National Drug Early Warning System (NDEWS): New Findings on Synthetic Opioids from NDEWS Sentinel Community Sites (SCS) and HotSpots

The National Institute on Drug Abuse (NIDA) awarded funding to CESAR in 2014 to create the Coordinating Center for the National Drug Early Warning System (NDEWS). NDEWS is the first national public health surveillance system in the United States with the ability to monitor SCSs and conduct HotSpot studies to rapidly identify emerging drugs, especially NPS and their metabolites, and facilitate a more rapid and informed response to outbreaks and changes in substance use and misuse.

Methods: NDEWS Coordinating Center staff work with experts across the U.S. to collect, generate, and disseminate critically-needed information about emerging drugs and their public health consequences. Synthetic opioids became a special focus in 2016. Data and information on opioids such as fentanyl were collected through a combination of activities, including the NDEWS Network of more than 1,500 drug experts from around the world, a targeted HotSpot study in New Hampshire, analyses of national and local drug indicators nationwide and in 12 Sentinel Community Sites (SCS), language studies, and regular newspaper and web scans. The recently completed HotSpot study conducted with researchers at Dartmouth College, University of Maine, and University of Maryland involved structured interviews with first responders, emergency personnel, and drug users and an in-depth analysis of fentanyl-related overdose deaths including medical record reviews, geospatial analyses of deaths and sociodemographic indicators, and expanded urinalyses.

Results: NDEWS techniques support rapid, informed, and effective interdisciplinary responses to emerging drug trends. Recent epidemiologic research has focused on heroin, fentanyl, and other synthetic opioids to assess local drug trends and how these trends may vary across the country. A just completed HotSpot study on increases in fentanyl overdoses in New Hampshire that involved two parts will be discussed: structured interviews with 111 first responders, emergency personnel, and drug users and an innovative in-depth analysis of 540 decedent medical and behavioral histories coupled with interaction between mortality experts and clinical specialists to generate hypotheses and prevention approaches. Data for 12 NDEWS SCSs including drug treatment admissions, drug poisoning deaths, law enforcement seizures, and poison center calls highlighting current local synthetic opioid trends will also be reviewed.

Discussion: The presenters will discuss late-breaking research findings assessing increases in overdoses related to synthetic opioids for NDEWS SCSs and New Hampshire and will review progress made establishing NDEWS, highlighting challenges and successes in identifying emerging drugs and drug trends. Successes to be highlighted include innovative methodologies for investigating local outbreaks through HotSpot studies, how HotSpot studies can support local efforts to drug overdoses, and analyzing social media to identify changes in how people talk about drugs and drug use.