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New drugs and drug use trends often burst on the scene rapidly. NIDA’s National Drug Early Warning System (NDEWS) reports on emerging trends and patterns in many metropolitan areas and states.

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NDEWS Publications
The NDEWS Sentinel Community Site Reports for 2018 (describing drug use trends in the 12 NDEWS sentinel communities) are now available on the NDEWS website.
NDEWS Presents are monthly webinars convened by the NDEWS Coordinating Center to explore emerging drugs and timely drug-related topics.

Past announcements are available on the NIDA Archives site

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CDC and FDA Issue Updates on Vaping-Related Health Issues

Updated October 18, 2019

Originally posted October 2019; Links below are frequently updated

The CDC and FDA have posted and continue to update important information for consumers related to recent deaths and illnesses that could be linked to vaping:

U.S. Surgeon General Warning on Marijuana Use in Adolescence and During Pregnancy

Posted on August 30, 2019

The U.S. Surgeon General has issued a warning about the potential health risks of marijuana use in adolescence and during pregnancy. The warning, which states that no amount of marijuana use during pregnancy or adolescence is known to be safe, comes after recent increases in access to marijuana, and long term trends in higher potency. The Surgeon General notes a 2018 recommendation from the American Academy of Pediatrics against marijuana use during pregnancy based on concerns for its potential impact on the developing fetus. He also cites research suggesting that frequent marijuana use during adolescence is associated with changes in the areas of the brain involved in attention, memory, decision-making, and motivation, and notes that earlier initiation of marijuana use is associated with an increased risk of developing addiction.

State of Illinois Announces Death Linked to Vaping; Warns of Respiratory Illnesses

Posted on August 26, 2019

The State of Illinois has announced the death of an individual who was hospitalized with a severe respiratory illness after vaping. This comes after a public health warning earlier this month about 22 people ranging in age from 17-38 who were hospitalized with respiratory illness after vaping nicotine or THC, the main psychoactive ingredient in marijuana. The Illinois Department of Public Health (IDPH) also reported that it is trying to track down the source of these illnesses, working with local health departments, other state health departments, the Food and Drug Administration and the Centers for Disease Control and Prevention (CDC) to investigate the names and types of e-cigarettes, vaping products, and devices, as well as where they were obtained. IDPH urges anyone experiencing chest pain or difficulty breathing after vaping or using e-cigarettes seek immediate medical attention, and encourages health care providers who see patients with these pulmonary symptoms to ask about their vaping history.

FDA Special Announcement: Reports of Seizures After Using Nicotine Vaping Devices

Updated August 08, 2019

Update: On August 7, 2019 the FDA issued an FDA In Brief asking the public for information on the possible connection between vaping and seizures. Although the FDA does not have enough information to determine if e-cigarettes are causing the seizure incidents, they are seeking additional information from the public.

(From the FDA web site) The FDA has become aware that some people who use e-cigarettes have experienced seizures, with most reports involving youth or young adult users. Seizures or convulsions are known potential side effects of nicotine toxicity and have been reported in the scientific literature in relation to intentional or accidental swallowing of e-liquid. However, a recent uptick in voluntary reports of adverse experiences with tobacco products that mentioned seizures occurring with e-cigarette use (e.g., vaping) signal a potential emerging safety issue. The FDA continues to monitor all adverse experiences reported to the agency about the use of e-cigarettes and encourages the public to report cases of individuals who use e-cigarettes and have had a seizure via the online Safety Reporting Portal, as further described below.

Seizures result from sudden, abnormal electrical activity in the brain. Though often associated with convulsions in which a person’s entire body shakes uncontrollably, not all seizures show full-body shaking. Other possible signs of seizures include a lapse in awareness or consciousness, which may look like a person is staring blankly into space for a few seconds or suddenly stops moving. The person may or may not fall down. Most seizures end in a few seconds or minutes, and the person may seem fine, sleepy, confused or have a headache afterwards. They may not remember what they were doing or what happened right before the seizure. While seizures generally do not cause lasting harm, they indicate the need for prompt medical attention to look for a cause and to prevent future seizures, if possible. If you think a person is having a seizure, call 911 and seek immediate medical help. For exposures with less serious visible effects or if you have questions, call poison control at 800-222-1222.

Select Kratom Products Recalled Due to Potential Contamination with Salmonella

Posted on March 06, 2019

The U.S. Food and Drug Administration posted Sunstone Organics’ recall announcement on March 1, 2019. Sunstone Organics is voluntarily recalling two lots of Sunstone Organics Kratom. These two lots include Sunstone Organics White Vein Kratom Lot 119 and Sunstone Organics Maeng Da Kratom Lot 124A in both capsules and powder form and in all sizes. The products have been found potentially to be contaminated with Salmonella.

Symptoms of Salmonella can include: illness, vomiting, and in some cases, even death.

For more information about this recall see – Sunstone Organics Issues Voluntary Nationwide Recall of Select Kratom Products Due to Potential Contamination by Salmonella (FDA)

Ohio State Highway Patrol Reports Heroin and Fentanyl Mixture in Ross Correctional Institution

Posted on September 06, 2018

The Ohio State Highway Patrol identified a mixture of heroin and fentanyl found in the Ross Correctional Institution in Chillicothe after one inmate showed possible signs of an overdose and 27 staff members required medical attention on the morning of August 29, 2018. The inmate and several staff members received doses of naloxone prior to hospitalization. One staff member/first responder and one inmate remain in treatment.

For more information:

Connecticut Governor Warns of Overdoses Linked to K2/Spice

Posted on August 17, 2018

The Governor of Connecticut, working with the state Department of Public Health (DPH) and Department of Mental Health and Addiction Services, issued a statement in response to a large number of overdoses linked to synthetic cannabinoids (K2 or Spice) in the New Haven, CT area in mid-August, 2018.

For more information about the alert:
https://portal.ct.gov/Office-of-the-Governor/Press-Room/Press-Releases/2018/08-2018/Gov-Malloy-Statement-on-Outbreak-of-Overdose-Cases-in-New-Haven and https://www.newhavenct.gov/news/displaynews.htm?NewsID=527&TargetID=61

For more information about synthetic cannabinoids:
https://www.drugabuse.gov/publications/drugfacts/synthetic-cannabinoids-k2spice

FDA Warns of Synthetic Cannabinoids Laced with Anticoagulant

Posted on July 26, 2018

The U.S. Food and Drug Administration issued a warning statement on July 19, 2018 about numerous health emergencies, mostly in midwestern states, caused by consumption of synthetic cannabinoid products laced with brodifacoum, an anticoagulant (blood-thinning) compound commonly used in rat poison. Hundreds of users of synthetic cannabinoid products typically sold in gas stations and convenience stores under various brand names such as “K2” and “Spice” have been treated for complications such as bleeding, and several people have died. Users of these products should be alert for bleeding and other symptoms like easy bruising, oozing gums, and nosebleeds and seek medical attention if they suspect they may have consumed contaminated drugs. Brodifacoum remains in the body a long time and can raise bleeding risk for weeks after consumption.

Delaware Health Officials Issue Warning on Heroin Products

Posted on June 04, 2018

A mound of powder heroin Photo by ©iStock.com/Kondor83

The Delaware Department of Health and Social Services issued a warning about heroin to people with substance use disorders, after two people died from suspected overdoses in a 24-hour period. The two deaths occurred on May 24 and May 25 and involved heroin packets with the same stamp. In Delaware, there have been 106 deaths from suspected overdoses through May 27 of this year, including three since Friday, May 25.

Physical signs of heroin overdose include:

Face is extremely pale or clammy to touch
Breathing is very slow or stopped
Body is limp
Fingernails or lips are blue or purple
Vomiting or making gurgling noises
Cannot be woken up from sleep or unable to speak
Slow heartbeat and/or low blood pressure

If you suspect an overdose, please call 911 immediately. Under Delaware’s 911/Good Samaritan Law, people who call 911 to report an overdose and the person in medical distress cannot be arrested for low-level drug crimes.

For more information about the alert: https://news.delaware.gov/2018/05/29/delaware-health-officials-issue-warning-2-deaths-involve-stamp-packets-heroin/

For more information about heroin: https://www.drugabuse.gov/publications/drugfacts/heroin

New York City Police Department Issues Alert on Synthetic Cannabinoid Products

Posted on May 21, 2018

Image of K2-Spice package Image Courtesy Lieutenant John Grimpel, NYPD

The New York City Police Department (NYPD) has issued an advisory alert for residents in the Brooklyn North Borough Command, warning people about a toxic batch of K2 that has been linked to 49 overdose cases since May 18. The NYPD is investigating the specific source of the drug distribution and has made arrests.

Synthetic cannabinoids like K2 are human-made mind-altering chemicals that are sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense and are marketed under a wide variety of specific brand names, including K2 and Spice and often labeled “not for human consumption.”

Synthetic cannabinoids can cause serious mental and physical health problems including:

rapid heart rate
vomiting
violent behavior
suicidal thoughts

Officials urge citizens to call 9-1-1 immediately if they or someone they know are experiencing signs of overdose. For more information: http://nypdnews.com/2018/05/nypd-issues-k2-advisory-warning-brooklyn-residents/

Counterfeit “Oxys” Containing Dangerous Fentanyl in Mississippi

Posted on May 11, 2018

Photo of Oycontin pills Photo courtesy of NLMWhile not an actual photo of the recovered pills, this photo is very similar – round blue pills marked with “A 215.”

Police in Gulfport Mississippi have issued a warning to the public (May 7, 2018) about counterfeit Oxycodone tablets that look like regular “oxys” but are actually made of the dangerous synthetic opioid fentanyl. Analysis in a DEA lab revealed the pills contained no oxycodone at all. Pills containing fentanyl carry a high risk of overdose and death, especially if users are unaware of their actual content and are likely to take too many. For more information: http://www.gulfportpolice.net/notices/public-notice-oxycodone-fentanyl/

FDA Cites 40 Retailers for Violations Related to Youth Sales of JUUL E-Cigarettes

Posted on May 08, 2018

iIage of a JUUL e-cigarette device in a hand Photo by:CC BY-SA 4.0

The Food and Drug Administration (FDA) has been conducting a nationwide effort to stop the sale of popular e-cigarette brands to youth, like JUUL, at brick-and-mortar stores and online retailers. Forty warning letters to various retailers were issued in April 2018. The JUUL brand is especially popular in youth and teens because it resembles a flash drive and is therefore difficult for parents and teachers to recognize. These products have high levels of nicotine and emissions that are hard to see. Reports show that teens are using and liking these products without knowing that they contain nicotine. This is problematic because we know that an adolescent brain is still developing, and early nicotine use can cause changes in the brain that result in continued use as an adult. Read more about the FDA press announcement.

FDA and FTC Take Action Against Manufacturers and Retailers Who Target E-Cigarettes to Youth

Posted on May 08, 2018

Photo by: FDA

The National Poison Data System data between January 2012 and April 2017 indicates there were more than 8,000 e-cigarette and liquid nicotine exposures amongst children under six. Exposure to nicotine in children is especially dangerous and can result in serious harm or even death. The FDA has collaborated with the Federal Trade Commission (FTC) to warn companies about selling e-liquids used in e-cigarettes with advertising that resemble kid-friendly products.

Children are mistaking these products for juice boxes, cookies, or candy and consuming the products. The FDA is considering issuing product standards and other regulations on e-cigarettes and similar products, including limiting flavors that appeal to youth, implementing child-resistant packaging, and instituting strict product labeling. Read more about FDA and FTC’s actions.

Multiple States Issue Alerts on Synthetic Cannabinoid Products

Updated April 06, 2018

Update – Indiana and Wisconsin (April 6, 2018)

Indiana State Department of Health and Wisconsin Department of Health Services also issue a warning about the dangers of synthetic cannabinoid product use, reporting cases in their respective states in which synthetic cannabinoid product users experienced symptoms similar to those experienced in Illinois. Read more about the warnings from the Indiana State Department of Health and the Wisconsin Department of Health Services.

Update – Maryland (April 5, 2018)

The Maryland Department of Health and Maryland Poison Center issued a memorandum yesterday to Emergency departments, emergency medical services, health care facilities, and local health departments reporting on a case in central Maryland in which a user of synthetic cannabinoids was hospitalized with symptoms similar to those experienced by cases in Illinois linked to synthetic cannabinoid product containing a rat poison that acts as an anticoagulant. Read more about this memorandum from the Maryland Poison Center.

Additionally, the Illinois Department of Public of Health has issued a second warning on April 4, 2018, stating that they have now received reports of 81 cases. Read more about this updated alert from the Illinois Department of Health.

The Illinois Department of Public Health (IDPH) has reported 56 cases of users of synthetic cannabinoid products experiencing severe bleeding, likely due to contamination. In each case, hospitalization was required for coughing up blood, blood in the urine, severe bloody nose, or bleeding gums. Two people have died.

IDPH does not yet know which product or products are associated with the reported emergencies and deaths. Nine people tested positive for a lethal rat poison called brodifacoum that acts as an anticoagulant (causing bleeding), thus suggesting that the drugs had been laced with this substance. Synthetic cannabinoid chemicals, while potentially dangerous, are not known to cause bleeding. IDPH’s investigation is ongoing.

Synthetic cannabinoids are chemicals related to THC (the active ingredient in marijuana), but often more potent, that are sprayed on dried, shredded plant material so they can be smoked or sold as liquids to be vaporized and inhaled in e-cigarettes and other devices. These products are also known as herbal or liquid incense and are marketed under a wide variety of specific brand names.

IDPH is advising that anyone who has a reaction to synthetic cannabinoid products, such as severe bleeding, should call 911 or have someone take them to the emergency department immediately. Read more about this alert from the Illinois Department of Health.

FDA Investigates Multistate Outbreak of Salmonella Infections Possibly Linked to Kratom Products

Posted on February 21, 2018

The U.S. Food and Drug Administration (FDA) along with the Centers for Disease Control and Prevention (CDC) and state and local officials are investigating a multistate outbreak of Salmonella infections linked to products reportedly containing kratom. The CDC reports that 28 people ages 6 to 67 years in 20 states are infected, with 11 people who have been hospitalized. No deaths have been reported.

Salmonella bacteria cause the foodborne illness salmonellosis. Most people infected with Salmonella develop diarrhea, fever, and abdominal cramps. The illness usually lasts 4 to 7 days, and most people recover without treatment. However, in the current outbreak, an unusually high rate of cases have been hospitalized for their illness.

Kratom is a tropical deciduous tree native to Southeast Asia, with leaves that contain mitragynine, a psychoactive opioid. Kratom is consumed for mood-lifting effects, pain relief, and as an aphrodisiac. It is marketed in many forms, including leaves, pills, capsules, powder, and tea.

The FDA, CDC, and state and local officials are working to identify specific brand names or suppliers of products and will share more information as it becomes available. If you have questions about food safety, call 1-888-SAFEFOOD or consult the fda.gov website at http://www.fda.gov.

Betel Quid

Posted on February 20, 2018

Betel quid usually includes a combination of the Areca nut (from the Areca catechu tree) and slaked lime (calcium hydroxide obtained by heating or harvesting sea shells or quarrying limestone) wrapped in a betel leaf. In some countries, when tobacco is added, the combination is called gutka; without tobacco, it’s called pan masala. Spices are also added in some cases for flavoring. It is the fourth most commonly self-administered psychoactive substance in the world after caffeine, alcohol, and tobacco and the most commonly used in Asia. It is estimated that more than 600 million people use betel quid worldwide.

The areca nut contains arecoline, muscarine, and pilocarpine, which can have stimulant and relaxation effects. The International Agency for Cancer Research has classified betel quid as being cancerous with or without tobacco. Other health effects include risk of having a low-birth weight baby if consumed while pregnant.

Although betel quid use disorder (BUD) is not formally identified as an addictive behavior, studies are looking at chronic use leading to myriad of health problems including oral health cancers. Read more in the Journal of the American Medical Association.