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, 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

👩🏽‍🔬Newly Detected Substances

In November, we saw 8 substances that were new-to-us. That's right in the middle of the normal range of new substances monthly.

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:

Here's the November list:

🔬 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 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 (by GCMS detection) and in a mix with just lidocaine (no psychoactive substances).

💫 Reversal Agents

See new expert statement from 60 health providers in North Carolina.

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). 🤣

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!

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 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) 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 by January 10, 2025.

✈️ Out and About

Nab was honored to be the keynote speaker (slides) at the HIT Hot Topics Conference in Liverpool, England last month. Here's the recap 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.

Photos by the legendary Nigel Brundson (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? Explores the implications of regime change in Syria and the hugely popular counterfeit stimulant
KFF Health News: Opioid Settlement Funds Tracked in New Database Details how states, counties, and cities allocate billions from opioid lawsuit settlements to address the crisis.
NY Times: Fraud Allegations at Acadia Methadone Clinics. Examines concerns of financial mismanagement and patient care at some of the largest methadone chains. Sad.
NYC Health: Drug Checking Program Implementation Guide 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 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.

And, you don't want to miss Maya Doe-Simkins and Eliza Wheeler discussing the first 2 years of Remedy Alliance naloxone distribution data over in the American Journal of Public Health. The supplemental table 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.

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 that you'll want to bookmark. From the monthly summary, ED visits for opioid overdose are down -35% since this time last year.

📣 Team Voices

Check out monthly blog posts from members of our team!

👋 Meet our Team Members

Each month will feature different team members 😊

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.

🏆 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.