the number of overdoses independently. ### Definitions "Overdose" definitions can vary. For example, are suicides included? How do you count overdoses with no specific listed substance? At the end of the day, we chose to let each state define the overdose metric that is of local importance. While this may not be standardized, there are a finite set of ways of counting. As long as the ICD codes that were used are explicit, we chose to proceed with the metric(s) that each state has *chosen* to report. In this way we are respecting local autonomy. To [state the obvious](https://www.youtube.com/watch?v=hXP0IZYE6aA) – the overdose death spikes that accelerated during COVID restrictions are due almost exclusively to non-pharmaceutical fentanyl, in powder and fake pill forms. ### Comparison time window A fundamental question is what time frame to to compare. Overdose ED visits are influenced by factors like ambient temperature and time spent outdoors, so in Delaware OD visits [increase](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9124554/) in April-May, while in Arizona they [decrease](https://www.azdhs.gov/opioid/dashboards/index.php#overdose-deaths) around the same time as people stay indoors out of desert heat. In [Rhode Island](https://journals.lww.com/epidem/fulltext/2019/09000/increased%5Frisk%5Fof%5Fopioid%5Foverdose%5Fdeath%5Ffollowing.5.aspx) *cold weather* increased overdose. In [British Columbia](https://www.cmajopen.ca/content/11/3/E569.short) *hot weather* increased overdose. Collectively we call this "seasonality" and you can see the cyclical pattern in Ohio, where overdose *counts* are lowest in Jan-Feb. (February also has fewer days.) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-42-1-1.png) [Source](https://odh.ohio.gov/know-our-programs/violence-injury-prevention-program/suspected-od-dashboard2): Ohio Department of Health Regardless of the cause, a common way increase validity is to compare to the same time the previous year. We chose to compare the same month in 2024 to the same month in 2023 (i.e. year-over-year monthly change). ## Data Considerations At the [Opioid Data Lab](https://opioiddata.org), our scientists have been at the forefront of addressing the [methodological](https://link.springer.com/article/10.1007/s40471-019-00201-9) [nuance](https://www.longdom.org/open-access-pdfs/defining-controlled-substances-overdose-should-deaths-from-substanceuse-disorders-2161-0495.1000164.pdf) of [measuring](https://pubmed.ncbi.nlm.nih.gov/21668762/) [overdose](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547584/). We are constructively critical of the whole enterprise, and have offered [new solutions](https://cph.uky.edu/research/projects/DMI2EpiTool) to improve data quality. At the links below we list some caveats. [Deep Dive: Overdose mortality data caveatsCaveats to consider when looking at overdose death data in the United States.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w1200/2024/09/photo-1518186285589-2f7649de83e0.jpeg)](https://www.opioiddata.org/deep-dive-overdose-mortality-data-caveats/) [Deep Dive: Hospital ED overdose data caveatsData considerations when looking at hospital emergency department overdose data from syndromic surveillance sources.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/size/w256h256/2024/08/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://images.unsplash.com/photo-1513224502586-d1e602410265?crop=entropy&cs=tinysrgb&fit=max&fm=jpg&ixid=M3wxMTc3M3wwfDF8c2VhcmNofDd8fGhvc3BpdGFsfGVufDB8fHx8MTcyNjYxNjkyOHww&ixlib=rb-4.0.3&q=80&w=2000)](https://www.opioiddata.org/deep-dive-hospital-ed-overdose-data-caveats/) ## 1\. Are Overdoses Down? OD mortality, hospital emergency visits, ambulance runs # Overdose Mortality CDC [adjusts](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm) for the reporting lag with a "predicted" rate of overdose nationally. These models don't predict the future. Instead they “predict” what happened about 6 months ago, the general average lag time for autopsy investigations. As of September 2024 the predictions go through April. The dots and line are on top of each other, meaning the prediction and actual performs very well over time. **The overdose curve bends lower starting in 3Q2023.** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-31.png) [Source](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm): CDC NVSS With the adjustment for reporting delays, currently, the US is reported to be ata **\-10.0% year-over-year decrease in overdose deaths**, through April 2024\. (Without adjustment, the crude rate is -12.2%.) Note that these are changes in the *absolute number of deaths* in each state. But, this could also be explained by Simpson's Paradox: The national *aggregate* death count driven down by more substantial decreases in larger population states, while some states are going up. We should keep our skepticism. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-32.png) [Source](https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm): CDC NVSS --- # Hospital Emergency Visits So let's look at an independent data source. CDC also aggregates overdose-related visits to emergency departments in hospitals. This is a *completely different system*, maintained by a different part of CDC. Aggregating the hospital data is a totally different process from the mortality data, having worked to [build these system](https://knowledgerepository.syndromicsurveillance.org/search?keys=nabarun+dasgupta). Again, these data originate locally. In this case, they are from hospitals, many of them privately owned. Note that these are changes in rates per total ED visits, which is another standard way to adjust for fluctuations in the total number of ED visits. (Staffing, ED crowding, and other factors can influence the overall number of hospital visits.) To align with the mortality map above, we can compare ED visits in 2023 vs. 2024, showing an unprecedented 24% decline across Aprils. ## East to West Moreover the general spread of states matches mortality. Declines in both mortality and ED visits in the Northeast, then the South and Midwest. Nevada and Alaska are higher on both. Washington, Hawaii, Nebraska, Oregon, and New Hampshire are discordant, but within expected noisiness. (Unfortunately no data are available from Wyoming and Iowa, of the few states where mortality was higher than the the month in the year previous.) The association isn't perfect, but the overall pattern holds. Each state is a hexagon. Orange represents the rate of overdose hospital emergency visits being higher than the same month the previous year. Dark gray is no change. And blue is a decrease compared to the same month in the year previous that is "statistically significant." ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-36.png) ## From Orange to Blue We created the animated GIF below to show the change over a longer time span, and you can [modify the visualization here](https://www.cdc.gov/overdose-prevention/data-research/facts-stats/dose-dashboard-nonfatal-surveillance-data.html?CDC%5FAAref%5FVal=https://www.cdc.gov/drugoverdose/nonfatal/dose/surveillance/dashboard/index.html). On average over the first nine months of calendar year 2024, opioid overdose-related visits to hospital EDs seem to be down, around -15% to -20%. Notice the map going from orange to blue. And notice the pattern is that the declines started in the east and migrated to the west. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/ED_visits-black-end-1.gif) Source: [CDC DOSE](https://www.cdc.gov/overdose-prevention/data-research/facts-stats/dose-dashboard-nonfatal-surveillance-data.html?CDC%5FAAref%5FVal=https://www.cdc.gov/drugoverdose/nonfatal/dose/surveillance/dashboard/index.html), GIF by Opioid Data Lab. Change in overdose ED visits compared to same month previous year (Jan'23 to May'24) The available data go through June 2024, which shows a **13% decline** in hospital ED visits for opioid overdose from the previous June. (Discrepancy is within the known variability in this data system, and statistical moving averages, smoothers, etc. that can be applied if we wanted to go there.) **Here's the takeaway: ED visits look to be down about 15-20% since last year.** Put another way, the more meticulous final OD mortality data will give us a magnitude of effect that will serve as the metric of record. In the meantime, the fast hospital data give us confidence we are on the right track. --- # EMS 911 Calls Now we turn to another completely independent system. EMS responses (e.g., from 911 calls) are recorded in the National Emergency Medical Services Information System ([NEMSIS](https://nemsis.org/what-is-nemsis/)). This is the fastest-available data nationally. Overdose data are compiled into a dashboard by the [National Highway Traffic Safety Administration](https://nemsis.org/non-fatal-opioid-overdose-tracker-is-now-available/). **First responders are reporting that non-fatal opioid overdoses are down 16.7% in September 2024 compared to September 2023.** ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-73.png) [Source](https://nemsis.org/drug-overdose-surveillance-dashboard/): NEMSIS --- ### Other National Data Sources Considered We also checked in on: [NDEWS](https://ndews.org/) has no public trend data for their real-time 911 calls, and [ODMap](https://www.odmap.org/) has weekly data from police and EMS but prohibit public access. [NMURx](https://www.radars.org/annual-meetings-a.html) 2024Q1 data were available ([slide 18](https://www.radars.org/system/events/Dart%20-%20Ever%20Changing%20Landscape%20of%20the%20Prescription%20Drug%20Crisis.pdf.tmp)) and was the only data source that showed any increase in illicit fentanyl use this calendar year. Data from the new [DAWN ED](https://www.samhsa.gov/data/release/2024-drug-abuse-warning-network-dawn-releases) system are limited to HHS federal agencies only. In conversations on September 16, 2024 at the DAWN Engage convening in Silver Spring, Maryland (in which we participated), data scientists at DAWN said they had received the data but not yet completed the time trend analysis through July/August 2024\. We will update this page when we hear from them. Their initial take was that some EDs may be testing more regularly for fentanyl in 2024 than in previous years, so any actual decrease in time trend may appear attenuated. ****Skip ahead**. [Why are overdoses down?](#eight-hypotheses-why) --- # Looking to the States Okay, so the national numbers across three independent sources are in agreement: A 10-20% decline in fatal and non-fatal overdoses compared to last year. We’ve been hearing stories from all over: Maine, Missouri, Ohio, North Carolina, Kansas, New Mexico, Indiana, and beyond. The message is consistent: *Local overdose death numbers from fentanyl seem to be dropping.* Here is the Governor of Maine: >> Overall, the U.S. CDC found that drug overdose deaths in the United States decreased by three percent in 2023, the first annual decrease since 2018\. Drug overdose deaths in Maine decreased by nearly 16 percent over this same period; only Kansas, Nebraska, and Indiana also saw decreases of 15 percent or more, according to the report from the U.S. CDC’s National Center for Health Statistics. [Source](https://www.maine.gov/governor/mills/news/governor-mills-announces-16-percent-decline-fatal-drug-overdoses-maine-2023-among-nations) To be clear, this is not happening everywhere, and locally, things may fluctuate from month to month. Also, state or national numbers will feel wrong when there's a run of overdoses in a neighborhood, and we find ourselves at yet another funeral. Acknowledging all that, let's see what the state data can tell us. Data below from 16 states: North Carolina, Kentucky, Vermont, Maine, Arizona, Ohio, Florida, Connecticut, Oregon, Pennsylvania, Alaska, Rhode Island, Washington, Georgia, Illinois, and Maryland. Most other public state dashboards had not been updated since 2022 and some are stuck in [2020](https://experience.arcgis.com/experience/3f46876d8cfa4f42981a6ba4922d554d/page/Statistical-Data-and-Maps/?views=Time) or [2021](https://healthdata.dshs.texas.gov/dashboard/drugs-and-alcohol/opioids/opioid-related-emergency-department-visits). 🙄 **The trend is clear. Something changed in late 2023 and into Spring 2024 to bring overdoses down. Change in magnitude is roughly in the -10 to -20% range.** 📊 If you work in a state health capacity and want to provide us with updated numbers, we would be happy to include them below. You can reach us at opioiddatalab@unc.edu. --- ### North Carolina Pulling up the **North Carolina Statewide Overdose Surveillance Report** from July 2024 (which, BTW, you should sign up to receive at SubstanceUseData@dhhs.nc.gov), we see: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Screenshot-2024-08-23-at-8.21.26-AM-1.png) [Source](https://injuryfreenc.dph.ncdhhs.gov/DataSurveillance/StatewideOverdoseSurveillanceReports/OpioidOverdoseEDVisitsMonthlyReports/OCMEMonthlyFentanylDeaths%5FUpdatedMay2024.pdf) NC DHHS This view is striking because, while unacceptably way too many people we love are dying, we also see that the rate of increase in fentanyl OD deaths stalled in 2022 and 2023, after 25% to 61% annual increases the five years before. And then 2024 is the dramatic plunge. We talked to our colleagues at the NC DHHS who published the graph above. We asked if there were any data processing artifacts that might artificially deflate the trend. And we asked if they were noticing any patterns with sex, age, or race. Here's what they told us: - The 2023 death certificate data are still incomplete, especially Q4. - There were no notable differences in the percent breakdowns by sex. - There were small increases in the 35-44 and 65+ age brackets and a small decrease among 45-54-year-olds. Other age groups were the same year over year. - The percent-of-total by race/ethnicity showed decreases for non-Hispanic whites and non-Hispanic American Indians. Percent-of-total increased for non-Hispanic Blacks and Hispanics. They went to the sources behind the published numbers and looked into the 2024 cases that are still under investigation. The toxicology findings are available for these, so fentanyl-positivity can give us a sense of what's happening, since nearly all of these eventually get adjudicated to be overdose deaths. - No notable differences in sex. - Small increases in 2023 and 2024 among 35-44-year-olds. - Larger percent of fentanyl-positive deaths are among Black individuals, smaller percentage are white. This has been consistent since 2021\. --- ### Kentucky Kentucky has some of the cleanest and fastest overdose death data in the country. So let's start there. (We work closely with our colleagues at U of KY where they created the [system](https://injuryprevention.bmj.com/content/24/1/60.abstract).) Deaths from all drug-related overdoses were down from 187 to 123 April 2023 to March 2024 = -34.2% drop in *mortality*. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-106.png) [Source](https://uky-edu.maps.arcgis.com/apps/dashboards/0317b21f4833452d9b762bf35cfd1656) And here is non-fatal ED visits for all drug overdoses. April 2023: 1,245 versus March 1,046 = -16.0%. For most other states we will see that OD mortality is smaller magnitude than ED visits, so this is reading in KY is interesting. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-107.png) [Source](https://uky-edu.maps.arcgis.com/apps/dashboards/0317b21f4833452d9b762bf35cfd1656) --- ### Vermont Vermont is also another state with very fast overdose death reporting. The 3-year average was 107 through June (2021-2023), but in in 2024 it was 90, so down -15.9%. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-108.png) [Source](https://www.healthvermont.gov/sites/default/files/document/dsu-monthly-opioid-report.pdf) --- ### Maine The great state of Maine is another heavyweight in reporting of overdose deaths in terms of speed and accuracy. Marcie Sorg has been running this program for 2 decades and the data are consistent. We'll just paste what she says: "The total number of confirmed and suspected fatal overdoses January–July 2024 is 302, **17.3% lower** than the total confirmed fatal overdoses for the same period in 2023, 365\. The total number of nonfatal overdoses January–July 2024 is 4,980, 12.2% lower than the total confirmed nonfatal overdoses for the same period in 2023, 5,670. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-109.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-110.png) [Source](https://mainedrugdata.org/wp-content/uploads/2024/09/2024-07-ME%5FOD%5FReport-Final.pdf) So we can compared to other states, looking at ED visits, year-over-year for the most recent month available, we get: July 2023 340 July 2024: 293 That is a -13.8% drop in ED visits, comparable again to fatalities. They also provide EMS and police responses, which is one of the few states where we can probe differences between these two types of uniformed fist responders. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-111.png) And, then there is the super-composite, which includes fatal ODs, ED non-fatal, EMS not transported, community reversals, and law enforcement reversals. Got to love a small population state with dedicated data nerds! All together in July 2023 this came to 904 composite overdose in July 2023, and 739 in July 2024\. That is -18.2%. All very consistent among the indicators. Data gold mine up in here! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-112.png) --- ***And now for some other states, nearly all of which have at least some 2024 data.*** --- ### Arizona Overdose deaths: - March 2023: 163 - March 2024: 139 - Change: -14.7% Hospital ED visits: - 2023: 176.8 per 100,000 ED visits - 2024: 152.1 per 100,000 ED visits - Change: -14.0% ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-23.png) [Source](https://www.azdhs.gov/opioid/dashboards/index.php#overdose-deaths) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-22.png) [Source](https://www.azdhs.gov/opioid/dashboards/index.php#overdose-deaths) --- ### Ohio Noticeable declines in ED visits in late 2023. For all drug overdoses. Dec 2022: 2,318 Dec 2023: 1,890 \= -18.5% ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-42.png) [Source](https://odh.ohio.gov/know-our-programs/violence-injury-prevention-program/suspected-od-dashboard2) --- ### Florida Both heroin and all-opioid ED visits in Florida were down starting in later 2022 and early 2023. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-47.png) [Source](https://www.flhealthcharts.gov/ChartsDashboards/rdPage.aspx?rdReport=SubstanceUse.Overdose) --- ### Connecticut Major drop in OD visits starting in April 2024, to less than 100 per month. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-27.png) [Source](https://public.tableau.com/app/profile/heather.clinton/viz/SUDORS%5FDashboard%5Ffinal2/OverdoseDashboard) --- ### Oregon ED visits for opioid overdose started coming down noticeably in April 2024. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-46.png) [Source](https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/SUBSTANCEUSE/OPIOIDS/Documents/quarterly%5Fopioid%5Foverdose%5Frelated%5Fdata%5Freport.pdf) --- ### Pennsylvania We pay attention to Allegheny County (Pittsburgh) because of our good friends at Prevention Point Pittsburgh and because we have ongoing studies there. After a spike in 2022, we see opioid overdose ED visits drop to some of the lowest levels in nearly a decade in the second half of 2023. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-44.png) [Source](https://public.tableau.com/app/profile/pennsylvania.pdmp/viz/PennsylvaniaODSMPDrugOverdoseSurveillanceInteractiveDataReport/Contents) --- ### Alaska Hospital ED visits **Males** July 2023: 34 per 10,000 June 2024: 40 per 10,000 Average: 37 per 10,000 ED visits **Females** July 2023: 27 per 10,000 June 2024: 32 per 10,000 Average: 29.5 per 10,000 ED visits Change July 2023 to June 2024: -20.3% ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-20.png) [Source](https://public.tableau.com/shared/RN9H4F72C?:display%5Fcount=y&:origin=viz%5Fshare%5Flink&:embed=y) --- ### Rhode Island Considerable drops in ED visits starting in September 2023. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-94.png) [Soucre](https://ridoh-drug-overdose-surveillance-eddashboard-rihealth.hub.arcgis.com/) --- ### Washington - King County EMS calls for overdose trending down in 3Q2023 and dropping further into 2024. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-95.png) --- ### Georgia ED visits declined from 17.7 to 14.5 per 100,000 population from July 2023 to July 2024\. Trended back up over the summer months a bit. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-97.png) [Source](https://dph.georgia.gov/document/document/monthly-od-sys-report-july-2024pdf/download) --- ### Illinois Axis is cutoff in screen cap but see the [full image here](https://idph.illinois.gov/OpioidDataDashboard/). This is monthly count of ED visits for heroin and opioids. May 2023: 1341 May 2024: 1003 That is a -25.2% decrease. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-104.png) [Source](https://idph.illinois.gov/OpioidDataDashboard/) --- ### Maryland This dashboard breaks out opioid-related ED visits by 3 broad categories of race. We can see a clear downward trend of multiple years for White, but a substantial increase for Black. ("NH" = non-Hispanic). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-105.png) [Source](https://health.maryland.gov/dataoffice/Pages/mdh-dashboards.aspx) --- ### Massachusetts EMS responses for opioid-related incidents and severity categories (dead on arrival (of opioid overdose), acute opioid overdose, opioid intoxicated, opioid withdrawal, and other opioid-related incident). 1Q2023: 4,185 2Q2023: 4,584 3Q2023: 5,000 4Q2023: 4,261 1Q2024: 3,566 2Q2024: 3,783 2Q2023 vs. 2Q2024: Down -17.5% ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-113.png) [Source](https://www.mass.gov/info-details/ems-regional-opioid-related-incident-dashboard) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-114.png) [Source](https://www.mass.gov/info-details/ems-regional-opioid-related-incident-dashboard) From 2022 to 2023 there was a -10% decrease in overdose deaths. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-115.png) [Source](https://www.mass.gov/doc/opioid-related-overdose-deaths-among-ma-residents-june-2024-0/download) But for the sake of full transparency, worth looking at the opioid overdose mortality data which show [don't show a decrease in 2024](https://www.mass.gov/doc/opioid-related-overdose-deaths-among-ma-residents-june-2024-0/download) but understandably have a lot of pendings. The Massachusetts health department wrote to us after the blog was initially published and pointed out that the decreases in deaths in 2023 (vs. 2022) were not evenly distributed. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-116.png) [Source](https://www.mass.gov/doc/opioid-related-overdose-deaths-demographics-june-2024-0/download) --- # Our Perspective A 15-20% decrease in non-fatal overdose and a 10% decrease in fatal overdose is a major impact. There is barely any public health intervention that has credibly achieved this magnitude of decrease. Our conclusion is that the dip in overdoses is real, and not a data artifact. It remains to be seen how long it will be sustained. If it is sustained, whatever caused it would be one of the strongest "interventions" ever witnessed in this domain of public health. Therefore, we need to next consider the **possible causes**. --- ## Continued below... But if you like what you're reading sign up for our newsletter Subscribe Email sent! Check your inbox to complete your signup. Free. No spam. Unsubscribe anytime. ## 2\. Why are Overdoses Down? 8 hypotheses from across the board ## Eight Hypotheses Why (also meaning we'll piss everybody off with this post, ha!) 1. [Removing barriers to drug treatment](https://www.opioiddata.org/are-overdoses-down-and-why/#1-increasing-drug-treatment) 2. [Increased distribution of naloxone](https://www.opioiddata.org/are-overdoses-down-and-why/#2-increased-distribution-of-naloxone) 3. [Law enforcement operations at US-Mexico border](https://www.opioiddata.org/are-overdoses-down-and-why/#3-law-enforcement-operations) 4. [Cartel arrests and fentanyl shipment restriction](https://www.opioiddata.org/are-overdoses-down-and-why/#4-dto-changes) 5. [Depletion of susceptibles](https://www.opioiddata.org/are-overdoses-down-and-why/#5-depletion-of-susceptibles) 6. [Marijuana legalization](https://www.opioiddata.org/are-overdoses-down-and-why/#6-marijuana-legalization) 7. [Xylazine reducing overdose severity](https://www.opioiddata.org/are-overdoses-down-and-why/#7-xylazine) 8. [Transition to smoking & price](https://www.opioiddata.org/are-overdoses-down-and-why/#8-transition-to-smoking) Let's put one hypothesis to rest: Reductions in opioid analgesic prescribing is not driving the changes in overdose rates. We've [studied](https://doi.org/10.1016/j.drugalcdep.2022.109727) it, and that's not what is driving current fentanyl overdoses. Before we dive in – there is no single obvious answer. We've [evaluated](https://injuryprevention.bmj.com/content/24/1/48.abstract) multi-intervention overdose prevention studies. It's not easy. We may never know what caused this dip, and if it will last, but it seems like folks really want to discuss this! So we provide some possibilities below. --- ✍️ ****Sketchy**. For most hypothesis we sketched the theoretical change over time in overdose (⬛ black line), the date of the intervention (🟥 red), the data we would want to see (🟦 blue) to draw conclusions. For simplicity we assume the impact of each hypothesis alone. In reality we would expect the lines to be muddier as interventions happened contemporaneously. ## (1) Increasing drug treatment ### **Assessment: We wish, but unlikely.** Evidence-based drug treatment reduces overdose, though some medications are [likely more effective than others](https://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2823%2900113-7/fulltext). And, alarmingly, some forms of forced-abstinence treatment increase overdose risk [even more than continued drug use](https://www.sciencedirect.com/science/article/pii/S0376871623012784). So we focus on the two forms that have the most scientific credibility. **January 12, 2023**: DEA [eliminated extra licensing ("X-waiver")](https://www.deadiversion.usdoj.gov/pubs/docs/A-23-0020-Dear-Registrant-Letter-Signed.pdf) for doctors and nurses to treat patients with buprenorphine. **February 1, 2024**: [Made permanent](https://www.whitehouse.gov/ondcp/briefing-room/2024/02/01/white-house-drug-policy-director-statement-on-new-actions-to-expand-access-to-treatment-and-save-lives/#:~:text=HHS'%20historic%20action%20today%20will,take%2Dhome%20doses%20of%20methadone.) the COVID-era rules that allow greater flexibility of [take-home doses](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10232933/) of methadone. Limited data are available on ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-85.png) Hypothetical impact of increasing access to drug treatment Hypothetical geographic scope: **Uniform**. Both rules applied to all states at once. But some states and clinics have done better than others in implementing the rule changes for medications for opioid use disorder. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-68.png) Impact should be felt in nearly all states, maybe stronger in states with established addiction medicine practice networks. These data show no change in the monthly number of patients receiving buprenorphine. That's pretty flat! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-80.png) [Source](https://www.nejm.org/doi/10.1056/NEJMc2312906) Chua et al. **NEJM* In West Virginia we can see the number of prescriptions for OUD in 2024 are at lower than previous years. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-91.png) [Source](https://dhhr.wv.gov/vip/county-reports/Documents/2024%20CSMP%20Reports/July%202024.pdf) West Virginia Board of Pharmacy | Yes | But | | ---------------------------------------------------------------------------------------------------------------------------------------------------- | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Both bup and methadone are [scientifically proven](https://jamanetwork.com/journals/jamapsychiatry/article-abstract/2780655) to prevent OD mortality | Buprenorphine initiation in era of fentanyl + xylazine has become more difficult | | Timeframe for buprenorphine plausible, with a ramp-up period | [Documented](https://www.nejm.org/doi/10.1056/NEJMc2312906) that number of prescribers increased but not patients (graph below) | | Methadone payment and take-home policies evolved during COVID. | The 2024 rule change was a continuation of [temporary changes from 2020](https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2805031) and should have been seen earlier. | | Rule changes were initially lauded. | After initial improvements, methadone clinic practices [gravitated towards more restrictive](https://www.sciencedirect.com/science/article/pii/S0376871624002047). | --- ## (2) Increased distribution of naloxone ### **Assessment: Plausible for naloxone saturation plans, but requires actual implementation dates.** ### **Assessment: Possible for OTC naloxone, but requires information on actual utilization/reversals.** ### **August 2022**: Launch of major national [non-profit organization](https://remedyallianceftp.org/) providing bulk naloxone at low or no cost to harm reduction programs. **September 2022**: [Naloxone saturation plans](https://jamanetwork.com/journals/jama-health-forum/fullarticle/2811061) via SAMHSA SOR implemented massive [scale-up](https://www.samhsa.gov/sites/default/files/grants/pdf/fy-22-sor-nofo.pdf) of naloxone distribution via state health departments. Some variation in starting time is likely; saturation plans in some states (like North Carolina) weren't fully implemented until 2023. **Spring 2023**: Prices of naloxone nasal spray drop because of generic competitors, challenging [decade-old high-price monopoly](https://cdr.lib.unc.edu/concern/multimeds/3r075494j?locale=en). **July 2023**: Naloxone nasal sprays become available [without prescription](https://www.fda.gov/news-events/press-announcements/fda-approves-second-over-counter-naloxone-nasal-spray-product) (OTC). ### Naloxone saturation Fairly rapid (3-6 month) decline in overdoses following naloxone saturation plan roll-out. This hypothesis is supported by the start of the decline in overdoses in mid-2023. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-87.png) Hypothetical geographic scope: **Mixed**. Bulk purchasing of naloxone considerably [state dependent](https://cdr.lib.unc.edu/concern/scholarly%5Fworks/t722hm45f?locale=en), but saturation plans were uniformly required. East-to-west spread hard to explain, but within the realm of possibilities. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-63.png) Naloxone Saturation effects expected to be strongest in states with most distribution directly to people who use drugs (like Missouri, Washington, Arizona, Maine). | Yes | But | | ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------------------------------------------------------------------------------- | | Saturation showing [early success](https://www.maine.gov/governor/mills/news/governor-mills-announces-16-percent-decline-fatal-drug-overdoses-maine-2023-among-nations) | Implementation in some states started in earnest later than others, and may now just be getting off the ground. | | Bulk naloxone distribution via NEXT Distro and RAFTP reached underserved high-risk groups. | Geographically patchy making state-level changes hard to assess. | | Extensive SSP-based distribution to highest risk injectors | How well are they serving people who smoke? | --- ### OTC naloxone The drop in overdoses seemed to be happening around the time of OTC naloxone becoming available in pharmacies. But whether those doses were actually used to reverse an overdose, and in what time lag, is debatable. Still, expect pharma financial reports to feature similar graphs taking credit. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-98.png) OTC pharmacy sales would have attenuated effect since they are not distributed to highest risk groups for free. Hypothetical geographic scope: **Uniform.** OTC naloxone should have generally uniform distribution. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-64.png) OTC naloxone approval was meant to be a nationally uniform regulatory recision. | Yes | But | | ------------------------------------------------------------------ | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | | Narcan manufacturer reported 22% increase in sales in 2023 | In 2Q2024 sales were down [\-10%](https://investors.emergentbiosolutions.com/news-releases/news-release-details/emergent-biosolutions-reports-second-quarter-2024-financial) | | OTC increases number of places naloxone can be sold | In practice, [hard to find and expensive](https://www.nbcnews.com/health/health-news/narcan-opioid-overdose-drug-otc-access-varies-us-stores-rcna135324) | | OTC increases access to naloxone for worried parents | Family members less likely than peers to be present during overdose | | Naloxone available from many more venues, festivals, schools, etc. | How much actually gets used to save a life? | *COI note: ND is a co-founder of Remedy Alliance For The People* --- ## (3) Law Enforcement Operations ### **Assessment: Unlikely due to magnitude, temporal, and geographic inconsistency.** Major federal law enforcement operations disrupting entry into US-Mexico border for fentanyl and methamphetamine. One operation is designed to interrupt the flow coming into the US, while the other intends to disrupt logistics by specifically targeting 27 micro-networks responsible for last-mile delivery. Operation Apollo saw heavy increased inspection and arrests at ports of entry first in CA on a smaller scale, and ramped up in AZ months later. We can measure the volumetric impacts of Operation Apollo directly, but impact of Operation Plaza will have to be measured indirectly. Operation Apollo has had a [steady](https://www.tucsonsentinel.com/local/report/080224%5Frecord%5Ffentanyl%5Fseizure/) [stream](https://www.nbcsandiego.com/news/local/5000-pounds-meth-found-shipments-celery-watermelon-near-us-mexico-border/3602007/?os=...&ref=app) of [local](https://abcnews.go.com/US/50-lbs-meth-found-ice-chest-full-dead/story?id=109375719) [news](https://gilaherald.com/cbp-officers-apprehend-trusted-traveler-with-methamphetamine/) coverage. **March-April 2023**: Increase in fentanyl seizures at border **October 2023**: Operation Apollo [California](https://www.cbp.gov/newsroom/national-media-release/dhs-doubles-down-cbp-efforts-continue-combat-fentanyl-and-synthetic) **April 2024**: Operation Apollo Arizona **April 2024**: [Operation Plaza Strike](https://www.cbp.gov/border-security/frontline-against-fentanyl/operation-plaza-spike-fact-sheet) If border actions have been effective in reducing ODs, we would expect correlations with overdose deaths at around the time of major seizures. Put another way, we would expect a spikey decay instead of a smooth one. Data below from CBP also show that the vast majority of the interdiction was for marijuana and methamphetamine, with fentanyl being a relatively smaller amount by weight. One view of the supply chain is that we would expect to see large impacts from interdiction to show up 6-8 months after interruptions due to the massive amount of fentanyl in the supply chain. We would also expect to see an increase in replacement fentanyl manufacturing, which could be tracked by analyzing chemical signatures in fentanyl. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-99.png) We would expect a dose-response if border interdiction impacted OD rates. Hypothetical geographic scope: **Directional.** Immediate impact in border states; secondary but widespread impact throughout continental US where supply doesn't originate from other trafficking networks. Alternatively, we would have to assume trafficking occurs in a chain, with ad ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-67-1.png) Impact should be highest and/or immediate in 2 border states. Diffusion to other states by adjacent geography, contingent on trafficking routes. | Yes | But | | -------------------------------------------------------------------------------------------------------- | ------------------------------------------------------------------------------------------------------------------------------------------------------- | | How could you not have an impact by removing hundreds of thousands of pounds of product from the street? | Most of the seizures are meth and marijuana | | Impact felt immediately | Drug supply becomes more adulterated and [dangerous](https://ajph.aphapublications.org/doi/10.2105/AJPH.2023.307291); may increase overdose (see below) | | Plaza strike goes after logistical leaders of fentanyl and meth trafficking | Plaza Strike yet to announce successes | ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-50-1.png) [Source](https://www.cbp.gov/newsroom/stats/drug-seizure-statistics): Customs and Border Patrol ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-52-1-1.png) FENTANYL seizures at US-Mexico border. [Source](https://www.cbp.gov/newsroom/stats/drug-seizure-statistics): Customs and Border Patrol Interestingly, our [Meth Purity Tracker](https://deepnote.com/app/opioiddatalab/Methamphetamine-Tracker-dc555ee4-5c80-4fcd-b64b-c360d0e4ce07) is sensitive enough to register the spikes in methamphetamine adulteration that follow increases in drug seizures. We detected a sudden increase in meth adulteration over the Summer, starting in May 2024, exactly corresponding to the increase in border seizures. **The number one adulterant of meth was fentanyl**. So, the impact of the border seizures may be bi-directional: Decreasing fentanyl-only overdoses *and* increasing fentanyl-methamphetamine overdoses. Yikes, these graphs are hard to line up visually, so this will be a deep dive for another blog post. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-54-1-1.png) [Source](https://deepnote.com/app/opioiddatalab/Methamphetamine-Tracker-dc555ee4-5c80-4fcd-b64b-c360d0e4ce07): UNC Street Drug Analysis Lab ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-55.png) Methamphetamine seizures at US-Mexico border. [Source](https://www.cbp.gov/newsroom/stats/drug-seizure-statistics): Customs and Border Patrol --- ## (4) DTO Changes ### Assessment: Let's see how this plays out with rivals. "DTO" is copspeak for "drug trafficking organization." One of the most intriguing hypotheses was brought to our attention by Dennis Cauchon in Ohio in this [pair](https://www.harmreductionohio.org/ohio-overdose-deaths-down-by-one-third/) of [posts](https://www.harmreductionohio.org/big-decrease-in-overdose-death-continues-in-ohio/) in early August. A major producer of fentanyl in México announced they would stop shipping fentanyl to the United States, enforced with brutality. In October 2023, the *Wall Street Journal* [reported](https://www.wsj.com/world/americas/mexican-sinaloa-cartels-message-to-members-stop-making-fentanyl-or-die-b96d3e09) that: > "The Sinaloa cartel, the leading exporter of fentanyl to the U.S., is prohibiting the production and trafficking of the illegal opioid in its territory after coming under increasing pressure from U.S. law enforcement, cartel members say." (Note: Not all the authors of this post are convinced that fentanyl stopped flowing, as none of our sources have reported having a hard time finding fentanyl at any point in the last 2 years.) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-71-1.png) [Source](https://www.harmreductionohio.org/big-decrease-in-overdose-death-continues-in-ohio/) Harm Reduction Ohio Still, there was local speculation as to what was driving the decrease in overdose. > Some credit statewide drug treatment and outreach efforts, particularly those connected to fentanyl. Some point to a decline in fentanyl contamination of other drugs. And some say a drug cartel may be making good on a promise to cut fentanyl production. Regardless of the reason, those who have worked for years to reduce overdose deaths say the trend is good news. But they want to know why it’s happening, because that could help them fight the problem more effectively in the future. ([Source](https://www.healthpolicyohio.org/health-policy-news/2024/07/12/overdose-deaths-in-ohio-dropped-to-9-year-low-experts-differ-on-why)) **And this is why we are laying out this article.** The drop in overdose deaths in Ohio is consistent in time with the limitation on fentanyl production. [Data from CSFRE](https://www.cfsre.org/nps-discovery/public-alerts/sentinel-snapshot-purity-of-tablets-seized-at-the-us-southwest-border) corroborate that there was a dip in the amount of fentanyl per fake pill seized at the border coincident with the DTO restriction in time. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-61-1.png) [Source](https://www.cfsre.org/nps-discovery/public-alerts/sentinel-snapshot-purity-of-tablets-seized-at-the-us-southwest-border): Fentanyl quantification of pills seized at US-México border Further adding chaos to transnational drug markets, in mid-August 2024 US authorities announced the [dramatic capture](https://www.aljazeera.com/news/2024/8/12/why-are-there-questions-about-arrests-of-mexicos-sinaloa-cartel-leaders#:~:text=Zambada%2C%2076%20and%20Guzman%2C%2038,US%20custody%20for%20drug%20trafficking.) of two senior members of the Sinaloa organization. Unsurprisingly, this action, in September 2024, has led to an entirely predictable internecine conflict between successors [making day to day life less liveable](https://english.elpais.com/international/2024-09-16/life-stops-in-sinaloa-amidst-war-between-el-mayo-and-los-chapitos.html) for the local community. One view of the supply chain is that we would expect to see large impacts from the stop-shipments to show up 6-8 months after interruptions due to the massive amount of fentanyl in the supply chain. We would also expect to see an increase in replacement fentanyl manufacturing, which could be tracked by analyzing chemical signatures in fentanyl. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-101.png) Geographically we would expect to see a bigger impact in border states. The idea of supply "chains" can be misleading: Picking up a package may not be from an adjacent state, of course. There may be a hopscotching of impact that is nearly impossible to fully quantify. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-67-1.png) Impact should be highest and/or immediate in 2 border states. Diffusion to other states by adjacent geography, contingent on trafficking routes. --- ## (5) Depletion of susceptibles ### Assessment: Plausible, but complex. Past exposure to a drug can decrease the present risk of a drug. Think of it like active immunity to a virus – if you’re exposed to the flu, your immune system produces antibodies and you’re less susceptible to catching it again for a while ([paywall](https://ebm.bmj.com/content/23/5/199.long), but great example). In the same way, if you use a certain drug for long enough, you’ve developed tolerance (or practiced techniques to make use safer). This kind of partial ‘immunity-building’ can happen on a population level. And when enough folks have curtailed the risks posed by the drug supply, epi nerds would call it the “[depletion of susceptibles](https://www.sciencedirect.com/science/article/abs/pii/0895435694901708).” Let’s get messy and imagine that we can aggregate every person who (potentially) uses opioids based on their risk (i.e., type, amount, and route of substances used) and tolerance (i.e., physiological and practical adaptation to substances). At a population level, for any year that this aggregated ‘risk-tolerance’ gap grows, overdose is more likely. When the gap shrinks, overdose is less likely. We’re ignoring the ecological fallacy in this thought experiment. Bear with us. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-89.png) [Source](https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates): NIDA The epidemic begins with prescription analgesics like oxycodone, which in the scheme of opioids, aren’t as potent as what is circulating now. Overdose rises steadily between 1999 and 2007 then slows down until stabilizing in 2010\. We can reasonably assume two things in this period: That the market for prescription opioids approaches saturation, and that people who use prescription opioids gradually develops tolerance (in the senses discussed above). Hence, in the mid-2000s, the gap between the ‘sum’ of everyone’s risk and the ‘sum’ of everyone’s tolerance shrinks. Enter heroin, slightly more potent than oxycodone. Heroin overdose rises between 2010 and 2016 then stabilizes. Now the rise is more precipitous, and there are two clear reasons: previous prescription users make the switch and need time to adjust to increased potency (and to learn their new limits, and to learn how to dose a messy, unregulated substance), and opioid-naïve folks (i.e., those using for the first time) are being introduced to a slightly stronger product than if they took prescription pills on their first go. But in time, the population adjusts to heroin. Been there, done that. Again, the risk-tolerance gap shrinks after a few years. This is where things obviously get scary. Fentanyl – orders of magnitude more potent than heroin or most prescription pills – appears around 2014, and unsurprisingly, the rise in overdose is the steepest yet. Same process as above – switchers adjust to increased potency, opioid-naïve folks are introduced to an immensely stronger product at first go. There’s a slight deceleration between 2017 and 2019 (risk-tolerance gap shrinking?) before COVID strikes and throws a wrench in disease models everywhere. (Fentanyl overdose starts slowing again after the worst of the pandemic is over.) Finally, we have the rise in [stimulant and polydrug use](https://onlinelibrary.wiley.com/doi/10.1111/add.16318) (especially [meth/cocaine plus opioids](https://www.npr.org/sections/health-shots/2023/09/14/1199396794/fentanyl-mixed-with-cocaine-or-meth-is-driving-the-4th-wave-of-the-overdose-cris)). This trend starts around the same time as fentanyl but really takes off in 2019\. What happens here? Same same, but different: Folks switching from fentanyl only to fentanyl + stims adjust to a new version of overdose susceptibility, and the opioid-naïve are introduced to an immensely dangerous combination. Add in people-who-used-stimulants-all-along now contending with fentanyl adulteration, and you have a new risk-tolerance gap that needs time to correct. Well perhaps that time is now, and the risk-tolerance gap is at its nadir. Are there any new susceptible populations left? We’ve reached the apex of opioid potency – fentanyl and its analogues – and cleared the additional hurdle of polydrug interactions. People who use these drugs intentionally are used to them. And people use who them unintentionally (e.g., mono meth users) have had several years to figure out what to do avoid adulteration (or have given into the reality that fentanyl is unavoidably part of their repertoire). Risk, meet tolerance. This tolerance peak has been shared anecdotally. People who use fentanyl are reporting that they no longer use to get high but to [stave off withdrawal](https://www.tandfonline.com/doi/abs/10.1080/10826084.2024.2306221) (We hear folks say all the time, ‘You use to stay well’). It feels like the aggregate risk in this epidemic has peaked, and the aggregate tolerance has finally caught up. Supply side, what’s next? Perhaps the cartel are happy with where the market stands – they’ve saturated their audience, demand isn’t going away, and they’ve managed to control the problem of customer attrition (i.e., overdose). Tinker around the edges with cuts to stretch profit, but otherwise let sleeping dogs lie. Hypothetical geographic scope: **Directional**. Slower in states where fentanyl was introduced more recently and tolerance hasn’t caught up to risk ([largely, west of the Mississippi](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7521591/)). Oregon and Washington are good case studies, having the most months in 2023 where [overdose increased](https://www.cdc.gov/overdose-prevention/data-research/facts-stats/dose-dashboard-nonfatal-surveillance-data.html?CDC%5FAAref%5FVal=https://www.cdc.gov/drugoverdose/nonfatal/dose/surveillance/dashboard/index.html#stateInfo) over 2022\. Fentanyl didn’t become prevalent in the PNW until [about](https://adai.washington.edu/WAdata/heroin%5Fversus%5Ffentanyl.htm) [2019](https://www.oregon.gov/oha/ph/preventionwellness/substanceuse/opioids/pages/fentanylfacts.aspx), much later than the rest of the country. Another take on depletion of susceptibles is grim. Chronic pain patients who have had their stable medication doses forcibly reduced are at [greater risk of suicide](https://jamanetwork.com/journals/jamanetworkopen/article-abstract/2795159). Rapid dose reductions of patients who are stable on opioids is [known to increase overdose risk](https://journals.sagepub.com/doi/full/10.1177/08897077231186216), and opioid "de-escalation" measures have [driven](https://www.sciencedirect.com/science/article/abs/pii/S1526590023006144) many formerly stable patients to street supply. There is a tragic feeling among pain patient advocates we speak with that their numbers are dwindling directly from suicides. 💔 We don't know if good population level data exist to link this directly to the changes in overdose we are seeing, but depletion of susceptibles through aggressive de-prescribing is worth more thought. --- ## (6) Marijuana legalization ### Assessment: Highly unlikely without stronger evidence. On an individual level it seems intuitive that marijuana legalization may offer some people who use opioids an alternative. "Why can't they just smoke weed?" is something that gets naively thrown around. At the level of population statistics, that association gets tenuous. The relationship between cannabis legalization and opioid overdose has been studied [over](https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2676997) and [over](https://link.springer.com/article/10.1186/s40621-019-0213-z) and [over](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2017.304059) and [over](https://academic.oup.com/aje/advance-article-abstract/doi/10.1093/aje/kwae210/7716347) and [over](https://jamanetwork.com/journals/jama-health-forum/fullarticle/2813866) and [over](https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/1898878) and [over](https://www.sciencedirect.com/science/article/abs/pii/S0955395921003546) and [over](https://www.sciencedirect.com/science/article/abs/pii/S016762962300005X) and [over](https://www.sciencedirect.com/science/article/pii/S0277953623000357) again, but let's just say that the relationship at a population level is [hard to see](https://www.pnas.org/doi/abs/10.1073/pnas.1903434116). Regardless, the reduction in overdoses doesn't seem to follow the geographic pattern. We saw reductions in overdose the South fairly early, which has no legal marijuana, but has plenty of Delta-8 dispensaries. Still, there isn't a strong temporal connection either. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-62.png) [Source](https://en.wikipedia.org/wiki/Legality%5Fof%5Fcannabis%5Fby%5FU.S.%5Fjurisdiction): Where is weed "legal"? Lots of maps with nuance out there. Here's one. --- ## (7) Xylazine ### Assessment: Whoa, really? Carl Sagan said: "Extraordinary claims require extraordinary evidence..." (which we don't have, ha!) This is the most provocative of hypotheses, one that has had lots of resonance with people who have *actually used fentanyl-xylazine.* And wholly surprisingly, it was dismissed out of hand by much of the medical establishment. **This is the only hypothesis that shows a strong east-to-west geographic spread.** Colin writes: The recent drops in OD deaths are absolutely amazing and fill me with hope. However, it is dangerous to ascribe this huge success wrongly. When looking at how the recent decreases in ODs spread across the lower 48 starting in the Eastern US and spreading Westward, many explanations that people are suggesting are responsible for this drop in deaths don’t fit, but one that I have heard from a whole lot of drug users, follows the East to West movement, and makes a lot of sense is this: **Xylazine has had some unexpected benefits**. Now don’t get me wrong, xylazine has some terrible effects on the human body that I wouldn’t wish on anyone. That said, what we have discovered about xylazine binding to the Kappa opioid receptors combined with the general consensus of drug users being that it seems to make the dope last longer point towards xylazine *lowering the number of times one uses a drug in a day*; this combined with what I assume is a lowered risk of OD from dope that is less fentanyl/analogues/nitazines/whatever, with those drugs in part being replaced with xylazine, which I’m guessing has a lower fatal OD risk profile than the aforementioned synthetic opioids. ([Supported by clinical study](https://www.tandfonline.com/doi/abs/10.1080/15563650.2022.2159427).) Less rolls of the loaded dice. On top of this is another, often unmentioned positive result of xylazine contamination – the horrible wounds thought to be the cause of injecting **xylazine are pushing PWID to utilize different routes of administration (ROA) like snorting,** smoking, and booty bumping. In some cases it might even cause folks to stop completely. While overdose is still very possible with these ROA, it is less so than with IV use – it’s easier to titrate up and such with other ROA vs IV use. But this adjustment period takes time. Once xylazine appears in the drug supply locally, people will continue to use, and experience the agitation and anxiety that comes from withdrawal due to an irregular supply. The increased chaos that folks are experiencing in places where xylazine is less than a year at less than 10% penetration may be coming from this initial period. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-103.png) Hypothetically speaking... "In 2024, 36 percent of fentanyl powder samples and nearly 6 percent of fentanyl pills are adulterated with xylazine" ([source](https://www.whitehouse.gov/wp-content/uploads/2024/08/ONDCP-2024-FAAX-Implementation-Report.pdf)). Different places reached a certain xylazine threshold, say 10% of fentanyl, at slightly different times. This hypothesis should be able to be tested using drug sample data. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-102.png) Xylazine spreading east-to-west, like the declines in overdose Among [drug seizures](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10473811/) (2018-22): ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-39.png) And here's our data for 2023 through August 31, 2024. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Artboard-1@3x.png) UNC Street Drug Analysis Lab samples, through Aug 2024\. Xylazine in primary abundance. Percents linearly interpolated. Okay, there are a lot of "but..." retorts here. Clearly, too much xylazine in dope can be destabilizing (see: Philadelphia), and there cannot be an assumption of linear benefit. Benzo dope has been around in the PNW for awhile and operates somewhat like xylazine in its role in the street supply. Ohio proudly scheduled xylazine to CIII in [March 2023](https://www.pharmacy.ohio.gov/documents/compliance/lawenforcement/csrules/8-factor%20anlaysis%20-%20xylazine.pdf), shortly before the overdoses started dropping . Just pointing this out... either scheduling had zero impact, or it flies in the face of this hypothesis. This hypothesis fascinates us because is this a market-driven example of "safe" supply? Clumsy, not optimized, and bad side effects! It kind of feels like ethanol in gasoline: It reduces the immediate consequences but doesn't change underlying demand. But it may be meeting an underappreciated market demand – an opioid that prevents withdrawal but doesn't cause a strong high (and isn't locked up behind clinical and regulatory gatekeepers). --- ## (8) Transition to smoking & price ### Assessment: Plausible, but why the sudden timing? We discussed ROA in the xylazine section, as an accelerant to reducing injection. Again, less rolls of the loaded dice. Less exposure to fentanyl per drug use episode. And there's a physical limit to how much you can smoke. Both studies below start with OD deaths and look back at xylazine. But this approach, albeit useful, completely misses folks using other routes who don't die. [Routes of Drug Use Among Drug Overdose Deaths ...This report describes different routes of drug use observed in drug overdose deaths.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-1.png)Centers for Disease Control and PreventionCDCMMWR![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/mm7306a2_Routes-Drug-Use_IMAGE_15FEB2024_1200x675_v2.png)](https://www.cdc.gov/mmwr/volumes/73/wr/mm7306a2.htm) [Smoking is the number one consumption mode tied to B.C.’s overdose deaths. Here’s whyShift from injection drug use to smoking occurred in 2017![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/at.png)Vancouver Is AwesomeMike Howell![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/smokeone.JPG;w=1200;h=800;mode=crop)](https://www.vancouverisawesome.com/local-news/why-smoking-drugs-is-now-number-one-consumption-mode-connected-to-bcs-overdose-deaths-vancouver-fentanyl-5078020) There’s another unexpected cause of the drop in OD deaths which also has to do with drug markets – the rapid drop in the cost of drugs in the last couple of years combined with increased availability of drugs. I have a number of folks that I speak to regularly about drug prices across the country and everyone has said the same thing over the past few years – drugs are getting cheaper and cheaper across the board. To give some examples, here in North Carolina, the price of meth has gone from around $80-$120/gram to $20-$40/gram, fentanyl has gone from $100-$140/gram to $50-$80/gram, and so on. Quality has gone up as well, although this began prior to the price drop that we’ve seen in the past couple of years. This is important for a number of reasons. First off, if drug prices have been dropping for the past couple of years, any suggestion that drops in OD deaths have anything to do with interdiction efforts or the drug supply being significantly affected to where we see hundreds of thousands of people stopping use are not based in facts. If the drug supply is affected in such a way, it would almost certainly cause a rise in drug prices, where we have seen just the opposite. Second, it meshes well with research that has shown us that the removal of opioids from an person who is opioid dependent (i.e. going to jail, detoxing, etc.) increases the likelihood of overdose by quite a bit (Hartung, et al., 2023; Heimer et al., 2024). If when opioids are not used by a person who is opioid-dependent, whether due to treatment, jail, or supposed drug shortages, we would expect OD to potentially rise, not drop, especially if the shortages of drugs were such that a fifth of opioid users just up and quit. Another piece of this is that when opioids are more affordable, less people using them come up short of their habit, resulting in oscillating between getting dopesick and getting well, which is another example of something that lowers tolerance, just like treatment or jail, therein raising OD risk. I argue that cheaper durgs have resulted in more people not going into withdrawl as often due to not having enough money to get well. --- # Other Voices Of course, we had to ask our favorite people at Remedy Alliance, Maya and Eliza, to weigh in. > Hmmm 🤔 it could be so many things and it seems so local and dependent on the drug supply (IMHO). For us, the drugs are absolute garbage shit, like so bad people think there’s naloxone in it. So it would track that less people are od’ing (what would they od on?) but we also saw this same thing happen in 2010-2011 when the heroin was at about 3% “purity” and it was such garbage that we had TEN heroin-involved overdose deaths in a year. But what we did have was a steep rise in other drug related deaths because people were desperately trying to not be sick and survive. And then in 2012 we got an influx of strong stuff and people started dropping. So I feel like it’s sort of an ominous dip because the drugs suck. But that’s just my thoughts. - Eliza Wheeler talking about the Bay Area > Just becasue people aren't dying from ODs doesn't mean that things aren't really terrible for PWUD right now. For those still alive, one could actually make the case that things are worse than ever. -Maya Doe-Simkins We'll leave it on that note. Some things to be happy about, many new questions --- ## Get more like this Sign up for a \~monthly newsletter where we share our expeiences and observations and data. We are a public service of the University of North Carolina at Chapel Hill. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### [LA Times] An industrial chemical is showing up in fentanyl in the U.S., troubling scientists URL: https://www.opioiddata.org/la-times-an-industrial-chemical-is-showing-up-in-fentanyl-in-the-u-s-troubling-scientists/ Last updated: 2024-09-18T14:31:04.000Z [An industrial chemical is showing up in fentanyl in the U.S., troubling scientistsAn industrial chemical used in plastic products has been cropping up in illegal drugs from California to Maine.![](https://www.latimes.com/apple-touch-icon.png)Los Angeles TimesEmily Alpert Reyes![](https://ca-times.brightspotcdn.com/dims4/default/b944f9d/2147483647/strip/true/crop/6720x3528+0+476/resize/1200x630!/quality/75/?url=https%3A%2F%2Fcalifornia-times-brightspot.s3.amazonaws.com%2Fac%2F1d%2Fee41579744ad8e46a2b089aebb71%2F1272911-me-0323-drug-checking-gem-001.jpg)](https://www.latimes.com/california/story/2024-09-16/an-industrial-chemical-is-being-mixed-with-fentanyl) By [Emily Alpert Reyes](https://www.latimes.com/people/emily-alpert-reyes) **"Dasgupta said the detection of BTMPS represents the first example of the burgeoning network of drug checking programs working together to find a substance “before any health authorities or any law enforcement did.”** Godvin said that “just a few years ago, we wouldn’t have even known about this” and [urged Angelenos](https://www.instagram.com/p/C-3fa4hy928/) to get drugs analyzed through Drug Checking Los Angeles if they are able." Links to our [live data report](https://www.opioiddata.org/mystery-substance-summer-2024/). ### The Solution is Painfully Obvious; Getting there? Not so much… URL: https://www.opioiddata.org/the-solution-is-painfully-obvious-getting-there-not-so-much/ Last updated: 2024-09-12T17:17:42.000Z The work many of us have committed our lives to can often cut deep in myriad ways, especially for those of us whose relationship to substances has created trauma and difficulties in our lives. I’ve realized for me that the part that’s the hardest to deal with, the element that continues to pour salt over wounds that are the essence of my suffering, is the constant pressure that many of us feel (and most certainly those we work alongside and for feel) from a society that has decided to criminalize, ostracize, and pathologize us and our humanity. I was a child when I first can recall getting the message from adults in my life – teachers, family, whoever – that I was not okay. That I had to change myself and rebel against the things that made me feel alive, better, seen, heard – that my humanity made others uncomfortable, that I had to change. “Fake it ‘til you make it!” “Your disease is outside doing pushups!” or “You can’t trust your thinking - your mind is the problem” or the two absolute worst things you could ever say to someone who has endured significant trauma, “You have to realize that you are powerless” and “What role did you play?” It has taken me the better part of my 42 years on this planet, having navigated the systems that told me that my “brain needs some washing”, to accept myself as I am, to be honest about my needs, and to know deep down that I am worthy of Love. It has been the combination of lived experience, a deeper understanding of disability rights, and learning more about what is actually evidence-based, that has pointed me firmly towards what I have always known the solution to be deep down: it is our society, our systems, and most importantly, the ideas we all carry that would have us look upon a struggling, deeply hurt person and see someone who “can’t stop partying” rather than someone who has done their best to deal that realities that many of us could never comprehend without experiencing them ourselves. My entire life has been wrapped up in trying to help those who are dealing with situations that I have lived myself. I feel their pain. I couldn’t begin to guess what works for them, and I would never doubt what they say works for them. At the heart of the question of how we will ever be able to slow the deaths of the 100,000+ mothers, daughters, fathers, sons, uncles, aunts, friends, lovers, and human beings that we are losing too soon to overdose, is this: will we collectively be able to first acknowledge, and then move towards the reality that a human life should never be sacrificed because of our own discomfort with drugs? Due to or own our inability to recognize that we are allowing thousands to die because of our own willingness to accept and lean in to the stereotyping, pathologizing, and cruel treatment of those of us who find drugs of varying kinds necessary to live a happy life, to recognize their own humanity, and to realize that all of us are worthy and deserving of *Love*, of understanding, and of community? Either way, I’m front lines until I’m in the ground – **I hope to see more of you alongside us*.* ### Stigma and Language Change: The Problem with Low Hanging Fruit URL: https://www.opioiddata.org/stigma-and-language-change-the-problem-with-low-hanging-fruit/ Last updated: 2024-09-11T20:32:15.000Z Stop me if you’ve seen this before. You’re browsing the web for the latest harm reduction best practices and come across an infographic from a federal agency or county health department. The title is something like “Using Person-First Language” or “How Your Vocabulary Can Make A Difference.” There’s a bulleted list of words you should and shouldn’t use (“Instead of ‘drug user,’ try ‘person who uses drugs’”). You forward the infographic to your social media intern, who posts it on Facebook. Engagement is strong – a couple dozen likes, a few comments thanking you for the insight. This is stigma reduction in the modern age – but is it enough? Indulge me with ten minutes of your time to explain how we’re missing the forest for the trees. Or in this case, the tree for the apples. A metaphor! I’ll come back to that. But first, let’s jump in our proverbial time machine and travel back to Mrs. Walker’s algebra class. Painful memories, I know. Today, we’re learning conditionals. If X, then Y. “IF I stay awake for this entire lecture, THEN I’ll pass this class.” If only it were so easy. In logic, we call this condition (staying awake) NECESSARY but INSUFFICIENT. Sure, we NEED to stay awake to make the grade, but that ain’t gonna cut it alone. We also have to do our homework, participate in discussions, and pass the final exam (Hey, don’t blame me, it’s on the syllabus). Language change is a NECESSARY but INSUFFICIENT condition for ending stigma: We can’t live in a humanizing world where people who use drugs are disparaged with unfair labels, but respectful language simply won’t be enough. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/boolean.png) Source: Wikipedia If you grew up in the South like me, you’re probably familiar with the phrase “Bless your heart.” If you grew up somewhere else, allow me to clarify: “Bless your heart” is not how we sympathize, it’s how we condescend. We smile and say, “Bless your heart,” but what we really mean is “Oh you poor, miserable fool.” So let’s agree there can be a gap between the words we use and how we think and act. (If you’re a linguistics wonk, look up the debunking of the Sapir-Whorf hypothesis.) Then it’s reasonable to conclude that even if we had all the resources in the world to change the language of substance use, there’ll still be a huge swath of folks who use the right terminology but still hold prejudicial attitudes under the surface (“Those *people who use drugs*…bless their hearts.”). Teach a man to say ‘fish’… Okay, okay, so language change isn’t a panacea. But what’s the harm? At least we’re doing *something*. Let me present my low hanging fruit hypothesis. In stigma reduction, language change is the lowest hanging fruit on the tree. We hand out flyers that read, “Use these words, not those words.” We put up billboards that say, “She’s more than her drug use, she’s someone’s daughter.” We start an “End the stigma” campaign website. Few resources, wide reach. Stigma, begone! How about them apples? Well, two problems. I’ll call them the mealy fruit problem and the poisoned fruit problem. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-15.png) Photo by [Doriana Dream](https://unsplash.com/@dorianadream?utm%5Fcontent=creditCopyText&utm%5Fmedium=referral&utm%5Fsource=unsplash) on [Unsplash](https://unsplash.com/photos/selective-focus-photography-of-green-grape-qSfbOJOwXjE?utm%5Fcontent=creditCopyText&utm%5Fmedium=referral&utm%5Fsource=unsplash) *The mealy fruit problem*: In ending overdose, let’s face it, stigma gets deprioritized. Most resources go toward improving treatment and harm reduction access and delivery. So we pick the simplest stigma intervention (language change) even if it’s mealy, full of worms, and less ripe than the fruit at the top of the tree. It’s not palatable, but it’s something. We wipe our hands and check stigma reduction off our list. And hey, it’s important to prioritize improving the services we deliver. But I’d argue that stigma reduction is just as important. Stigma discourages people from seeking help, rendering harm reduction and treatment innovations moot. Stigma reduces equitable access to housing and employment, trapping people in the vicious cycle of use. Oh, and stigma may directly increase overdose risk. We need to reach for higher fruit, even if it means investing in a taller ladder. *The poisoned fruit problem*: There’s an apple tree in the language change orchard that looks *great*. Even the farmers say its fruit is delicious! We feast until our bellies are full. But a few days later, cramps set in. Then fever. The apples were poisoned, and now we feel worse than when we started. It turns out that language change can backfire, influencing attitudes and beliefs in the *wrong* direction! (Pat Corrigan writes all about it in “The Stigma Effect: Unintended Consequences of Language Change.) A prescient example is the disease frame of substance use disorders. If we call SUD a disease, the public may indeed feel more sympathetic toward people who use drugs. At the same time, the public is likelier to believe that people who use drugs lack control, increasing perceptions of dangerousness and desire for social distance. Research also shows that telling people how to be less prejudicial can actually make them *more* prejudicial. Scientists call this reactance: Messages may threaten an individual’s sense of autonomy and cause them to double down on their preconceived notions. And we just don’t have enough research in the area of substance use stigma to know whether this is happening. The problem in this poisoned fruit scenario is that, by the time we realize the fruits are poisoned, everyone’s gone home with a basket. In summary, language change is usually good and sometimes bad, but never enough. So what *should* we do? Beyond educating the public, I see two priorities, one bottom-up and one top-down. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-16.png) Photo by [Alexander Grey](https://unsplash.com/@sharonmccutcheon?utm%5Fcontent=creditCopyText&utm%5Fmedium=referral&utm%5Fsource=unsplash) on [Unsplash](https://unsplash.com/photos/girl-standing-near-plants-wx3JOq0Xbh4?utm%5Fcontent=creditCopyText&utm%5Fmedium=referral&utm%5Fsource=unsplash) Let’s start with the on-the-ground solution. Try as we might, we will never completely erase the stigma of substance use. There are simply too many people to educate. Besides, attitudes are incredibly resistant to change. But what if we gave people who use drugs the tools to resist stigma? Research shows that certain psychotherapeutic approaches like Acceptance and Commitment Therapy can give folks the cognitive and emotional toolkit to feel less ashamed and more empowered to push through stigma. Absent resources, even a couple daily supportive text messages may be enough to move the needle, as we’ve shown in a recent pilot study (manuscript forthcoming). No, it’s not the responsibility of the marginalized to be resilient to injustice. But, until we can solve these giant social issues, every little bit helps. Which leads to the top-down solution: Policy change. And specifically, civil rights protections for people who use drugs. Folks with SUDs get the short end of the stick when it comes to civil protections. Substance use is accommodated in the Americans with Disabilities Act, but protections are *much* weaker as compared with physical disabilities and other mental health challenges. In fact, current use of unregulated substances – whether or not it impacts work performance, and whether or not the use is labeled as dependence – remains legal grounds for discrimination. And there’s no wiggle room there. In the ten years following the ADA’s 2008 expansion, federal courts sided with plaintiffs with SUDs only *once* in 26 cases of employment discrimination. Punitive and prejudicial policies in employment, housing, education, and healthcare reinforce the message that substance use is an immoral and socially destructive act, and that people who use drugs deserve punishment, not support. It’s no surprise that substance use stigma remains higher than other conditions, like mental illness and HIV/AIDS, that have won more legal protections in the past three decades. So long as prejudice and discrimination against people who use drugs remain legally sanctioned, they’ll flourish in the social realm, too. Heavy news, I know. But be hopeful: We know to pick the riper fruit, we only need a taller ladder. Take that first step today: Tell a person who uses drugs that they *are* enough and they *do* deserve better. Then call your elected representatives and give them your best Howard Beale: “I’m mad as hell, and I’m not gonna take this anymore.” ### Lab Technician Summit 2024 URL: https://www.opioiddata.org/lab-technician-summit-2024-2/ Last updated: 2024-12-22T22:48:45.000Z ## Advancing Drug Checking Practices On June 5-6, 2024, laboratory technicians and researchers from across North America gathered at the University of North Carolina at Chapel Hill for a groundbreaking summit on laboratory-based drug checking practices. The event, supported by NACCHO, and co-hosted by Remedy Alliance, brought together experts from various institutions to discuss current operations, challenges, and future collaborations in laboratory drug checking. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_5082.jpeg) Group activity showing things we are thankful for. 🙏🏾NACCHO for bringing us together! ## Key Takeaways 1. **Diverse Approaches**: Participants shared their varying methods for sample collection, preparation, and analysis. Technologies ranged from high-resolution GCMS to LCMS to DART-MS to QTOF to FTIR, showcasing the range of tools available for drug checking currently. 2. **Standardization Efforts**: A major focus was on standardizing practices across labs. Discussions covered quantitative vs. qualitative analysis, data designations (major/minor/trace), and the use of reference standards. Standardization for data and interpretation were also discussed. 3. **Data Sharing and Privacy**: Attendees addressed the complexities of data collection and sharing, emphasizing the need for transparency with harm reduction partners and protecting privacy. 4. **Funding Challenges**: Labs reported relying on a mix of government grants, fee-for-service models, and donations. Sustainable, long-term funding remains a critical need. 5. **Legal Considerations**: The group discussed the legal grey areas of drug checking, highlighting the need for policy changes to protect both service providers and users. 6. **New Technologies**: Evaluation of emerging handheld devices was a hot topic, with emphasis on rigorous testing before field deployment. 7. **Advocacy Role**: Participants debated the role of laboratory drug checkers in influencing drug policy, recognizing the need for education and collaboration with existing advocacy groups. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_5017.jpeg) Lab tour with Dr. Brandie Erhmann ## Looking Ahead The summit concluded with plans for continued collaboration, including: - Regular virtual meetings to discuss new compound identifications - Development of best practice guidelines and educational resources - Exploration of a shared website or Slack channel for ongoing communication - Potential for a follow-up summit in 2025 This gathering marks a significant step forward in the field of drug checking, fostering a community of practice that aims to enhance harm reduction efforts and save lives in the face of an ever-changing drug supply landscape. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_5021.jpeg) Group exercise mapping who uses the lab data # Lab Organizations Represented at the Lab Technician Summit 2024 1. **University of North Carolina (UNC) at Chapel Hill** - Host of the summit - Operates a drug checking lab with 160 sites across 34 states 2. **Toronto Drug Checking Service** - Operates 6 safe consumption sites (with 5 more planned) - Uses multiple collection sites including CAMH and St. Mike's Hospital 3. **University of California, San Francisco (UCSF)** - Previously supported community-based drug checking program - Working with EBDC and planning to support programs in California 4. **National Institute of Standards and Technology (NIST)** - Federal agency involved in drug checking, mail-based collection - Uses DART-MS and LC-QTOF for analysis 5. **Center for Forensic Science Research & Education (CFSRE)** - Analyzes about 2000 samples/year from across the US, multi-instrument capabilities - Major resource for drug information. 6. **California Department of Public Health (CDPH)** - State public health laboratory involved in drug checking - Newer on solid drug samples but enthusiastic 7. **DC Department of Forensic Sciences** - Supports randomized drug submissions from harm reduction partners - Syringe residue and other materials available 8. **Massachusetts Drug Supply Data Stream (MADDS)** - Covers 15 sites across Massachusetts and New England - Provides training and custom software, thought leadership 9. **DrugsData (Erowid Center)** - Accepts samples by mail from across the country - Longest running drug checking program in North America 10. **Connecticut State Public Health Laboratory** - Operates 3 active sites with 2 more coming online 1. **University of Notre Dame** - Analyzes trace residue from test strips and baggies; develops test strip technology - Starting to support community drug checking locally 1. **Rhode Island Hospital Toxicology Lab** - Works with community partners to analyze drug samples via LCMS - Also receives blood and hospital samples 1. **Colby College** - Supports Maine Health and trains students in the field - Lab for Maine drug checking ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_5083.jpeg) More things that make us glad. These organizations represent a mix of academic institutions, public health laboratories, forensic science centers, and community-based programs, all contributing to the field of drug checking and harm reduction. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_5078.jpeg) Things that make us sad/mad And here are the individuals who made the trip to Chapel Hill. 1. Erin Tracy 2. Nab Dasgupta 3. Adina Badea 4. Joshua DeBord 5. Alex Krotulski 6. Meera Bissram 7. Elise Pyfrom 8. Meghan Appley 9. Hirudini Fernando 10. Sne Parikh 11. Na Li 12. John Halifax 13. Sylvia Thyssen 14. Cole Altomare-Jarczyk 15. Das Thamattoor 16. Savannah Fay 17. Clare Schmidt 18. Julie Karr ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_5057.jpeg) Exercise mapping out needs of each service user ### 📖 Reading Room Sept 2024 URL: https://www.opioiddata.org/reading-room-sept-2024/ Last updated: 2024-09-11T02:49:27.000Z *Excerpt from the September 2024 newsletter.* - Secret Shoppers: [Evidence-based treatment for opioid use disorder is widely unavailable and often discouraged by providers of residential substance use services in North Carolina](https://www.sciencedirect.com/science/article/pii/S2949875924001863) \[Carroll et al., open access, [press release](https://news.ncsu.edu/2024/08/nc-opioid-treatment-providers/)\] - [Is "surveillance" a bad word?](https://www.opioiddata.org/is-surveillance-a-bad-word/) \[Morabia et al., open access\] - Great discussion on [naloxone pricing in North Carolina](https://www.wral.com/story/naloxone-distribution-efforts-help-fight-opioid-crisis-in-nc/21600947/) and the importance of IM naloxone, featuring CDC Director Mandy Cohen and NC AG Josh Stein at a kit making event in Raleigh \[WRAL Grace Hayba\] - [Secret Shoppers: $96 for Narcan® in NC Pharmacies](https://www.opioiddata.org/96-for-narcan-in-nc-pharmacies-2/) \[Marley et al., open access\] - [Drug Mention with Involvement (DMI) and Polydrug Poisoning Classification Methodology Tool (DMI2EpiTool)](https://cph.uky.edu/research/projects/DMI2EpiTool) \[Slavova et al., open access software\] - This is a great new tool developed by our friends at the Univ. of Kentucky that 1) identifies drugs involved from literal text of death certificates, and 2) classifies them as polysubstance or not. This is a much-anticipated update that runs as a SAS file, and will be invaluable for state health officials. \[Funded by US FDA\] ### Uncovered: 1970s BTMPS tox studies URL: https://www.opioiddata.org/btmps-toxicity-foia/ Last updated: 2024-09-11T13:04:09.000Z Over the summer we filed a Freedom of Information Request with the US Food and Drug Administration to obtain the toxicology studies filed by the manufacturer of Tinuvin® 770 in order to get it approved to be an additive in adhesives and pharmaceutical-grade plastics. Most of the documents are from 1975-76. We received the tranche of documents on September 10, 2024\. While almost all are animal studies, *there is way more information than in the academic literature*. (Which is why we always caution against drawing inferences from what little leaks from industry to scientific journals.) We are posting all the documents we received here without comment so our community can learn from them. --- ## Summary of Safety This is the Summary of Safety information submitted by the manufacturer in 1976\. These tables summarize the the studies in PDFs that follow. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-11.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-12.png) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-13.png) ## Cardiac Tissue This was as a surprising conclusion to me: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-14.png) [DATA SUMMARY\_000789\_RedactedCardiac tissue studies (guinea pig)DATA SUMMARY\_000789\_Redacted.pdf191 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/DATA-SUMMARY%5F000789%5FRedacted.pdf "Download") [DATA SUMMARY\_000791\_Redacted3H binding to heart membranes (guinea pig)DATA SUMMARY\_000791\_Redacted.pdf189 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/DATA-SUMMARY%5F000791%5FRedacted.pdf "Download") [DATA SUMMARY\_000793\_RedactedForce of contraction of atria (guinea pig)DATA SUMMARY\_000793\_Redacted.pdf155 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/DATA-SUMMARY%5F000793%5FRedacted.pdf "Download") [DATA SUMMARY\_000795\_RedactedVascular effects on mesenteric artery (rat)DATA SUMMARY\_000795\_Redacted.pdf167 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/DATA-SUMMARY%5F000795%5FRedacted.pdf "Download") --- # Specific Toxicity Studies ## Acute Oral Toxicity to Rats [PRIMARY DATA\_000018\_RedactedAcute Oral Toxicity to RatsPRIMARY DATA\_000018\_Redacted.pdf306 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000018%5FRedacted.pdf "Download") ## Acute Dermal LD50 in Rat [PRIMARY DATA\_000024\_RedactedPRIMARY DATA\_000024\_Redacted.pdf232 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000024%5FRedacted.pdf "Download") ## Acute Dust Inhalation Toxicity and Acute Vapor Inhalation Toxicity Society [PRIMARY DATA\_000027\_RedactedInhalationPRIMARY DATA\_000027\_Redacted.pdf353 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000027%5FRedacted.pdf "Download") ## Acute Vapor Inhalation Toxicity in Albino Rats [PRIMARY DATA\_000034\_RedactedPRIMARY DATA\_000034\_Redacted.pdf237 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000034%5FRedacted.pdf "Download") ## Acute Dust Toxicity [PRIMARY DATA\_000039\_RedactedPRIMARY DATA\_000039\_Redacted.pdf302 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000039%5FRedacted.pdf "Download") [PRIMARY DATA\_000050\_RedactedPRIMARY DATA\_000050\_Redacted.pdf302 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000050%5FRedacted.pdf "Download") ## Acute Vapor Inhalation Toxicity [PRIMARY DATA\_000045\_RedactedPRIMARY DATA\_000045\_Redacted.pdf236 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000045%5FRedacted.pdf "Download") [PRIMARY DATA\_000056\_RedactedPRIMARY DATA\_000056\_Redacted.pdf227 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000056%5FRedacted.pdf "Download") ## Skin Irritation, Sensitization, Phototoxicity [PRIMARY DATA\_000060\_RedactedSkin irritationPRIMARY DATA\_000060\_Redacted.pdf653 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000060%5FRedacted.pdf "Download") [PRIMARY DATA\_000083\_RedactedSkin sensitizationPRIMARY DATA\_000083\_Redacted.pdf887 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000083%5FRedacted.pdf "Download") [PRIMARY DATA\_000121\_RedactedSkin phototoxicityPRIMARY DATA\_000121\_Redacted.pdf704 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000121%5FRedacted.pdf "Download") [PRIMARY DATA\_000130\_RedactedSkin photoallergenicityPRIMARY DATA\_000130\_Redacted.pdf561 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000130%5FRedacted.pdf "Download") ## Acute Eye Irritation [PRIMARY DATA\_000070\_RedactedEye irritationPRIMARY DATA\_000070\_Redacted.pdf829 KBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000070%5FRedacted.pdf "Download") ## Human Skin "Repeated Insult" [PRIMARY DATA\_000097\_RedactedSkin insultPRIMARY DATA\_000097\_Redacted.pdf1 MBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000097%5FRedacted.pdf "Download") ## Salmonella/Mammalian Mutagenicity [PRIMARY DATA\_000139\_RedactedMutagenicityPRIMARY DATA\_000139\_Redacted.pdf1 MBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000139%5FRedacted.pdf "Download") ## Dietary Toxicity [PRIMARY DATA\_000624\_Redacted90 Day dietary toxicity in dogsPRIMARY DATA\_000624\_Redacted.pdf17 MBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000624%5FRedacted.pdf "Download") [PRIMARY DATA\_000817\_RedactedOral toxicity in ratsPRIMARY DATA\_000817\_Redacted.pdf2 MBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PRIMARY-DATA%5F000817%5FRedacted.pdf "Download") --- # FDA Review as Food Adhesive Review of studies by FDA in August 1998 for the use of Tinuvin® 770 as an adhesive for food. [PDER\_000872\_RedactedFDA Review 1998PDER\_000872\_Redacted.pdf9 MBdownload-circle](https://www.opioiddata.org/content/files/2024/09/PDER%5F000872%5FRedacted.pdf "Download") ### Our Goal: Empowering Communities URL: https://www.opioiddata.org/our-goal-empowering-communities/ Last updated: 2024-09-12T00:39:00.000Z Street drug checking is a crucial harm reduction tool, offering individuals and communities the knowledge they need to navigate the ever changing drug landscape. With the rise in drug contamination and unpredictable potency, the ability to verify the contents of substances is not just beneficial—it’s lifesaving. Street drug checking provides immediate, actionable information that helps individuals make informed choices, reducing the likelihood of overdose and other harmful effects. By promoting *transparency* and awareness, it plays a key role in public health, giving people the power to protect themselves and those around them. At the UNC Street Drug Analysis Lab, our primary focus is on empowering communities to answer their own questions about the drugs present in their environments. We’re here to serve as a resource, offering the tools and support necessary for individuals and communities to take control of their safety. While it’s heartening to hear about how our services are being used, our mission goes beyond that—it’s about ensuring that people have the knowledge and resources they need to protect themselves and their loved ones. This work is for the individuals and their communities, fostering a sense of autonomy, safety, and trust in the information they receive. Our goal is to be a partner in harm reduction, helping to build safer, more informed communities. Best, Illyana Massey, Community Liaison❤️ ### Hear Our Take 🎧 URL: https://www.opioiddata.org/podcasts/ Last updated: 2024-10-03T20:50:32.000Z August 2024 [Episode 87: Drug Testing Equals Empowerment with Dr. Nabarun Dasgupta and Charlton Roverson — NarcoticaNarcotica is a podcast giving you the straight dope about drugs and the people who use them.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-narcotica-logo-itunes-.jpg)NarcoticaNarcotica![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/NARCOTICA-defaijhghff.jpg)](https://narcocast.com/episode-87-drug-testing-equals-empowerment-with-dr-nabarun-dasgupta-and-charlton-roverson/) July 2024 [Just Increasing Access to Drug-Checking Services – Forensic Technology Center of Excellence![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-favcon-ftcoe-270x270.png)Forensic Technology Center of Excellence - A program of the National Institute of Justice LogoErica Christensen![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/1920x300px_Tox_Stat_Series_v2-744x300.jpg)](https://forensiccoe.org/podcast-2024-cossup-ep4/) January 2024 [Why Fentanyl is Suddenly Everywhere with Dr. Nabarun DasguptaWhile the rise of fentanyl may seem like it emerged out of nowhere, it has a long and complicated history dating back hundred years. The pharmaceutical industry![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-180.png)Apple Podcasts![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/1200x630wp-60.jpg)](https://podcasts.apple.com/fr/podcast/why-fentanyl-is-suddenly-everywhere-with-dr-nabarun/id1463460577?i=1000640407312) ### Lights, Camera...Action Decision Log URL: https://www.opioiddata.org/lights-camera-action-decision-log/ Last updated: 2024-09-11T14:13:35.000Z *Keeping up with action items and final decisions throughout the lifecycle of a project can be HARD! Sometimes, it involves searching through pages and pages of meeting notes and emails.* *An action & decision log can help keep this information in one place.* *While the template can vary, I tend to prefer an Excel workbook with two sheets (one for actions and one for decisions). The action sheet includes the following column names: date recorded, category, project, action, responsible individual(s), status, due dates, date completed and comments. The decision sheet includes the following column names: date recorded, date of decision, category, project (if applicable), decision and comments. The benefits include providing transparency to existing team members and providing historical (and current) information to new team members. Individual team members should review, add, and update their open action items weekly. Collectively, the team should review open items monthly. This review offers the opportunity to discuss any "stale" open actions and to close any completed actions. The team can capture any recent final decisions as well (can recorded on an ongoing basis).* *Let us know if you have any feedback on this method or any suggestions for keeping up with actions and decisions throughout the lifecycle of the project.* *Sincerely,* Natalie Sutton, Program Manager ### How to use the Kit Request System URL: https://www.opioiddata.org/how-to-use-the-kit-request-system/ Last updated: 2025-09-22T22:35:28.000Z 0:00 /3:15 1× **To Access the Jira Service Portal** - Type *streetsafe.supply* in the website bar - *Click on the page to “Request kits” on the streetsafe.supply website* - *On that page, click on the link to “Request kits” on the streetsafe.supply website* - *Select “I need more kits”* - *You should be routed to the Jira portal (currently UNC Drug Checking Lab)* **Kit Requests** - *For kit requests, select the *Kit Requests* box (Request kits for existing customers)* - For existing customers, select the **Kit Request** link - In the **Program Name** field, enter the program name - Example: *ABC Safe Supply* - In the **Number of Kits Requested** field, enter the number of kits that are being requested - Example: *25* - In the **Address** field, enter the address for the shipment - In the **City** field, enter the city name for the shipment - In the **State** field, enter the state name for the shipment - In the **Zip Code** field, enter the zip code for the shipment - To add another contact for the request, check the **Add another contact for this request** square - In the **Contact Name** field, enter the contact name for the shipment - In the **Contact Phone** field, enter the contact phone number for the shipment - In the **Contact Email** field, enter the email address for the shipment - In the **Anything else you'd like us to know?** field, enter any additional information that you would like to add about the ticket - Example: *I am requesting 25 kits for program ABC. If possible, send the kits by Friday, June 28, 2024.* - Select the blue **Send** button to submit your request - You should receive an email response within 1-2 business days **General** - *For general inquiries, select the *General* box* - Select **Ask a question** or **Submit a request or incident** - For **Ask a question**: - In the **What is your question or general request?** field, enter your question or request - In the **Description** field, please enter any additional information that you would like to add about the question - Select the blue **Send** button to submit your request - You should receive an email response within 1-2 business days - For **Submit a request or incident**: - In the **Summary** field, please enter a brief summary of your request or incident - In the **What are the details of your request?** field, please enter any additional information that you would like to add about the request or incident - Select the blue **Send** button to submit your request ### Vital Strategies URL: https://www.opioiddata.org/vital-strategies/ Last updated: 2024-09-12T01:25:14.000Z In August 2024, our incredible funders from **Vital Strategies** visited our lab to learn more about the drug checking process. Vital Strategies is dedicated to advancing public health by promoting evidence-based, locally driven policies and practices. Thanks to their generous support, we are able to expand our outreach to underserved communities in North Carolina, particularly those often excluded from *vital* health services. It was a pleasure to showcase our work and share our progress with such passionate advocates. We deeply appreciate their continued support and enjoyed hosting them! [Click here to learn more about Vital Strategies](https://www.vitalstrategies.org/) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_2900-1.jpg) Erin Tracy, chemist showing off the awesome GCMS in action! ### New website, new vision URL: https://www.opioiddata.org/new-website-new-vision/ Last updated: 2024-09-18T06:16:16.000Z # Why we are doing this We built https://streetsafe.supply with a lot of love. But we built it really quickly. Like, in 3 days. (We tried to use RedCap but they negged us.) The site has served us well for 3 years and 7,500 samples. And we love the domain name. **But y’all have asked for more features than we can build with our current setup.** (Like being notified when your samples are ready!) Therefore, we are migrating some content to other platforms so we can dedicate https://streetsafe.supply to just individual results. Did you know https://streetsafe.supply is a squarespace e-commerce site? Each result is technically a $0 product being shown for sale. That is why y’all can’t do geographic searches, filter, etc. Clever in the moment, but also not fully in our control. **We are tired of social media platforms with rules against talking about drugs.** And we are tired of making content that drives revenue for the likes of tech billionaires (🖕🏾Elon Musk). We are intrigued by other social media platforms but remain non-committal. Maybe demure. We like [this vision](https://activitypub.ghost.org/) of interoperability. We needed a modern way to communicate with our programs, participants, but also government folks, funders, scientists. We thought “newsletter, but better.” Tried Substack but again content moderation and platforming Nazis was a turnoff. We chose ghost.io because it feels modern, is super flexible, integrates with our data science tools, looks fly, we will (eventually) host it in our own servers, and they have a legit commitment to free expression. # What we are building We will keep https://streetsafe.supply do not worry!! But will split out functions across different platforms. A huge thanks 💐 to **Vital Strategies** for funding these upgrades! 1. **CMS**: Our team’s dedicated software developer, David, is building us out a custom “content management system” so we store and process card data and lab results more efficiently. And securely. This will be the backbone of our internal data initially. Stage Two will be pull from that to directly display into https://streetsafe.supply so results will be easier to get and search. All the capabilities you asked for and more. 2. **JSM**: We started by having a simple webform to leave a “comment” that acted like a kit request to a shared inbox. It worked well for a long time, but now the request volume is too high and we were missing requests. Jira Service Management allows us to communicate back to programs and get status updates on shipping. It will also host our Community Education materials, which we will be unveiling this Fall. This includes a searchable knowledge base geared towards harm reduction programs. 3. **ghost.io**: In 2021 when we started, we needed to *convince* people about drug checking. Now we are ready to change tone and *show* the benefits. And we also get a lot of questions from folks that we would like to answer with data and links. So the explanatory content from https://streetsafe.supply will migrate here, with the more hands-on technical content for programs we serve over to JSM. 4. **Deepnote**: We have fallen hard in love with this cloud-based Jupyter notebook. This is Python (and R)-based platform let’s us publish our Live Reports. It’s AI-enabled data science bliss. It will also host our new Program Summary reports launching this Fall, where programs can get a daily updated report of their samples. 5. **OpioidData.org**: The original! We keep this for our broader collection of studies with University of Kentucky. It needs a refresh, but as we edge further away from research and towards direct service, we’ll see how it adapts. We do like being able to point to all the other work we are involved in that addresses the many many many things drug checking cannot. # In conclusion… We value communication when it is clear and honest. We believe these tools will help us serve the people we love better. And at the same time keep us accountable to our community. Thanks for your patience as we kick around new ideas and TOGETHER WE CREATE. ### 🪲 Insecticide: acetamiprid URL: https://www.opioiddata.org/insecticide-acetamiprid-2/ Last updated: 2024-09-10T19:39:45.000Z 💡 In late August 2024, FTIR-based drug checking programs in Seattle and New Mexico identified an insecticide in street samples. It has also been reported in the midwest. This is a toxin and should not be in the drug supply. # Our Take On This Insecticides-in-dope is a trope, and doesn't feel inherently unsurprising. But "insecticide" is a marketing label given to a set of commercial chemicals that are pharmacologically diverse. Therefore, we urge us to focus on the specific substance (acetamiprid) and the specific experience of people exposed right now. Machine-based drug checking within harm reduction settings gives us new power. By having more precise and rapid chemical identification, we also have heightened responsibility: Stay calm and be critical/skeptical of any information before you provide to participants. It's naturally tempting to draw connections between the current circumstance and what we shows up on google scholar "insecticide fentanyl" - or linking back to street stories. But these superficial connections have been a routine driver of Drug War moral panic. Let's do better. Right now this is a local concern. If you are seeing it in your area based on drug checking results, you know how best to communicate to your people. **If you don't have access to drug checking equipment** and suspect acetamiprid in your supply, [reach out to us for 5 free kits](https://www.streetsafe.supply/contact) (even if you've previously done you starter 5 in the past, mention this blog post). We got your back, and appreciate y'all for looking out for the people we serve and love. --- # Molecular Identity [AcetamipridAcetamiprid | C10H11ClN4 | CID 213021 - structure, chemical names, physical and chemical properties, classification, patents, literature, biological activities, safety/hazards/toxicity information, supplier lists, and more.![](https://pubchem.ncbi.nlm.nih.gov/pcfe/favicon/apple-touch-icon.png)PubChemPubChem![](https://pubchem.ncbi.nlm.nih.gov/image/imgsrv.fcgi?cid=213021&t=l)](https://pubchem.ncbi.nlm.nih.gov/compound/213021) --- # UNC Samples [acetamipridData apps for data scientists and data analysts.![](https://deepnote.com/static/apple-touch-icon.png)DeepnoteOpioid Data Lab![](https://deepnote.com/project/caafa973-a110-454e-8225-fa8864567dfd/social-image)](https://deepnote.com/app/opioiddatalab/acetamiprid-caafa973-a110-454e-8225-fa8864567dfd) #### Column names **Blank values indicate no response was received by UNC.* ****sampleid** is the UNC tracking number ****date\_collect** is the date sample was collected by local harm reduction program ****state\_county** is the state and county of sample collection ****abundance** designates if bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate was detected in primary or trace abundance. "Trace" is designated is the peak is less than 5% peak height of most abundant species detected on chromatogram ****expectedsubstance** are the substances it was sold as or expected to be based on participant experience or harm reduction program FTIR analysis ****total\_substances** are the number of unique molecules detected by GCMS. "1" means that only bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate was identified on GCMS. ****other\_drugs** is other substances detected on GCMS in the sample beyond bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate ****color** relates to the physical appearance of the original power/rock form of the street drug ****sensations** and overdose are self-reported by the participant donating the sample. 📍 ****A note on geography.** Seeing more samples from one location doesn't mean that that location is seeing more of this substance than other places. These are early days, and programs are preferentially sending us samples that they think might contain it. The widespread nature of the substance does provide clues about the extent of its distribution. There are plenty of places we don't get samples from, so not seeing a state on this list doesn't mean the substance is not present there. --- # Timeline - **August 29:** We've seen 5 samples at UNC, still only from NM and WA. Two samples (one from each state [806556](https://www.streetsafe.supply/results/p/806556) and [806239](https://www.streetsafe.supply/results/p/806239)) contain no other substances detected on GCMS, not even fentanyl. We were a disheartened to see acetamiprid showing up alongside BTMPS in [this sample](https://www.streetsafe.supply/results/p/805898), and the local program communicated this info to the local community as needed. (Which, we think, is exactly the way we think this process should work!) - **August 20**: We have been alerted that acetamiprid has appeared in street drug samples from Missouri and Michigan analyzed by local crime labs. - **Index Samples:** The first identification of acetamiprid in the drug supply was Georgia Phillips with Kings County Health Department in Washington, in late July 2024\. The first sample of acetamiprid that we handled at UNC came from the Mountain Center in Española, New Mexico in mid-August, flagged by Kelly Mytinger, who saw putative library match on FTIR for acetamiprid on samples collected around August 8, 2024\. **Kudos to heroes* Georgia and Kelly for attention to detail and alertness!* 🙏🏽 --- # Harm Reduction Notes - In both NM and WA, samples **tested positive on benzodiazepine test strips** (immunoassay), but no benzos were detected ([806420](https://www.streetsafe.supply/results/p/806420), [806239](https://www.streetsafe.supply/results/p/806239), [805072](https://www.streetsafe.supply/results/p/805072)). - Samples have been found to contain [mixtures](https://deepnote.com/app/opioiddatalab/acetamiprid-caafa973-a110-454e-8225-fa8864567dfd) as well as just acetamiprid itself ([806239](https://www.streetsafe.supply/results/p/806239)). Other compounds also detected include gabapentin, fentanyl, methamphetamine, ***and with*** 🤔 another emergent substance we are tracking [bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate](https://www.opioiddata.org/mystery-substance-summer-2024/). - Samples were described as being "weird" and "unusual" and causing headaches. - No overdose cases have been reported to us. --- # Scientific Literature From: D.R. Wallace, in [Encyclopedia of Toxicology (Third Edition)](https://www.sciencedirect.com/referencework/9780123864550/encyclopedia-of-toxicology), 2014 ### Abstract > [Acetamiprid](https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/acetamiprid) belongs to a relatively new class of insecticide that developed in the late 1980s, the ‘neonicotinoids’. The precise structure of [acetamiprid](https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/acetamiprid) is that of a chloronicotinyl compound and it has been shown to be a potent agonist at the [nicotinic acetylcholine receptors](https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/nicotinic-receptor) in insects. The primary use for acetamiprid is to control insects such as aphids, which have been known to attack and damage leafy plants. Acetamiprid is available as a ready-to-use formulation in addition to wettable powders and water-dispersible granules. Although acetamiprid has shown to have higher affinity for nicotinic receptors in insects compared to mammals, there have been some reports of [imidacloprid](https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/imidacloprid) (another neonicotinoid) undergoing biotransformation in rodents resulting in a compound that has higher affinity for then the nicotinic receptor compared to (−)-nicotine. This could potentially lead to toxicity in mammals. There have been no reports of [chronic toxicity](https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/chronic-toxicity) or of [bioactivation](https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/bioactivation) of acetamiprid so far in mammals. A recent report has shown that acetamiprid can undergo transepithelial absorption across intestinal cells, possibly resulting in toxicity if acetamiprid accumulates within the body. It is not thought that acetamiprid contamination of soil is persistence and the general thought is that acetamiprid presents low hazard risks to human/vertebrate populations under normal conditions. --- # Talking Points - It is too early to tell what is going on with this. - Rapid identification occurred in harm reduction drug checking programs. - Drugs do not spread like inevitable weather. At this time this is not a - Positive identification in multiple regions of the US simultaneously do not mean it will spread inevitably elsewhere. - If drugs sold as fentanyl taste "chemically" or like "bug spray" – stop using them. Dispose of them. And provide feedback to your plug. - 😑 This is **not** the same substance as Appalachian [wasp dope](https://doi.org/10.1111/add.15291) (pyrethroid-containing insecticides). Do not conflate them. They happen to be chemicals that have industrial uses as insecticides, but not much else in common chemically or behaviorally. - At the current time, to avoid sensationalism, we strongly caution against news media mentioning pyrethroid insecticides in reporting on acetamiprid. 📋 Bookmark this page -- we will be updating with FTIR and GCMS spectra, scientific literature, and other information. ## Sign up for Opioid Data Lab Street Drug Analysis Lab @ UNC Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### Deep Dive: Hospital ED overdose data caveats URL: https://www.opioiddata.org/deep-dive-hospital-ed-overdose-data-caveats/ Last updated: 2024-09-18T06:17:36.000Z The [DOSE website has a great explainer](https://www.cdc.gov/overdose-prevention/data-research/facts-stats/dose-dashboard-nonfatal-surveillance-data.html) on the limitations of these data. We have pasted it below without edits because it is so clear. (Hope y'all don't mind.) **Important caveats to consider when interpreting the data include:** 1. **Some data may be missing.** Data sent from EDs to health departments may be delayed or may stop for a period of time. When EDs begin sharing data again, information about visits during the lapse may never be shared. 2. **Reporting facilities and the data they report can change.** Several states continue efforts to onboard new facilities that can begin to share data in syndromic surveillance systems, and some facilities experience periodic interruptions or a cessation of syndromic surveillance data feeds. Some of these issues became more pronounced during the earlier phase of the COVID-19 pandemic. Syndromic data also can be updated with new information over time, for example, with additional diagnosis codes. Therefore, numbers and rates reported could change over time as more facilities began sharing data or sharing higher quality data as well as facilities that may stop sharing data for a period of time. Some EDs also had increases in the proportion of ED visits in syndromic data that contain diagnosis codes, which facilitate the identification of overdose-related visits. 3. **Data are updated over time.** The chief complaint, or the reason for the ED visit, is available in syndromic surveillance systems within 48 hours for \~70% of ED visits. However, the chief complaint field may be incomplete. ED visit data may be updated over the course of several weeks, and relevant overdose discharge diagnosis codes or revised chief complaint text may be received during this time. However, DOSE data are reported with a one-month time lag and not typically updated each month. 4. **These are suspected overdoses.** Because these data are not determined by toxicological testing, they are not considered confirmed cases, but “suspected” overdoses. 5. **Data likely represent an undercount,** given inaccuracies in coding and missing chief complaint information. 6. **New ICD-10-CM codes were added for fentanyl and methamphetamine during the data collection period:** Syndromic surveillance definitions use information from both the chief complaint and discharge diagnosis fields to identify suspected cases. ICD-10-CM diagnosis codes were introduced to address gaps in the classification of fentanyl poisonings (T40.41, effective October 1, 2020) and methamphetamine poisonings (T43.65, effective October 1, 2022). Prior to the availability of these codes suspected fentanyl or methamphetamine poisonings may have been classified under a broader drug overdose or poisoning code, decreasing the likelihood that the visit would be captured by the syndrome definition. Additionally, incorporation of new ICD-10-CM codes into routine use at healthcare facilities may vary between facilities or jurisdictions. Due to these limitations, comparisons of data collected before and after the introduction of the respective codes should be interpreted with caution. 7. **Overdose visit numbers are not mutually exclusive** but rather reflect nesting of drug categories (depicted in the figure below) and some overdose visits involved multiple substances (e.g., a given overdose ED visit could have involved both opioids and stimulants). ### Deep Dive: Overdose mortality data caveats URL: https://www.opioiddata.org/deep-dive-overdose-mortality-data-caveats/ Last updated: 2024-09-18T06:17:44.000Z - There is no local or national source that accurately quantifies drugs entering or circulating in terms of absolute volume. Overdose mortality data are a useful metric because it's the outcome that matters most to most people. But it is at best a proxy for the drug supply. - Specific substances identified in mortality data are limited by what is assayed for and how they are named in death records. - Death records in many, but not all, states are public information. - Causal emphasis on what substance was involved in an overdose can vary by coroner or medical examiner, a [longstanding](https://journals.sagepub.com/doi/full/10.23907/2013.010) problem that has made considerable strides. - Death certificates are limited by what is measured and recorded. They often contain little/no mental health and social antecedents. - We cannot systematically distinguish intentional vs. accidental polysubstance use from mortality data. - Most models do not account for if people moved or died of other causes. - ICD-10 coding using T-codes [lumps](https://doi.org/10.1007/s40122-021-00254-z) illicitly manufactured fentanyl with pharmaceutical fentanyl. - Most data dashboards include unintentional deaths and suicides. - Presence of a substance in post-mortem body fluids doesn't automatically mean that that substance was involved in the fatal event. - Stimulant-related toxicity has a lot of variation in how it is ascribed in a death. - There is a 4-18 month delay in cause of death investigations, varying by state resources. Not all states have the same resources for these investigations. - Coroner-based systems (in contrast to medical examiners) may have [less specific](https://doi.org/10.1080/00952990.2022.2072223) causes of death. Some states have coroners, others do not. - Incomplete death records are an issue, and missingness is [not distributed uniformly](https://doi.org/10.1016/j.annepidem.2019.08.006). - There are know differences between urban and rural areas, so a state's average is inherently heterogeneous. Same goes for age, sex, and race. - Spikes in overdose happen, often based on street drug potency (at the current time). Single month comparisons need to be interpreted in this context. - Declines in opioid overdose may be offset by increases in other types of substances. ### Deep Dive: Overdose Death Data Process URL: https://www.opioiddata.org/deep-dive-overdose-death-data-process/ Last updated: 2024-09-18T06:17:27.000Z Here is a simplified overview of how national OD numbers happen. Much of this process is dictated by vital statistics laws. 1. At the time of death, a doctor writes a *suspected* cause of death on a registration form. The death is registered with county government and becomes a death certificate. 2. Depending on professional suspicions, coroners and medical examiners do autopsies, part of which is to run tests on bodily fluids. Based on these findings, the death record is updated with a *definitive* cause-of-death. This process can result in refinement: A death with doctor-assigned suspected cause-of-death (COD) of “overdose” can be updated to “overdose involving fentanyl and alcohol intoxication.” If we are looking specifically at one drug or a class of drugs, this is obviously an upgrade. The process takes the better part of a year because the talented workforce that does the work is under-resourced. 😳 3. Regardless of COD, *all* local death records originating in counties, parishes, and cities get passed to state health departments. 4. State health departments often make dashboards and reports. These are the state data we will access below, because they are literally closer to the source truth. 5. State health departments are also required by law to send an abbreviated snippet of the records to CDC. If the autopsy investigation isn’t complete, states can send “provisional” data containing the *suspected* cause of death. Some states also report the provisional data in public reports, with asterisks. States send records to CDC in batches. 6. CDC takes these snippets of all deaths, and starts by standardizing. This mostly automated step takes into account spelling and other naming variations, returning ICD codes, an internationally accepted alphanumeric language for classifying all possible causes of death. 7. CDC extracts the records that are either definitively classified as an overdose, or have a suspected COD in provisionals. 8. So far, the whole process has take 4-18 months (with 8 a reasonable approximation). The next step is for CDC to make a national prediction. Along the way, there is opportunity for delay and inconsistency. Yet, the data are invaluable. ### Felony Snap Ban URL: https://www.opioiddata.org/felony-snap-ban-2/ Last updated: 2025-03-27T17:23:34.000Z ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/image-4-1.png) ### September 2024 Newsletter URL: https://www.opioiddata.org/sep2024/ Last updated: 2024-10-30T14:16:33.000Z Welcome to the ****first-ever** [****UNC Street Drug Analysis Lab**](https://streetsafe.supply)****'s Newsletter!** We're excited to bring you the latest from our team, including must-read articles, insightful blog posts, cutting-edge research, behind-the-scenes updates from the lab, and more! Whether you're here to learn about drug checking or catch up on what we're up to, we’ve got something for everyone. And if you can’t wait till next month, [our blog site](https://www.opioiddata.org/) will get regular updates. Check out [our vision for communicating](https://www.opioiddata.org/new-website-new-vision/). Dive in, stay informed, and let’s keep building safer, smarter communities together! --- # 〽️ Service Stats --- # 👀 Watch List Here are the [trends in the drug supply](https://www.opioiddata.org/unc-watchlist/) we are keeping an eye on this month. [BTMPS](https://www.opioiddata.org/unc-watchlist/#btmps) \- industrial chemical added to plastics [Acetamiprid](https://www.opioiddata.org/unc-watchlist/#insecticide-acetamiprid) \- insecticide [Xylazine & (dex)medetomidine](https://www.opioiddata.org/unc-watchlist/#xylazine-dexmedetomidine) \- sedatives mixed with fentanyl [Carfentanil](https://www.opioiddata.org/unc-watchlist/#carfentanil) \- potent opioid reemerges but in a new way [2-fluoro-2-oxo-PCE + fentanyl](https://www.opioiddata.org/unc-watchlist/#2-fluoro-2-oxo-pce) \- international club drug mixed with fentanyl [Shift to smoking](https://www.opioiddata.org/unc-watchlist/#shift-to-smoking) \- broad trend with implications for overdose prevention --- # 👋 Meet our Team Members Each month will feature different team members 😊 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/EPRipley_230912_31862.jpg) ## Erin Tracy Our lead chemist who joined the team in 2022 with 10 years of drug analysis expertise. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/0S4A7703.jpeg) ## Jalice Manso Our recent addition to the team, with more than 15 years of infrared and mass spectrometry experience as a research chemist. --- # 📣 Team Voices Check out monthly blog posts from members of our team! [The Solution is Painfully Obvious; Getting there? Not so much…The work many of us have committed our lives to can often cut deep in myriad ways, especially for those of us whose relationship to substances has created trauma and difficulties in our lives. I’ve realized for me that the part that’s the hardest to deal with, the![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabColin Wasson Miller![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1474649107449-ea4f014b7e9f.jpeg)](https://www.opioiddata.org/the-solution-is-painfully-obvious-getting-there-not-so-much/) [Our Goal: Empowering CommunitiesStreet drug checking is a crucial harm reduction tool, offering individuals and communities the knowledge they need to navigate the ever changing drug landscape. With the rise in drug contamination and unpredictable potency, the ability to verify the contents of substances is not just beneficial—it’s lifesaving. Street drug![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabIllyana Massey![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1591197172062-c718f82aba20.jpeg)](https://www.opioiddata.org/our-goal-empowering-communities/) [Lights, Camera...Action Decision LogKeeping up with action items and final decisions throughout the lifecycle of a project can be HARD! Sometimes, it involves searching through pages and pages of meeting notes and emails. An action & decision log can help keep this information in one place. While the template can vary, I tend to![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabNatalie Sutton![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1598899134739-24c46f58b8c0.jpeg)](https://www.opioiddata.org/lights-camera-action-decision-log/) [Stigma and Language Change: The Problem with Low Hanging FruitStop me if you’ve seen this before. You’re browsing the web for the latest harm reduction best practices and come across an infographic from a federal agency or county health department. The title is something like “Using Person-First Language” or “How Your Vocabulary Can Make A Difference.” There’![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabAdams Sibley![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/liana-mikah-YJWcZkXlGlI-unsplash-1.jpg)](https://www.opioiddata.org/stigma-and-language-change-the-problem-with-low-hanging-fruit/) --- # 🥼 Lab Visits ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Vital-strategies-5.JPG) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/RTI.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Dr-David-Nichols-and-friends-lab-tour-1.jpeg) ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Erowid_Sylvia.png) We love when we have visitors and to show off the lab! To find out who these cool individuals are and find out about the work they do-CLICK the link below! [Site Visits - Opioid Data LabWe love it when y’all come visit us on campus!![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data Lab![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1634300391876-cdc290e3610c)](https://www.opioiddata.org/tag/site-visits/) --- # 🤖 New Equipment ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_6214-1.jpg) ## Our new GCMS! Thanks to the NC Collaboratory, using opioid settlement funds from the NC General Assembly we purchased our new Agilent GCMS 8890/5977C. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_6216-1.jpg) ## Our new FTIR! Thanks to the US Food and Drug Administration to help us support a research study on community-based naloxone administration. The FTIR is a Thermo Nicolet iS20. --- # 👩🏼‍🔬 Lab Tech Summit This summer, 12 labs supporting community drug checking gathered on the UNC campus in Chapel Hill. Bet ya didn't know there were 12 labs doing this work! See what we discussed, and what makes us mad, sad, and glad. [Lab Technician Summit 2024Historic first meeting of a dozen labs involved in supporting drug checking across North America.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabErin Tracy![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/ACDC-Lab-UNC---2.jpeg)](https://www.opioiddata.org/lab-technician-summit-2024-2/) --- # 🎙️ Podcasts [Just Increasing Access to Drug-Checking Services – Forensic Technology Center of Excellence![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-favcon-ftcoe-270x270.png)Forensic Technology Center of Excellence - A program of the National Institute of Justice LogoErica Christensen![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/1920x300px_Tox_Stat_Series_v2-744x300.jpg)](https://forensiccoe.org/podcast-2024-cossup-ep4/) [Episode 87: Drug Testing Equals Empowerment with Dr. Nabarun Dasgupta and Charlton Roverson — NarcoticaNarcotica is a podcast giving you the straight dope about drugs and the people who use them.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-narcotica-logo-itunes-.jpg)NarcoticaNarcotica![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/NARCOTICA-defaijhghff.jpg)](https://narcocast.com/episode-87-drug-testing-equals-empowerment-with-dr-nabarun-dasgupta-and-charlton-roverson/?ref=opioiddatalab.ghost.io) You can find more podcast under the [Tags section](https://www.opioiddata.org/tags/) of our website. --- # 📖 Reading Room A place for things that taught us something new. With a focus on the Tar Heel State. - Secret Shoppers: [Evidence-based treatment for opioid use disorder is widely unavailable and often discouraged by providers of residential substance use services in North Carolina](https://www.sciencedirect.com/science/article/pii/S2949875924001863) \[Carroll et al., open access, [press release](https://news.ncsu.edu/2024/08/nc-opioid-treatment-providers/)\] - [Is "surveillance" a bad word?](https://www.opioiddata.org/is-surveillance-a-bad-word/) \[Morabia et al., open access\] - Great discussion on [naloxone pricing in North Carolina](https://www.wral.com/story/naloxone-distribution-efforts-help-fight-opioid-crisis-in-nc/21600947/) and the importance of IM naloxone, featuring CDC Director Mandy Cohen and NC AG Josh Stein at a kit making event in Raleigh \[WRAL Grace Hayba\] - [Secret Shoppers: $96 for Narcan® in NC Pharmacies](https://www.opioiddata.org/96-for-narcan-in-nc-pharmacies-2/) \[Marley et al., open access\] - [Drug Mention with Involvement (DMI) and Polydrug Poisoning Classification Methodology Tool (DMI2EpiTool)](https://cph.uky.edu/research/projects/DMI2EpiTool) \[Slavova et al., open access software\] - This is a great new tool developed by our friends at the Univ. of Kentucky that 1) identifies drugs involved from literal text of death certificates, and 2) classifies them as polysubstance or not. This is a much-anticipated update that runs as a SAS file, and will be invaluable for state health officials. \[Funded by US FDA\] --- # 🛣️ Maryalice Retires After more than 2 decades at UNC, our beloved project manager retired earlier this year. She helped create our drug checking service, and is the brilliance behind the kits and mailing paradigm. Maryalice also kept our complex research agenda moving and is an all around mensch. We miss you! ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/MaryAlice_Retirement_v1-19x27__1-3379--1.jpg) Illustration of Maryalice's career by Brittain Peck --- # 🤮 Corporate Ick Award Every day we keenly feel the corporate and commercial determinants of health. [WHO defines](https://www.who.int/news-room/fact-sheets/detail/commercial-determinants-of-health) this as "private sector activities that affect people’s health, directly or indirectly, positively or negatively." [Read more in *AJPH*](https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2018.304510) \[ironically, behind paywall\]. Better yet, check out the videos in DPA's [*Plunder, Profit, and Punishment: A Syllabus on Drug War Profiteering*](https://drugpolicy.org/resource/plunder-profit-and-punishment-a-syllabus-on-drug-war-profiteering/)*.* From test strips, to plastic scoops, to vials, to instruments, to computers and printers, to data servers, and package delivery and beyond, we are dependent on the products and services of more than a hundred corporations to operate. Yet, there are a *few* who's behavior is so outrageous, they deserve to be called out. So, we are taking nominations for a monthly Corporate Ick Award. 👹 In this monthly section we highlight Drug War profiteers, those who put profits over people, and those who ignore science for sales. Newsletter subscribers and organizations that use our service can send nominations for next month's Corporate Ick Award! Please provide examples and get specific. --- # 🛍️ Department of (un)Safe Supply We get insights into drug markets by looking at trends in consumer goods. Especially food and booze. We'll highlight examples that have analogies to the drug supply in this spot monthly. **Regulated products have intentional and unintentional problems: Why would we expect different from unregulated street drugs?** Our example this month comes [from your grocery store](https://www.msn.com/en-us/health/other/why-your-avocado-oil-may-be-fake-and-contain-other-cheap-oils/ar-AA1pvLot?ocid=BingNewsVerp): **Avocado oil** > The researchers found that at least 21 of the products labeled as avocado oil — nearly two-thirds of the 36 bottles they tested— were adulterated, in some cases with other oils that could pose a hazard to people with food sensitivities. The newly released findings are based on tests conducted in 2021 on bottles of store-brand avocado oil purchased from 19 large grocery stores in the United States and Canada. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/Screenshot-2024-09-11-at-1.38.11-PM.png) From MSN/[WaPo](https://www.washingtonpost.com/wellness/2024/08/27/avocado-oil-adulteration-tests/) based on [scientific article](https://www.sciencedirect.com/science/article/pii/S0956713523002372) Sounds familiar, right? If we can’t get pure avocado oil, let’s not be surprised when dope gets cut, stepped on, bulked up, mislabeled, colorized, hyped, etc. --- ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/chip---1-1-1-1.JPG) ## ❤️‍🩹 We were saddened to hear of the passing of Chip Ezzard, who we knew through our work with [WNCAP](https://wncap.org/) in Asheville. Chip was often the first person that people saw at the window when they came for help. He was an early adopter to our drug checking program, bringing his paramedic training to connect lab results to people’s lives. Chip’s insightful questions and requests helped make our program better. His calm, compassionate demeanor brought a moment of peace to the people he served, and those he worked with. May he now rest in his own peace. --- # 🏆 Box of the Month Sometimes our amazing partners write us a warm message, doodle or draw a picture on the return boxes we send out. This is in no way a requirement (♻️ we reuse the boxes), but we love receiving the random surprises! Each month, we will showcase boxes we love. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/IMG_3076.jpg) --- # 🫶🏽 Funders [FundersWe are grateful to our generous funders! Y’all make our work possible. 🎤Studies and writings at the Opioid Data Lab and UNC Street Drug Analysis Lab are conducted by independent scientists and do not necessarily represent the views of funders or partners. We do not accept any funding from the![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1503980599186-9cc36eda351a.jpeg)](https://www.opioiddata.org/funders/) --- ![1.png](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/1-1.png) ## Sign up for Opioid Data Lab Welcome to the Street Drug Analysis Lab @ UNC, a public service of the University of North Carolina at Chapel Hill. We provide analytical chemistry services and information for public health. Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### Our Terms & Conditions URL: https://www.opioiddata.org/our-terms-conditions/ Last updated: 2024-09-12T01:43:50.000Z **Terms & Conditions for Community Programs** The UNC Street Drug Analysis Lab requires programs to agree to Terms & Conditions prior to sending kits. This can feel like a formality. Why do we do need this? 1. Protect the whole entire community of programs we serve from bad actors 2. So we are accountable to our programs 3. So you are clear on what happens with the data This document outlines information and/or expectations including turnaround time, data use, pricing, shipping and handling, no resale policy, termination, etc.You can find the document at the following link: . | [![](https://lh6.googleusercontent.com/hRpokhYkFclnB43fsSbW6Tya3EWo5x1L4XlmW-Fd6FLvYu6K3bfACmj_i_tAUjw5UU-XYb2NEOw=w1200-h630-p)](https://docs.google.com/forms/d/e/1FAIpQLSedtUzoha0HB9fYQFd1mTCvrPmA23LH3cYkaz7orGsozXrB4A/viewform) | [Terms and Conditions](https://docs.google.com/forms/d/e/1FAIpQLSedtUzoha0HB9fYQFd1mTCvrPmA23LH3cYkaz7orGsozXrB4A/viewform)Welcome to the UNC Street Drug Analysis Lab! These are our community rules so we're all on the same page. Just accept the terms using the link at the bottom and we'll get your rolling with kits. In consideration of Client’s request and use of services offered by the UNC Street Drugs Analysis Lab to provide anonymized street drug analyses using mass spectrometry, the Client and the University of North Carolina at Chapel Hill (“University”), agree to the following terms and conditions. The University shall use reasonable efforts to commence the services promptly after the Effective Date, and to conduct the services in accordance with these terms and conditions. Turnaround Time While the University strives to deliver results within one week of receiving returned sample collection vials, turnaround times may take longer depending on a variety of factors (e.g., volume, issues and maintenance with equipment). The University will also try to accommodate requests to prioritize samples involved in overdose or otdocs.google.com | | -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | Once completed (signed by the program and UNC), the fully signed document will be sent to the program via email. Please let us know if you have any questions. Sincerely, Natalie Sutton, Program Manager ### Sample Collection Methods URL: https://www.opioiddata.org/sample-collection-methods/ Last updated: 2025-05-23T16:15:30.000Z 💡 This page will be helpful for programs submitting a sample for the first time. It focuses on how to prepare a sample to send to the UNC Street Drug Analysis Lab. # Types of Samples We only need a tiny amount of sample, the size of a grain of rice. Two scoops of powder works best. Swabs of the inside of baggies are also okay, but ***be sure to indicate that on the card*** so we can adjust our lab methods. A clean fragment of a pill works well, but be aware of the [Chocolate Chip Cookie Effect](https://www.health.ny.gov/diseases/aids/consumers/prevention/oduh/faqs.htm#:~:text=a%20match%20head.-,What%20is%20the%20%22Chocolate%20Chip%20Cookie%20Effect%22%3F,and%20its%20adulterants%20or%20contaminants.). Used cotton is exempt from paraphernalia laws and is convenient and works. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/image.png) --- # Video demonstration This video will walk you through the steps. --- # Scoop Using the enclosed spatula scoop approximately 1mg of the sample into the vial. Ensure the sample looks consistent throughout. If there are speckles or different colors in the bag, # Swab Dip and swirl the cotton swab into the liquid in the vial to get it wet, and run the wet swab along the inside of the bag 5 times. Make sure to get into the corners. Then, swish the swab around in the liquid in the vial, or the swab head can be cut or broken off and sealed inside. # Cotton The clear plastic spatula is convenient for dropping used cottons inside the vial. # Tablet You can drop a whole tablet into the vial. It also works to cut off a piece of the tablet (at least ¼); be sure to use a clean knife to cut the tablet! If the tablet has been broken/crushed, use the spatula to transfer powder to the vial. --- # Alternative Collection Methods ## Pipes and Foil We don't *recommend* this collection method because pipes could have been used more than once with different types of drugs, complicating your interpretation. Still, we do accept samples provided this way. Follow instructions of baggie swabs above. ## Cookers Wet the swab in the liquid from the vial and draw it along the surface of the cooker, including the sides. Then, swish the swab around in the liquid in the vial, or the swab head can be cut or broken off and sealed inside. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2025/03/image-1.png) Photo Credit: Pearson Ridley ## Syringes Wet the swab with liquid from the vial and swab the inside of the barrel and plunger. Alternatively, rinse syringes with liquid from the vial and transfer back to vial. Obviously, this method carries risk of needlesticks. Sometimes syringe samples also contain lotions from the skin, complicating your interpretation of the results. ## Liquids We can analyze liquids, like GHB. Add 5+ drops of the liquid sample to the vial. ## Plant Material (weed) and Fungus (shrooms) Use the spatula to drop a small amount of plant material into the vial. You want about a peppercorn's worth of the material at least. We haven't seen any fentanyl in weed (yet!). 🍬 We discourage sending us edibles. Gummies make a mess when they melt in our machines, and edibles don't contain a lot of unexpected substances. But if something terrible happened when someone took one, we'll analyze it for you. Please make a note on the card, or get in touch with us before sending. ### Interpretation of Results URL: https://www.opioiddata.org/interpretation-of-results/ Last updated: 2025-05-23T16:19:59.000Z 💡 Below is information on how to read GCMS results from UNC Street Drug Analysis Lab. ## GCMS Background Gas Chromatography/Mass Spectrometry is an instrumental technique used to separate and identify components in a mixture. The data output from a sample analyzed using GCMS is called a chromatogram. A chromatogram is a graph of time on x-axis and abundance on the y-axis. A typical chromatogram seen in our lab can contain between one and eight peaks (sample components) over the course of a 20 minute time scale. Each peak is assigned a time (based on when it was detected by the instrument). Additionally each peak has an associated mass spectrum (not pictured on the website) - a fragmentation pattern representing the chemical structure of the compound. The report will identify the compound and display the associated retention time. ## Interpreting Results **A sample's chromatogram is its visual fingerprint.** Each substance in the drug mix is usually represented by a separate peak, so more peaks means more substances. **This is important**: This method does not provide purity or quantification, and the height of the peaks just gives a rough idea of how much is in there. Tall peaks are the major components, and smaller blips are trace amounts. **Reading the graph.** The "relative abundance" on the vertical axis is a rough relative estimate of how much is present. It is not quantification. The time (min) on the horizontal axis means the time at which each of the substances was detected. But you can also look at the overall pattern to get a sense of what's common in your area. Also, similar substances can sometimes clump together into one peak, so we may run more tests to get separation. When we list the substances above, we've taken a whole set of lab tests into account, and it's not just looking at results from one graph. **The GCMS method is really sensitive.** We can pick up on trace amounts, and sometimes those can be cross-contamination. They may not be relevant for your context, but know that’s what we found in there. It's why we ask you to wear gloves and use the paper cloth when collecting the sample. The substances that drive the high are in the major peaks. Sometimes there can be side effects from the smaller peaks as well. **What the peak numbers mean.** The peak numbers are provided for transparency and completeness. The peak number is when (in minutes) the GCMS machine identifies the substance. The number itself isn’t all that important by itself - think of it like a label. If advanced methods (see below) were used, the peak numbers may not match up exactly. And some smaller peaks may be artifacts that we investigated and ruled out. **What we can and can't tell.** The GCMS method is most reliable for psychoactive substances. For cuts and fillers (like sugars) we may need to use other tools. If you see "FTIR" or "Derivitized GCMS" in the methods description above, we found additional substances when we used one of these additional techniques. ### BTMPS Mystery Substance URL: https://www.opioiddata.org/mystery-substance-summer-2024/ Last updated: 2024-12-22T22:29:21.000Z 💡 In mid-June 2024, a new chemical was identified by FTIR-based drug checking harm reduction programs on the West Coast. Within a month, it appeared as far south as Los Angeles, as far north as Seattle, and as far east as Michigan and New York, among samples we have received. In early August, it started to appear in fake blue M30s in Denver and New Mexico, but remained in powder form elsewhere; by September we saw both forms there and elsewhere, reaching Maine and North Carolina. Going into October, we've started seeing BTMPS in fake M30 and fake xanax pills without fentanyl. The substance has been identified as: ****bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate** ****Abbreviation: BTMPS** ("bee-temps") ****Brand name: Tinuvin® 770** ****Industrial uses**: UV-blocking component added to plastic, candle fragrance, adhesive for food stickers ****Health Risks** ****Highly noxious; not psychoactive.** Unusual taste, cough, blurry vision. Burning sensations reported when injected. Manufacturer toxicity studies suggest very low overdose risk. A screen against hundreds of human brain/body receptors suggests no binding to major psychoactive drug receptors. Along with colleagues in harm reduction, we are investigating the emergence of this substance. This page is updated as we gather new information. All content on this page can be shared. #### Table of Contents 1. [Background](https://www.opioiddata.org/mystery-substance-summer-2024/#background) 2. [Chemical Identity](https://www.opioiddata.org/mystery-substance-summer-2024/#chemical-identity) (pronunciation, MW, names) 3. [MSDS](https://www.opioiddata.org/mystery-substance-summer-2024/#msds) (safety info from manufacturer) 4. [Industrial Uses](https://www.opioiddata.org/mystery-substance-summer-2024/#industrial-uses) (plastic, fragrance) 5. [Timeline](https://www.opioiddata.org/mystery-substance-summer-2024/#timeline) 6. [UNC Samples (live data)](https://www.opioiddata.org/mystery-substance-summer-2024/#unc-samples) 7. [Sensation Reports](https://www.opioiddata.org/mystery-substance-summer-2024/#sensation-reports) 8. [Spectra (FTIR and GCMS)](https://www.opioiddata.org/mystery-substance-summer-2024/#spectra) 9. [Pharmacology](https://www.opioiddata.org/mystery-substance-summer-2024/#pharmacology) 10. [Manufacturer Toxicity Studies](https://www.opioiddata.org/mystery-substance-summer-2024/#foia-toxicity-studies) obtain via FOIA from FDA 11. [Scientific literature](https://www.opioiddata.org/mystery-substance-summer-2024/#scientific-literature) 12. [Interpretation](https://www.opioiddata.org/mystery-substance-summer-2024/#interpretation) (facts, alt hypotheses, what we don't know) 13. [Talking points](https://www.opioiddata.org/mystery-substance-summer-2024/#talking-points) (for media and harm reduction) 14. [Drug alert](https://www.opioiddata.org/mystery-substance-summer-2024/#drug-alert) (Canva, PowerPoint, etc. and style guide) --- # Updates 💡 We created this section to keep our return readers appraised of updates as the science evolves. New? [Start here](https://www.opioiddata.org/mystery-substance-summer-2024/#background). Looking for data? [Go here](https://www.opioiddata.org/mystery-substance-summer-2024/#unc-samples). ### December 20, 2024 More results from the amazing XP Huang at UNC. There had been some older papers suggesting that BTMPS had antagonist properties at nicotinic acetylcholine receptors (nAChRs). Using modern assays, XP now reports **no binding activity whatsoever of BTMPS to nACHRs**. So, think twice before making broad claims about molecular properties of BTMPS based on old papers who's findings were never reproduced. ### November 26, 2024 A national team of drug checking collaborators figured out why the FTIR spectra for BTMPS isn't aligning with the reference standard! [BTMPS Explainer: The Effect of ProtonationVikrant Jandev and Marya Lieberman, UND Blake Joachim (Outside In) and Cole Altomare-Jarczyk and Ivy Sabal (MADDS) What’s up with the IR spectrum of BTMPS? How come the literature spectrum doesn’t fit what we are seeing in drug samples? The literature IR spectrum of BTMPS is the free![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-13.png)Opioid Data LabMarya Lieberman![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1650978810641-6610f4b6d15a-1-1.jpeg)](https://www.opioiddata.org/btmps-explainer-the-effect-of-protonation/) ### November 17, 2024 Pittsburgh Post-Gazette does a [solid job on this article](https://www.post-gazette.com/news/health/2024/11/17/industrial-grade-chemical-btmps-street-drugs/stories/202411170011) about BTMPS, quoting many experts from our drug checking community. ### October 18, 2024 We have confirmation back from XP Huang that **BTMPS does not meaningfully activate any of the \~350 brain and body (G protein-coupled) receptors usually associated with psychoactive drugs.** This was via the PRESTO-TANGO assay. Remember back on September 26th we noted blips at 3 receptors that could indicate some low level binding? One of those was GPR151, which is believed to modulate neuropathic pain. GPR151 is highly expressed in the brain region [habenula](https://pmc.ncbi.nlm.nih.gov/articles/PMC2613689/#:~:text=The%20habenula%20is%20a%20pair,the%20lateral%20habenula%20%28LHb%29.) and is implicated in at least a couple of studies in [addiction](https://www.nature.com/articles/s41598-022-24395-z) [vulnerability](https://www.biorxiv.org/content/10.1101/720508v1.abstract); one current study proposes to develop a GPR151 *ant*agonist as a [treatment for opioid use disorder](https://reporter.nih.gov/search/2OvPReymnE6U0JttTJNLLA/project-details/10475113). So we wanted to see if GPR151 could be associated with the albeit rare reported positive sensations. Therefore, XP conducted a dose-response profile at GPR151: **The finding was no agonist activity**. XP will look at opioid modulating effects next, e.g., combining fentanyl with BTMPS at the same time. But thus far, none of the brain/body receptor hypotheses for BTMPS seem to doubtful. **This looks nothing like a controlled substance.** We hypothesize that reported physiological sensations from BTMPS is likely coming from the co-occurring fentanyl or through the general side effect of "[delirium](https://www.nature.com/articles/s41598-022-17182-3)" noted with pharmaceutical calcium channel blockers. ### October 1, 2024 [NPR mentions BTMPS](https://www.npr.org/2024/09/30/nx-s1-5124997/fentanyl-overdose-opioid-btmps-drug-cartel-xylazine-tranq-mexico-china) in a broader article about drug supply shifts. ### September 27, 2024 Alice Bell in Pittsburgh brought to our attention that they had seen BTMPS (albeit as trace) in a a yellow fake Xanax pill that was bromazolam, [without fentanyl](https://www.streetsafe.supply/results/p/903036). Then we saw [this result](https://www.streetsafe.supply/results/p/806995) of a fake blue M30 from New Mexico that contained BTMPS and acetaminophen with no fentanyl. What do these tell us? Are they one-offs? Who has motive and access to replace fentanyl with an aversive agent? ### September 26, 2024 We got results back from XP Huang @ UNC. He ran BTMPS in the [PRESTO-TANGO assay](https://pubmed.ncbi.nlm.nih.gov/25895059/) at 10µM concentration and found no significant binding activity to 320 brain/body receptors that drugs usually activate. There were very small blips at GPR151, HCA3, BB3, but did not rise to the level of binding signal. Interpretation: **BTMPS doesn't appear to have psychoactive activity across a large range of known human drug receptors.** ### September 24, 2024 [WRAL out of Raleigh](https://www.wral.com/news/state/dangerous-substance-discovered-eastern-north-carolina-oct-2023/) covers BTMPS after it was found in Edgecombe County, North Carolina. ### September 18, 2024 Washington State [Drug Brief](https://adai.uw.edu/wordpress/wp-content/uploads/dlm%5Fuploads/WA-State-Drug-Brief-9-2024.pdf) from ADAI ### September 16, 2024 New article in *Los Angeles Times.* First national news coverage. [An industrial chemical is showing up in fentanyl in the U.S., troubling scientistsAn industrial chemical used in plastic products has been cropping up in illegal drugs from California to Maine.![](https://www.latimes.com/apple-touch-icon.png)Los Angeles TimesEmily Alpert Reyes![](https://ca-times.brightspotcdn.com/dims4/default/b944f9d/2147483647/strip/true/crop/6720x3528+0+476/resize/1200x630!/quality/75/?url=https%3A%2F%2Fcalifornia-times-brightspot.s3.amazonaws.com%2Fac%2F1d%2Fee41579744ad8e46a2b089aebb71%2F1272911-me-0323-drug-checking-gem-001.jpg)](https://www.latimes.com/california/story/2024-09-16/an-industrial-chemical-is-being-mixed-with-fentanyl) The pre-print for the Shover et al. scientific article referenced in the news piece is below. [Rapid emergence of UV stabilizer Bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS) in the illicit fentanyl supply across the United States in July-August 2024: Results from drug and drug paraphernalia testingBackground Changes to the US drug supply historically unfold slowly with predictable patterns of geographic diffusion. Here we draw on drug checking results from around the United States to report a rapid shift in the illicit drug supply with important implications for public health. Bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate, or “BTMPS” is a hindered amine light stabilizer with various industrial applications. Animal studies indicate multiple kinds of adverse health effects. Methods Drug samples collected by community-based drug checking programs in Los Angeles and Philadelphia, along with drug residue samples from other jurisdictions in California, Delaware, Maryland, and Washington, were submitted to the National Institute on Standards and Technology. Samples were qualitatively tested with Direct Analysis in Real Time mass spectrometry, with reflex to liquid chromatography mass spectrometry (LCMS) for confirmatory testing. Quantitation – percent by mass – was performed using LCMS. At both sites where drug samples were collected, participants were asked to respond to a survey that included questions about what the substance was sold as and any unexpected effects. Results Between June 1, 2024 and August 31, 2024, a total of 178 samples sold as fentanyl were tested. Of these, 43 (24%) contained BTMPS, with the proportion per month rising from 0% in June to more than a third in August. An additional 23 residue samples from sites doing residue testing contained BTMPS. Fentanyl samples with BTMPS also contained many other compounds, including local anesthetics and alpha-2 agonists. Average fentanyl purity was significantly lower in samples with BTMPS compared to samples without. Conclusions The introduction of an industrial chemical to the illicit drug supply at this speed and scale is unprecedented and concerning. Further research is urgently needed to determine why it is present in the fentanyl supply and characterize effects on human health. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement A portion of this work was funded by the Division of Overdose Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention. Authors were also funded by grants from the National Institutes of Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: UCLA IRB determined that the activities described in this analysis, funded by CDC OD2A:LOCAL were public health surveillance and did not constitute human subjects research. The research activities in Philadelphia were approved by the WIRB-Copernicus Group (WCG IRB). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-2.ico)medRxivFind this author on Google Scholar![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/medrxiv_logo_homepage7-5-small-test-up.png)](https://www.medrxiv.org/content/10.1101/2024.09.13.24313643v1) ### September 10, 2024 Over the summer we filed a Freedom of Information Request with the US Food and Drug Administration to obtain the toxicology studies filed by the manufacturer of Tinuvin® 770 in order to get it approved to be an additive in adhesives and pharmaceutical-grade plastics. Most of the documents are from 1975-76 CE. Key revelation: Manufacturer studies suggest very low overdose risk with oral LD50 3,700 mg/kg [Uncovered: 1970s BTMPS tox studiesFreedom of Information Act information from FDA on bis(2,2,6,6,-tetramethyl-4-piperidyl) sebacate![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-1.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/Screenshot-2024-09-10-at-9.12.32-PM-1.png)](https://www.opioiddata.org/btmps-toxicity-foia/) --- # Background Subjective reports from participants are mixed. Burning sensation upon injecting, heavy coughing, and a chemical smell have been reported. We have not heard of widespread overdoses, but a handful were reported from one location but mixed with other substances and not verified. Unexpected, possible subjective overlap with fentanyl in terms of sensation have been reported in one site, but overall the reaction is very negative. The compound is not a controlled substance, and had not previously been identified in the drug supply. Its cardiac toxicology was [researched](https://www.opioiddata.org/mystery-substance-summer-2024/#scientific-literature) in the 1990s and early 2000s, growing out of concern from leeching out of plastics used in pharmaceutical packaging. --- # Chemical Identity Description: Hindered amine light stabilizer used in pharmaceutical plastics to block UV rays. ## Chemical names - bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate - decanedioic acid bis(2,2,6,6-tetramethyl-4-piperidinyl) ester - bis(2,2,6,6-tetramethylpiperidin-4-yl) decanedioate Abbreviations: BTMPS, bis-TMP Brand names: Tinuvin 770, Ultradur® - manufactured by BASF ## Pronunciation Here's a phonetic pronunciation guide for bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate: \[bis (2, 2, 6, 6-tet-ruh-meth-uhl-4-pi-per-i-dil) seb-uh-kate\] Breaking it down: - bis: \[bis\] - (2,2,6,6-tetramethyl-4-piperidyl): \[(2, 2, 6, 6-tet-ruh-meth-uhl-4-pi-per-i-dil)\] - sebacate: \[seb-uh-kate\] The stress in "tetramethyl" is on the second syllable: te-TRA-meth-yl. The stress in "piperidyl" is on the second syllable: pi-PER-i-dyl. The stress in "sebacate" is on the first syllable: SEB-uh-kate. ## Chemical Listings PubChem CID: [164282](https://pubchem.ncbi.nlm.nih.gov/compound/164282) IUPAC: bis(2,2,6,6-tetramethylpiperidin-4-yl) decanedioate CAS: 52829-07-9 UNII: [6803A71201](https://gsrs.ncats.nih.gov/ginas/app/beta/substances/6803A71201) EPA: [DTXSID0028030](https://comptox.epa.gov/dashboard/chemical/details/DTXSID0028030) ECHA: [258-207-9](https://echa.europa.eu/brief-profile/-/briefprofile/100.052.899) SMILES: CC1(C)CC(CC(C)(C)N1)OC(=O)CCCCCCCCC(=O)OC1CC(C)(C)NC(C)(C)C1 ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/f1e1e67f-a70c-47be-9ea4-53453a62bea9.png) 2D molecular structure from PubChem ## Molecular Weight Exact mass (via PubChem): 480.39270814 g/mol MW: 480.7 g/mol ## CSFRE Monograph [Monographs![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-2.png)The Center for Forensic Science Research & Education![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/BTMPS-1.png)](https://www.cfsre.org/nps-discovery/monographs/bis2266-tetramethyl-4-piperidyl-sebacate) --- ## MSDS Safety information sheets from the manufacturer. [ULD.B4040G6+BKQ29+15075\_30036585\_SDS\_GEN\_US\_en\_6-0 (1)Ultradur® MSDS pdfULD.B4040G6+BKQ29+15075\_30036585\_SDS\_GEN\_US\_en\_6-0 (1).pdf234 KBdownload-circle](https://www.opioiddata.org/content/files/2024/08/ULD.B4040G6-BKQ29-15075%5F30036585%5FSDS%5FGEN%5FUS%5Fen%5F6-0--1-.pdf "Download") [tinuvin®\_770\_df\_sds\_en\_ca (1)Tinuvin® 770 MSDS pdftinuvin®\_770\_df\_sds\_en\_ca (1).pdf239 KBdownload-circle](https://www.opioiddata.org/content/files/2024/08/tinuvin-%5F770%5Fdf%5Fsds%5Fen%5Fca--1-.pdf "Download") ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/image-1.png) Excerpt from Ultradur MSDS --- # Industrial Uses The [European Chemicals Agency](https://echa.europa.eu/brief-profile/-/briefprofile/100.052.899) lists the following as uses for the substance: > This substance is used in the following products: coating products, adhesives and sealants, fillers, putties, plasters, modeling clay and air care products. > > Other release to the environment of this substance is likely to occur from: indoor use (e.g. machine wash liquids/detergents, automotive care products, paints and coating or adhesives, fragrances and air fresheners) and outdoor use. This is consistent with what is known in the US. The [US EPA](https://comptox.epa.gov/chemexpo/datadocument/1516031/) lists it as a component of Glade Candle Sheer Vanilla Embrace. The [International Fragrance Association](https://ifrafragrance.org/priorities/ingredients/ifra-transparency-list) lists it as a component of commercial fragrances, and EPA [categorizes it as a fragrance](https://comptox.epa.gov/chemexpo/datadocument/1516031/). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/6ffcea76-ba1a-4e1a-a43c-394a57e1d016.png) Contains the mystery compound The major chemical manufacturing company [BASF lists](https://dispersions-resins-products.basf.us/products/tinuvin-770-df) it on their website too. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/09/image-117.png) Screencap from BASF.com --- # Timeline - In mid-June, Blake Joachim at OutsideIn in Portland, Oregon identified an unknown substance via FTIR. We received the sample the following week at UNC. Initially, we were unable to make a GCMS library match for the peak. Sharing scan information with CSFRE, they also confirmed that they had seen it and putatively suggested it might be bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate. We decided to order a reference standard to make a definitive match. - In the meantime, a total of 7 harm reduction programs also detected the substance via FTIR. Many email conversations were occurring with local pharmacology experts. - In conversations with harm reduction programs, fentanyl-experienced participants described sensations consistent with a quasi-substitution effect for fentanyl. We use these terms loosely! - In mid-July, UNC Street Drug Analysis lab obtained a reference standard of pure bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate, and Erin Tracy made a definitive determination on July 22, 2024 of the identity of the substance. We are now confident about the identification. - The reference standard was provided to X-P Huang at UNC to run on the [PRESTO-TANGO assay](https://pubmed.ncbi.nlm.nih.gov/25895059/) to determine GPCR binding sites, i.e., which human body receptors the substance actually binds to. Findings reveal essentially no binding at psychoactive receptor sites in human brain and body. - The FTIR and GCMS spectra were uploaded to this page and shared with the ACDC community the first week of August. - During August 1, 2024 ACDC call some key information was shared: - Earliest suspected samples from programs were June 4th in Los Angeles, and June 16 in Philadelphia. - Some cases of deaths-after-ingestion of mixtures containing bis(2,2,6,6-tetramethyl-piperidyl sebacate were reported in Philadelphia. (note: we do not get samples from Philadelphia) - It has been detected in 6-8 different stamps from Philly. - More than half the samples from Portland, OR tested locally with FTIR contained the substance, but wasn't showing up in the fake M30 pills. --- # UNC Samples The live report linked below lists all the samples we have seen containing bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate. [bis(2,2,6,6-tetramethyl-4-piperidyl) sebacateData apps for data scientists and data analysts.![](https://deepnote.com/static/apple-touch-icon.png)DeepnoteOpioid Data Lab![](https://deepnote.com/project/57aada26-47f7-4095-a52e-f6f334b086e8/social-image)](https://deepnote.com/app/opioiddatalab/bis2266-tetramethyl-4-piperidyl-sebacate-57aada26-47f7-4095-a52e-f6f334b086e8?%5F%5Fembedded=true) Data table displays best in separate window. 📍 ****A note on geography.** Seeing more samples from one location doesn't mean that that location is seeing more of this substance than other places. These are early days, and programs are preferentially sending us samples that they think might contain it. The widespread nature of the substance does provide clues about the extent of its distribution. There are plenty of places we don't get samples from, so not seeing a state on this list doesn't mean the substance is not present there. --- # Sensation Reports *Shared with individual participant permission.* Sampleid 805770 (7/3/24): "'Fish dope', smells like fish when smoking it." Sampleid 805374 (6/14/24): "Client reported that this batch was much stronger than previous. Client stated that they got high off smoking only one hit and that was rare. Client typically injects in neck and describes tolerance as very high." Sample 805700: "Client stated sample was 'good fentanyl, light, powerful, chemical aftertaste. Very white. Client described taste as lingering, tasting like chemicals, acetone, or bug spray." During the ACDC call on August 1, 2024, the following sensations were consistently described from participant experiences. *When smoked* - Ears ringing - Vision blurred - Hard coughing, coughing blood when smoked - Unusual taste (when smoked): "bug spray", "plastic", "adhesive" *When injected* - burning sensations - weird; weaker *and* stronger than fentanyl; unpleasant - vein rigidity at site of injection was discussed on ACDC - But also, rare pleasant feelings among experienced fentanyl users have also been reported. --- # Spectra ## FTIR Spectra Screenshot from UNC FTIR based on pure reference standard: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/image-2.png) reference standard FTIR scan by UNC Published FTIR spectra from the Wiley spectral database: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/image-3.png) Wiley FTIR library ## FTIR File *What’s up with the IR spectrum of BTMPS? How come the literature spectrum doesn’t fit what we are seeing in drug samples?* [BTMPS Explainer: The Effect of ProtonationVikrant Jandev and Marya Lieberman, UND Blake Joachim (Outside In) and Cole Altomare-Jarczyk and Ivy Sabal (MADDS) What’s up with the IR spectrum of BTMPS? How come the literature spectrum doesn’t fit what we are seeing in drug samples? The literature IR spectrum of BTMPS is the free![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon-14.png)Opioid Data LabMarya Lieberman![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/photo-1650978810641-6610f4b6d15a-1-2.jpeg)](https://www.opioiddata.org/btmps-explainer-the-effect-of-protonation/) And here is the protonated spectra that will be more apt to line up with BTMPS in street samples, courtesy of Vikrant Jandev and Marya Lieberman at the University of Notre Dame: [TINUVIN-2HCLTINUVIN-2HCL.040 KBdownload-circle](https://www.opioiddata.org/content/files/2024/11/TINUVIN-2HCL.0-1 "Download") For the sake of completeness, the pure reference standard FTIR spectra is here: [bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate FTIRFTIR scan of pure reference standard by UNC.Bis Std.SPA126 KBdownload-circle](https://www.opioiddata.org/content/files/2024/08/Bis-Std.SPA "Download") From FTIR technician Blake in Portland, Oregon, the file below may be useful for technicians because it is mixed in with other substances and is more representative of how it appears on the street. See also the [corresponding GCMS](https://www.streetsafe.supply/results/p/804594) for this sample. (shared with permission) [Industiral\_chems\_frakenspectrumFrom Blake Joachim - combination of street drugs with industrial chemicalIndustiral\_chems\_frakenspectrum.091 KBdownload-circle](https://www.opioiddata.org/content/files/2024/08/Industiral%5Fchems%5Ffrakenspectrum.0 "Download") --- ## GCMS GCMS Screenshots of retention time and fragmentation pattern: ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/image-4.png) GCMS run of reference standard by UNC ## GCMS File [bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate GCMSRun on Agilent GCMS of reference standard by UNCBis-sebacate.D.zip481 KBdownload-circle](https://www.opioiddata.org/content/files/2024/08/Bis-sebacate.D.zip "Download") --- # Pharmacology ## Predicted receptor targets From Bryan Roth @UNC on July 11, 2024\. These are *predicted* binding sites based on molecular structure. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/image-5.png) ## Receptor screening List of receptors the substance has been screened against. This indicates that opioid receptors have not been previously considered as a potential binding site for bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate. [Receptor targets investigated for bis(2,2,6,6-tetramethyl-4-piperidyl) sebacateFrom Byran Roth at UNCpubchem\_cid\_164282\_bioactivity.csv97 KBdownload-circle](https://www.opioiddata.org/content/files/2024/08/pubchem%5Fcid%5F164282%5Fbioactivity.csv "Download") ## Calcium Channel Blocker The substance is believed to be a [L-type Ca(2+)-channel blocker](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC47601/). --- # FOIA Toxicity Studies [Uncovered: 1970s BTMPS tox studiesFreedom of Information Act information from FDA on bis(2,2,6,6,-tetramethyl-4-piperidyl) sebacate![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/square-icon.png)Opioid Data LabNabarun Dasgupta![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/Screenshot-2024-09-10-at-9.12.32-PM.png)](https://www.opioiddata.org/btmps-toxicity-foia/) --- # Scientific Literature *Thanks to Adams Sibley @ UNC for running the lit review! Missing something? Let us know opioiddatalab@unc.edu.* ## Epidemiology The pre-print for the Shover et al. article on the state of the 2024 outbreak. [Rapid emergence of UV stabilizer Bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate (BTMPS) in the illicit fentanyl supply across the United States in July-August 2024: Results from drug and drug paraphernalia testingBackground Changes to the US drug supply historically unfold slowly with predictable patterns of geographic diffusion. Here we draw on drug checking results from around the United States to report a rapid shift in the illicit drug supply with important implications for public health. Bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate, or “BTMPS” is a hindered amine light stabilizer with various industrial applications. Animal studies indicate multiple kinds of adverse health effects. Methods Drug samples collected by community-based drug checking programs in Los Angeles and Philadelphia, along with drug residue samples from other jurisdictions in California, Delaware, Maryland, and Washington, were submitted to the National Institute on Standards and Technology. Samples were qualitatively tested with Direct Analysis in Real Time mass spectrometry, with reflex to liquid chromatography mass spectrometry (LCMS) for confirmatory testing. Quantitation – percent by mass – was performed using LCMS. At both sites where drug samples were collected, participants were asked to respond to a survey that included questions about what the substance was sold as and any unexpected effects. Results Between June 1, 2024 and August 31, 2024, a total of 178 samples sold as fentanyl were tested. Of these, 43 (24%) contained BTMPS, with the proportion per month rising from 0% in June to more than a third in August. An additional 23 residue samples from sites doing residue testing contained BTMPS. Fentanyl samples with BTMPS also contained many other compounds, including local anesthetics and alpha-2 agonists. Average fentanyl purity was significantly lower in samples with BTMPS compared to samples without. Conclusions The introduction of an industrial chemical to the illicit drug supply at this speed and scale is unprecedented and concerning. Further research is urgently needed to determine why it is present in the fentanyl supply and characterize effects on human health. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement A portion of this work was funded by the Division of Overdose Prevention, National Center for Injury Prevention and Control (NCIPC), Centers for Disease Control and Prevention. Authors were also funded by grants from the National Institutes of Health. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: UCLA IRB determined that the activities described in this analysis, funded by CDC OD2A:LOCAL were public health surveillance and did not constitute human subjects research. The research activities in Philadelphia were approved by the WIRB-Copernicus Group (WCG IRB). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-2.ico)medRxivFind this author on Google Scholar![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/medrxiv_logo_homepage7-5-small-test-up.png)](https://www.medrxiv.org/content/10.1101/2024.09.13.24313643v1) ### ## Health effects: Heart and skin - [A light stabilizer Tinuvin 770-induced toxic injury of adult rat cardiac myocytes](https://doi.org/10.1016/S0379-0738%2800%2900462-X) - [Comparative Study on Cardiotoxic Effect of Tinuvin 770: A Light Stabilizer of Medical Plastics in Rat Model](https://doi.org/10.1093/toxsci/kfh025) - [First Evidence of Hindered Amine Light Stabilizers As Abundant, Ubiquitous, Emerging Pollutants in Dust and Air Particles: A New Concern for Human Health](https://doi.org/10.1021/acs.est.3c08884) - [Hemodynamic Effects of the Light Stabilizer Tinuvin 770 in Dogs *In Vivo*](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6142673/) - [Contact allergy to Tinuvin 770, a hindered amine light stabilizer in sandals contributing to hyperkeratotic foot dermatitis](https://doi.org/10.1111/cod.13279) ## Contamination - [Mass Spectrometry Contamination from Tinuvin 770, a Common Additive in Laboratory Plastics](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3605923/) ## Pharmacological effects Pharmacological effects: Nicotinic acetylcholine receptor antagonism - [Inhibition of nicotinic acetylcholine receptors by bis (2,2,6,6-tetramethyl- 4-piperidinyl) sebacate (Tinuvin 770), an additive to medical plastics.](https://jpet.aspetjournals.org/content/268/2/718.short) - [Functional Central Nicotinic Acetylcholine Receptor Antagonism by Systemic Administration of Tinuvin 770 (BTMPS)](https://doi.org/10.2174/1567205053585747) - [A light stabilizer (Tinuvin 770) that elutes from polypropylene plastic tubes is a potent L-type Ca(2+)-channel blocker](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC47601/) - [Muscle-type nicotinic acetylcholine receptor delta subunit determines sensitivity to noncompetitive inhibitors, while gamma subunit regulates divalent permeability](https://doi.org/10.1016/S0028-3908%2896%2900103-7) ## Implications for dependence - [The use-dependent, nicotinic antagonist BTMPS reduces the adverse consequences of morphine self-administration in rats in an abstinence model of drug seeking](https://doi.org/10.1016/j.neuropharm.2011.05.026) - [Novel bis-2,2,6,6-tetramethylpiperidine (bis-TMP) and bis-mecamylamine antagonists at neuronal nicotinic receptors mediating nicotine-evoked dopamine release](https://doi.org/10.1016/j.bmcl.2009.12.089) - [The α3β4\* nicotinic ACh receptor subtype mediates physical dependence to morphine: mouse and human studies](https://doi.org/10.1111/bph.12741) --- # Interpretation ⏳ ****Science in progress...** This is our current thinking, including hypotheses and scientific speculation. Nothing below should be seen as firm conclusions. We good? ## Observations - The substance is showing mostly mixed with fentanyl, with the exception of [one sample](https://www.streetsafe.supply/results/p/805374) by itself in Los Angeles, and [one mixed with xylazine](https://www.streetsafe.supply/results/p/805142) in Oregon. - We are not seeing consistent overdose reports with this substance, even when mixed in with other drugs. But reports out of the mid-Atlantic may suggest otherwise. - The substance was detected from southern CA to Seattle, from Oregon to Michigan to New York, all within a month. - Harm reduction drug checking programs picked this up before it showed up in post-mortem toxicology or law enforcement data. - Reports from participants suggest some liking of the substance, and that it may have some substitution (very loosely defined!) effect for fentanyl. But this bears further characterization before we jump to conclusions. We also note that unexpected sleepiness was noted by participants. For the most part the experiences have been very negative. - Many participants noted it has a distinct unpleasant smell. It’s interesting to note that it is used as a fragrance in air fresheners and candles. - MSDS list it as an eye irritant. *Updates since original publication:* - **August 23, 2024\.** We noticed that BTMPS was found in over a dozen fake blue M30 samples in Denver (806231, 806750, 806629, etc.). A few samples from New Mexico were also fake M30s, but as of now we aren't seeing BTMPS in fake pills elsewhere. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/image-8.png) BTMPS samples from CO and NM show disproportionately more as fake blue M30s; whereas elsewhere it is powder. Data run on Aug 23, 2024 ## Our Current Thinking ⚠️ This is our ****speculation.** Subject to change. We do our best to support our claims with data. - **The substance appears to be incorporated into local drug preferences**, such as Michigan having diphenhydramine also in samples (805660, 804976), but bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate was only seen in trace amounts and also co-occurring with fentanyl. This suggests that it most likely that the substance entered the supply chain along with fentanyl. Local producers may be repackaging it unknowingly when bagging up fentanyl. Similarly in NY samples (804945, 805518) where the local supply is consistently characterized by the presence of procaine, samples containing bis(2,2,6,6-tetramethyl-4-piperidyl) was seen with procaine. - **Initially west coast samples had levels of bis(2,2,6,6,-tetramethyl-4-piperidyl) that were higher than elsewhere**. In June, it was only detected in trace abundance in samples from NY and MI, whereas it showed up as a primary substance in the west coast samples from the start. By mid-July it had shown up as primary in a NY sample (804945). This may represent an initial dilution of an upstream-contaminated fentanyl supply as it moved west-to-east across the country, but it’s presence as a component of street dope may be increasing. We urge caution in interpreting these patterns since we are biased by what we see. ## Alternative hypotheses - Given it’s use in plastics, we have to rule out that the substance is appearing as a contaminant from plastic containers used to store street drugs. The single peak sample provides some credence to this being an intentional additive at least in one instance. - It’s [earlier characterization](https://pubmed.ncbi.nlm.nih.gov/8415734/) as a calcium channel blocker suggests human physiological effects could be similar to Rx medications that use this mechanism. Instead of presuming any “fentanyl-like effects” we need to understand the nuance of the subjective experience of people who use drugs, especially in samples where the substance is the only compound detected. > Calcium channel blockers are medicines used to lower blood pressure. They stop calcium from entering the cells of the heart and arteries. Calcium causes the heart and arteries to squeeze more strongly. By blocking calcium, calcium channel blockers allow blood vessels to relax and open. > > Some calcium channel blockers also can slow the heart rate. This can further lower blood pressure. > > \- [Mayo Clinic](https://www.mayoclinic.org/diseases-conditions/high-blood-pressure/in-depth/calcium-channel-blockers/art-20047605#:~:text=Calcium%20channel%20blockers%20are%20medicines,vessels%20to%20relax%20and%20open.) ## What we don’t know - We don’t if there is overdose risk. EVERY substance at some volume will be toxic. - We don't know if naloxone (or any other antagonist) will act on it. - We don’t know if this substance *alone* causes euphoric effects. - We don’t know where this is coming from, or how it spread so quickly. - We don’t know if this is being manufactured clandestinely or sourced from chemical manufacturers. - **We see no reason to jump to scheduling this substance.** --- # Talking Points 🧐 ****Be careful not to speculate.** ****Acknowledge the uncertainty.** ****Don't have your guess become misinformation.** ****Do not say anything you'll have to walk back later.** - This is a substance that should be avoided. - It is being found primarily mixed with fentanyl. - BTMPS is not a controlled substance. We have established in new experiments conducted in Fall 2024 that it does not bind to any psychoactive receptors in the brain or body. - The known science is decades old. It is largely limited to rodents. We don't know everything it does in the human body. The one thing that has been established is that it is a [calcium channel blocker](https://pubmed.ncbi.nlm.nih.gov/8415734/), which means it lowers blood pressure. - Involvement in a handful of overdoses has been hypothesized, but always in conjunction with fentanyl and other substances. Medical examiners do not assay for this substance in post-mortem toxicology, so overdose data are unavailable. Until there is a validated autopsy test, for the foreseeable future overdose data will be unreliable. - It has moved rapidly this summer, and been confirmed in samples from Los Angeles, Portland, Seattle, Michigan, Pennsylvania, and New York. It may be in other places. - For harm reduction providers, it is sufficient to say that an "industrial chemical is being found in the drug supply, come get your dope tested." - Complications from smoking drugs contaminated with have been reported. If you're having hard coughs, bloody coughs, or noticing a fishy or chemical smell, get your drugs tested and avoid that batch. - The unregulated drug supply is constantly changing. Harm reduction drug checking programs were the first to detect and identify this harmful additive. This demonstrates the importance of drug checking as a public health paradigm. - This is a wholly predictable outcome from the War on Drugs. New and more dangerous substances continually emerge. ## What not to do - Do not speculate on pharmacology (e.g., smooth muscle tissue, nicotinic receptors, etc.) based on PubMed searches of old studies. Almost no medical toxicologist or law enforcement will have expertise. They too are guessing. - Do not call it Tinuvin to media or participants. It's a handy name, but online searches for "tinuvin" won't provide useful information because it goes by other brand and scientific names. --- # Drug Alert ⚠️ ****Responsible communication.** At the current time do not recommend issuing drug alerts widely. We discourage news media attention because it will invariably lead to additional street interest. If the substance has been confirmed by drug checking, the local community of people who use drugs could be notified with restraint, providing information that is actionable. ****Alerts are brief**. Encourage participants to come in and talk to you so you can provide them with the most current information. **Our health message communication studies have revealed that *less* information on the alert is best for new adulterants during early phases to reduce unintended risk-seeking.** Links to further information are helpful, but the initial alert needs to emphasize the downsides in plain language. These drug alert templates were created by health messaging experts [Tushar Varma](https://www.linkedin.com/in/tusharvarma/) and [Allison Lazard](http://hussman.unc.edu/directory/faculty/allison-lazard) @ UNC, with illustrations by [Brittain Peck](https://brittainpeck.com/). They are open source and can be modified for your local needs. Here are the links to the full set of Canva [**templates**](https://www.canva.com/design/DAGHefTRqXI/WlPAp%5Fx%5FgoJVE2o6BMq2hg/edit?utm%5Fcontent=DAGHefTRqXI&utm%5Fcampaign=designshare&utm%5Fmedium=link2&utm%5Fsource=sharebutton) and Canva [**examples**](https://www.canva.com/design/DAGHeTgSGSk/NhG4FIgjFauVnldBFqAZzw/edit?utm%5Fcontent=DAGHeTgSGSk&utm%5Fcampaign=designshare&utm%5Fmedium=link2&utm%5Fsource=sharebutton)if you want a different look. Other file formats available: [PowerPoint, InDesign, Illustrator](https://cdr.lib.unc.edu/concern/multimeds/70795m43k?locale=en). [Edit in Canva](https://www.canva.com/design/DAGMoatfh8w/ZrUiDaEdm%5FOwxjXdJCWvIQ/edit?utm%5Fcontent=DAGMoatfh8w&utm%5Fcampaign=designshare&utm%5Fmedium=link2&utm%5Fsource=sharebutton) [Drug Alerts - Style Guide by Tushar VarmaDownload the style guide for how to effectively communicate drug alerts.Drug Alerts - Style Guide\_v3\_PRINT.pdf6 MBdownload-circle](https://www.opioiddata.org/content/files/2024/08/Drug-Alerts---Style-Guide%5Fv3%5FPRINT.pdf "Download") [Drug alert PDFPDF including working link for more information linking back to this page.Template 4 (1).pdf370 KBdownload-circle](https://www.opioiddata.org/content/files/2024/08/Template-4--1-.pdf "Download") ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/08/Template-4--1--1.png) Formatted for digital sharing. Recommended only for areas where substance has been confirmed. ## License [Drug alert for bis(2,2,6,6-tetramethyl-4-piperidyl) sebacate](https://www.opioiddata.org/mystery-substance-summer-2024/#drug-alert) by [Tushar Varma, Brittain Peck, Allison Lazard, Nabarun Dasgupta](https://streetsafe.supply) is marked with [CC0 1.0 Universal![](https://mirrors.creativecommons.org/presskit/icons/cc.svg?ref=chooser-v1)![](https://mirrors.creativecommons.org/presskit/icons/zero.svg?ref=chooser-v1)](https://creativecommons.org/publicdomain/zero/1.0/?ref=chooser-v1) --- ## Sign up for Opioid Data Lab news Street Drug Analysis Lab @ UNC Subscribe Email sent! Check your inbox to complete your signup. No spam. Unsubscribe anytime. ### Program Requirements URL: https://www.opioiddata.org/program-requirements/ Last updated: 2025-06-25T19:13:20.000Z 💡 This page explains who we provide services to. It is helpful for organizations who are considering using our service. If your organization type isn't discussed here, reach out to us and we can see what we can do together. 🔗 [Program home page](https://streetsafe.supply/) · [Order kits](https://www.streetsafe.supply/contact) · [Knowledge base](https://uncopioid.atlassian.net/servicedesk/customer/portals) Our team operates according to the principles of harm reduction and acknowledge the reality that drugs are not going anywhere anytime soon. Rather than continue to use imprisonment, harassment, ineffective treatment modalities, etc..., we work to mitigate the harms that are tied to drug use itself. We aim to do this while simultaneously working on positive change that create undue harm (often blamed on drug use itself). In line with our harm reduction philosophy and ethics, we ask that potential partner programs and agencies commit to abiding by the five requirements listed below. **We can only test samples collected via organizations.** ## Eligible Organizations - Harm reduction programs - FTIR-based drug checking for confirmatory/complementary - Drug user unions - Health departments (state and local) - Clinics - Hospitals - EMS - PORT teams - Universities and research studies ## Requirements 1. **Samples must be provided voluntarily**. We are not legally permitted to test drug samples for bags found by parents, confiscated from hospital patients, seized by police, etc. We only test drug samples. We do not test urine or other biological samples. 2. **There must be a credible and timely way to return results to sample donors**. As [we wrote in the *American Journal of Epidemiology*](https://academic.oup.com/aje/article/191/2/248/6370874): “First and foremost, the program’s primary purpose should be to deliver results in a timely manner to people who use drugs to empower behavior change.” In the kit, we include a QR code card that can be given to the sample donor to help satisfy this requirement. We have found that more active engagement with people who use drugs can be of mutual benefit. 3. **We do not provide services to anyone working with law enforcement.** Our results are not admissible in court because they are anonymous and lack chain of custody pedigree. 4. **Sample collection must be done by someone on your staff.** We send batches of five kits with one return mailer. Everything is prepaid and included in the **price per sample#LINK**. You can request as many kits as you can use. The shelf life is 2-3 months. 1. We ask that trained program staff be the ones to collect the sample and put it in the vial. In our experience, giving kits to participants and asking them to bring them back or mail them directly is not successful. 2. Only a tiny sample (less than a grain of rice) is needed, and we can also accommodate used cottons or swabs of empty bags. We do not test urine or hair or other biological samples. 5. **Sample results cannot be used to deny treatment or penalize patients**. Knowing what is in the local drug supply can allow clinicians to better help patients. However, we are also wary how some clinics will use the information. Therefore, our staff will reach out to you to understand your clinic’s needs. We can share experiences on how drug checking has helped other programs. We are hoping clinics will bring new creativity on how to apply knowledge of the street drug supply, and include patients in decision making. ## Some Considerations - Shipments to Alaska, Hawaii and Puerto Rico may take weeks in transit in both directions due to being legally required to use FedEx Ground. We haven’t worked with many programs in these places, so we would be happy to work with together to figure out options. - Do not use other shipping services. Your samples will not get to us. Trust us, we’ve tried all the other options, and FedEx Ground is the only one that is reliable. - We only accept drug samples dissolved in the vial in our kits. Don’t send us bags of dope. Seriously, don’t. ### Lab Options URL: https://www.opioiddata.org/lab-options/ Last updated: 2025-03-07T20:53:35.000Z We aren't the only game in town. Other labs provide support services for drug checking and we encourage you to check them out. Many programs have contracts with more than one lab to answer different types of questions. 🥼 At UNC, our goal is to provide accurate, affordable, rapid, and high throughput drug composition analysis for public health. Below is a short list of labs that we feel have scientifically rigorous methods. You may also find local university labs that can meet your drug checking needs. --- # Questions to ask - What is the cost per sample? - What is your turn around time? - How do we send samples? - Do you search for all drugs, or a subset of common ones? - How are results delivered? - Do you work with law enforcement? - How long is the contract period? Are there minimums we must meet? - How do you help programs interpret results? --- # CFSRE The Center for Forensic Science Research and Education is the non-profit arm of NMS Labs in Pennsylvania. They use multiple detection methods, and have quantification capabilities. They have a strong track record of working with harm reduction programs. [The Center for Forensic Science Research & Education![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon-13.png)The Center for Forensic Science Research & Education![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/logo.png)](https://www.cfsre.org/) --- # NIST The National Institute of Standards and Technology is a federal government agency based in Maryland. They currently have options for free testing for community groups using DART-MS. [NIST Partnership Helps Communities Manage Unknown Dangers in Common Street DrugsWhen you buy a medication at a pharmacy, you know what’s in it. When someone buys street drugs, they have no idea what they’re really getting![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-10.ico)National Institute of Standards and TechnologyEdward Sisco![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/ed_sisco_dart_machine.jpg)](https://www.nist.gov/blogs/taking-measure/nist-partnership-helps-communities-manage-unknown-dangers-common-street-drugs) --- # DrugsData.org/Erowid Center The OGs in drug checking in the US! Based in California, they have been doing this work for decades. Check their website to see if they are currently accepting samples. ### Meth purity tracker URL: https://www.opioiddata.org/meth-purity-tracker/ Last updated: 2024-09-11T13:06:41.000Z In [our published analysis](https://www.sciencedirect.com/science/article/pii/S0376871623012231) we found the adjusted prevalence of fentanyl was 12.5% (95% CI: 2.2%, 22.9%) in powder methamphetamine, with notable geographic variation. Crystalline forms of methamphetamine (Chisq=57, p<0.001) were less likely to contain fentanyl: less than 1% of crystal methamphetamine (2/276). # Crystal vs powder meth The graph below shows the number of substances detected in crystal vs. powder methamphetamine samples. The red dashed line at 1.0 represents if methamphetamine was the only substance detected in that sample. Crystal meth rarely contains adulterants. # Changes over time One way to measure meth purity over time is to look at the percent of meth samples that have more than one substance. In this graph more contamination (less purity) is higher — so generally the higher the number the more adulterated. We’ve seen an uptick in meth adulteration from April through July 2024\. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/07/IMG_5857.png) 💡 Our meth tracker live report with these analyses and more is updated daily. [Methamphetamine TrackerData apps for data scientists and data analysts.![](https://deepnote.com/static/apple-touch-icon.png)DeepnoteOpioid Data Lab![](https://deepnote.com/project/dc555ee4-5c80-4fcd-b64b-c360d0e4ce07/social-image)](https://deepnote.com/app/opioiddatalab/Methamphetamine-Tracker-dc555ee4-5c80-4fcd-b64b-c360d0e4ce07) [All Data Trackers](https://uncopioid.atlassian.net/wiki/external/ZTk5NGQ0YWE3NDA1NGEwZGIxZjhiMDUyNGQ1ZWJiY2M#2.-Live-Reports) ## Data Caveats First, we are not differentiating between l- and d- isomers of meth. Second, we get more more samples from NC, WA, NY, CA, and MI than other states. Geographic data below should not be construed as prevalence. Third, people may preferentially send us samples because they caused unusual reactions. There is no possible data source on street drugs that is fully generalizable. Fourth, some “adulteration” of meth is intentional. Combos of meth + opioids may be sold as speedballs or goofballs. We aren’t trying to make a value judgement on these, but rather trying to describe what’s out there. ### Is "surveillance" a bad word? URL: https://www.opioiddata.org/is-surveillance-a-bad-word/ Last updated: 2024-07-18T23:30:41.000Z Recently in the *American Journal of Public Health*, we've been pondering whether it's time to retire the word "surveillance" when it comes to public health monitoring. Some of this semantic argument has real impact on how we think about data from drug checking. Three journal editors weighed in on the pros, cons, and alternatives in [this editorial](https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2024.307709) \[open access\]. > In the October 2023 issue of the Journal, [Kassler and Bowman](https://bit.ly/3Uvcot5) eloquently outlined why the term “surveillance” has proven to be an unfortunate choice within the realm of public health. Among the many reasons cited is the fact that “surveillance” is jargonistic and often misconstrued as a form of police activity or spying. Presently, the work is also linked to big tech tracking of consumer information for marketing purposes. Surveillance systems are also rooted in the needs of military emergency management, which prioritize immediate action over a deeper understanding of drivers of population heath ([cite](https://ojs.library.queensu.ca/index.php/surveillance-and-society/article/view/3251)). **“Syndromic surveillance” systems have been criticized because the practice “**[**prioritizes standardized and transportable knowledge over local and context-dependent knowledge**](https://www.mdpi.com/2075-4698/4/3/399)**.”** **We feel strongly that drug checking data are could head this direction unless we keep the service focused on meeting the needs of people who use drugs.** > For several months, *AJPH* has advocated adopting the term “public health monitoring” in lieu of “public health surveillance” ([cite](https://bit.ly/3UYIWxj), [cite](https://bit.ly/3y8QhkM)). Public health monitoring encompasses the systematic collection of population data aimed at tracking the health status of populations. We have now officially updated our [Instructions for Authors](https://bit.ly/3UWezHI) to encourage the systematic and consistent use of this terminology. > We note that the term “monitoring” is not entirely free of negative connotations either, even if these are not as readily apparent. In the context of global public health, “monitoring” may evoke systems of oversight established during colonialism: activities of [grantees in low-resource settings](https://bit.ly/3y0mElt) are “monitored” by donors in wealthier countries who have little knowledge of local context. Monitoring also has the taint of law enforcement punishment, specifically the practice of location-tracking devices affixed like shackles onto the ankles of parolees. **The commonality across these diverse settings is that information is** [**extracted for the benefit of authority powers**](https://bit.ly/3UsxBUB) **at the expense of local expertise**. ### Secret Shopper: $96 for Narcan in NC Pharmacies?! URL: https://www.opioiddata.org/96-for-narcan-in-nc-pharmacies-2/ Last updated: 2024-08-29T20:18:37.000Z **Context.** Just prior to naloxone [going OTC](https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray), we wanted to document how much naloxone nasal spray (Narcan) cost out of pocket at community pharmacies in NC. So we did a phone-based secret shopper study, of 202 community pharmacies [recently published](https://doi.org/10.1016/j.japh.2024.01.017). (email us if you need the PDF) This work was led by [Delesha Carpenter](https://pharmacy.unc.edu/directory/dlmiller/) and team at UNC Eshelman School of Pharmacy. ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/07/image-1.png) This paper was peer-reviewed. **By the Numbers.** Only 53% of pharmacies were willing to dispense naloxone without a prescription using [NC standing orders](https://naloxonesaves.org/for-pharmacists/north-carolinas-standing-order-for-naloxone/). Chain pharmacies (64%) were more likely than independent pharmacies (35%) to use the standing order. **Go Deeper**. The average cost for Narcan was approximately $96 (mean: $96.27; standard deviation \[SD\]: $38.16, median: $90). The average cost of naloxone at chain pharmacies (mean = $84.69; SD 34.9, median: $76.22) was significantly lower than independent pharmacies (mean = $113.54; SD: 36.54, median: $104.98). **Between the Lines**. Naloxone availability was not significantly different by rurality (χ2 \= 1.77, df = 4, *P* value = 0.78). **Yes, But**. Now that some naloxone nasal sprays are OTC, the price we've seen on the shelves is around $50, but we will systematically measure that in the fall to see what effect OTC status has on price. **Go Deeper**. Other results from the study provide more detail, below. > All health department pharmacies that reported they would dispense naloxone also said they would dispense naloxone for free. At community pharmacies, the cost ranged from $38.11 to $220.00 for a 2-pack box of 4-mg nasal spray. In 13 of 197 calls, pharmacies indicated that they could not look up the cost of naloxone without an active prescription. The average cost across all calls was approximately $96 (mean: $96.27; standard deviation \[SD\]: $38.16, median: $90). The average cost of naloxone at chain pharmacies (mean = $84.69; SD 34.9, median: $76.22) was significantly lower than independent pharmacies (mean = $113.54; SD: 36.54, median: $104.98) (t = 4.57, df = 130, *P* < 0.001). Quoted out-of-pocket cost was not statistically different between pharmacies on and off the standing order participant list (t = −1.731, df = 139, *P* \= 0.97). ![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/2024/07/image.png) ### Background According to a standing order in North Carolina (NC), naloxone can be purchased without a provider prescription. ### Objective The objective of this study is to examine whether same-day naloxone accessibility and cost vary by pharmacy type and rurality in NC. ### Methods A cross-sectional telephone audit of 202 NC community pharmacies stratified by pharmacy type and county of origin was conducted in March and April 2023\. Trained “secret shoppers” enacted a standardized script and recorded whether naloxone was available and its cost. We examined the relationship between out-of-pocket naloxone cost, pharmacy type, and rurality. ### Results Naloxone could be purchased in 53% of the pharmacies contacted; 26% incorrectly noting that naloxone could be filled only with a provider prescription and 21% did not sell naloxone. Naloxone availability by standing order was statistically different by pharmacy type (chain/independent) (χ2 \= 20.58, df = 4, *P* value < 0.001), with a higher frequency of willingness to dispense according to the standing order by chain pharmacies in comparison to independent pharmacies. The average quoted cost for naloxone nasal spray at chain pharmacies was $84.69; the cost was significantly more ($113.54; *P* < 0.001) at independent pharmacies. Naloxone cost did not significantly differ by pharmacy rurality (F2,136 \= 2.38, *P* \= 0.10). ### Conclusion Approximately half of NC community pharmacies audited dispense naloxone according to the statewide standing order, limiting same-day access to this life-saving medication. Costs were higher at independent pharmacies, which could be due to store-level policies. Future studies should further investigate these cost differences, especially as intranasal naloxone transitions from a prescription only to over-the-counter product. ### New to Drug checking? URL: https://www.opioiddata.org/coming-soon/ Last updated: 2026-05-11T15:47:33.000Z Check out our [Drug Checking Basics](https://uncopioid.atlassian.net/wiki/external/ZmRiZTljZGE1M2E4NDIzMzk2NGVhM2IyZjg4YTI1OWY). --- ## The Experts If you’re ready to get a machine and do drug checking, the best place to get started is the [Drug Checkers Guild](https://www.drugcheckingftp.org/) drop-in hours at Remedy Alliance For The People. They meet second and fourth Wednesdays 4pm EST/3pm CST/1pm PST ([link to zoom](https://us06web.zoom.us/j/84825486071)). **Please review the resources below before going to office hours.** A lot of careful attention went into developing these free guides from around the world. You can get much of what you need answered right here. 🤔 There is a ton of interest in drug checking right now, and we are glad to see it. But the people who have the most experience are also hard at work providing direct service. Therefore we ask you to be considerate of experts' time. Here's direct links to RAFTP [pre-implementation checklist](https://www.drugcheckingftp.org/resources/pre-implementation-preparation-for-drug-checking-programs), [job description for technician](https://www.drugcheckingftp.org/resources/drug-checking-technician-job-description), [materials list](https://www.drugcheckingftp.org/resources/materials-list-for-drug-checking), [sample budget](https://www.drugcheckingftp.org/resources/sample-drug-checking-program-budget), and [considerations for new technologies](https://www.drugcheckingftp.org/resources/considerations-for-new-drug-checking-technologies). Our Canadian colleagues have **excellent** resources, like the [Drug Checking Implementation Guide](https://drugcheckingbc.ca/wp-content/uploads/sites/2/2022/07/BCCSU%5FImplementation%5FGuide%5F2022.pdf), [standard operating procedures (SOPs)](https://drugcheckingbc.ca/guidance/), and [technician manuals](https://drugcheckingbc.ca/technician-tools/). [StreetCheck](https://www.info.streetcheck.org/new-to-drug-checking) at Brandeis University has these startup resources: [Drug Checking Presented by Folks who Aren't Scientists](https://www.info.streetcheck.org/%5Ffiles/ugd/1817d1%5Fb267919eb410472a9a08dd05ce555273.pdf), [technology and partnership considerations](https://drugchecking.community/wp-content/uploads/dlm%5Fuploads/2023/04/TDCS%5FOnsite-drug-checking-technology-purchase-and-partnership%5Fv4.pdf), [the 3 stages of program maturity](https://www.info.streetcheck.org/%5Ffiles/ugd/1817d1%5F7ed4a46b2a304c14aa933541abffccc3.pdf), [plain language summaries of substances](https://www.info.streetcheck.org/the-cut). The Trans European Drug Information Network ([TEDI](https://www.tedinetwork.org/)) has this great set of [guidelines for methodology](https://www.tedinetwork.org/guidelines/). --- ## Government Resources [Drug Checking | National Institute on Drug AbuseResearch is evaluating whether checking drugs for substances like fentanyl and xylazine may reduce harm.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/apple-touch-icon.png)National Institute on Drug AbuseNational Institute on Drug Abuse![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/GettyImages-1418246524.optimized.jpg)](https://nida.nih.gov/research-topics/drug-checking) From a governmental level, although from 2021 and a lot has expanded since then, [this ASPE document is a decent review](https://aspe.hhs.gov/sites/default/files/documents/79e1975d5921d309ed924148ef019417/drug-checking-programs.pdf). [Introduction to Drug Checking and its Role in Harm Reduction | Office of Justice ProgramsIntended for professionals who work in or provide ancillary services for public health and public safety, this “In-Brief” from the Forensic Technology Center of Excellence presents an overview of harm-reduction services for people who use illicit drugs (PWUD) in the United States, describes modes of drug checking within harm-reduction settings, and offers observations and lessons learned from emerging drug-checking needs.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon.png)Office of Justice Programs![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/ojp_og.png)](https://www.ojp.gov/ncjrs/virtual-library/abstracts/introduction-drug-checking-and-its-role-harm-reduction) --- ## Scientific Evaluations [Drug checking services for people who use drugs: a systematic reviewDrug checking services provide people who use drugs with chemical analysis results of their drug samples while simultaneously monitoring the unregulated drug market. We sought to identify and synthesize literature on the following domains: (a) the influence…![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/favicon-192.png)PubMed Central (PMC)Nazlee Maghsoudi![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/pmc-card-share.jpg)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9299873/) --- ## Legal Analysis [Legality of Drug Checking Equipment in the United States - Network for Public Health LawContaminants including fentanyl and fentanyl analogs are now present in the illicit drug supply throughout the U.S. Because no safe supply of most illicitly used drugs is available, helping people determine what is in the drugs they obtain can be an impactful harm reduction intervention. The easiest and most inexpensive way to accomplish this is often through use of fentanyl test strips and xylazine test strips. This resource outlines the legality of drug checking equipment in 50 states and the District of Columbia.![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-N-Logo-2-270x270.png)Network for Public Health LawCorey Davis![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/iStock-157398714-scaled.jpg)](https://www.networkforphl.org/resources/legality-of-drug-checking-equipment-in-the-united-states/) ### Doctor Visits URL: https://www.opioiddata.org/doctor-visits/ Last updated: 2024-09-12T18:27:15.000Z In January 2024, we had an *epic* time hosting Dr. David Nichols, a true pioneer in psychedelic research, and his awesome friends! Pictured above, you can spot Dr. Nichols and friends, including Dr. Glenn Withrow, as we gave them a tour of our lab. It was a blast sharing our drug checking process, swapping stories, and soaking up knowledge from one of the legends in the field! ### RTI URL: https://www.opioiddata.org/rti/ Last updated: 2024-09-12T01:41:32.000Z In January 2024, these amazing folks from RTI visited our lab. Pictured left to right is Nab, Nichole, Hope, Ruth, Cynthia, Lawrance. RTI International is a nonprofit research institute that provides science-based solutions and conducts research in areas such as health, education, environmental science, and social policy to address global challenges. Here is a link to the **Just Science** podcast, supported by RTI, *Just Increasing Access To Drug-Checking Services* episode featuring our very own Nab & Erin! [Just Increasing Access to Drug-Checking Services – Forensic Technology Center of Excellence![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/icon/cropped-favcon-ftcoe-270x270.png)Forensic Technology Center of Excellence - A program of the National Institute of Justice LogoErica Christensen![](https://storage.ghost.io/c/5b/77/5b77aa04-fe0b-45a2-a796-af3d64e3ea66/content/images/thumbnail/1920x300px_MDI-Myth-webinar-3_tox-screening_v1-744x300.jpg)](https://forensiccoe.org/podcast-2024-cossup-ep4/?ref=opioiddatalab.ghost.io) ### DrugsData URL: https://www.opioiddata.org/drugsdata/ Last updated: 2024-09-12T01:28:38.000Z In December 2023 Sylvia Thyssen from Erowid/DrugsData dropped by for a visit! DrugsData is an anonymous, independent laboratory analysis and drug-checking initiative run by the Erowid Center. We love connecting with other labs🤝