〽️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 to report test strip results, please specify if “MTS” means methamphetamine or medetomidine!
😩 One Year of BTMPS
This handy review from David Zhu of the spread of BTMPS 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 updated daily.
"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.
📉 Department of Data
Are overdose deaths back to pre-COVID levels? Who's left behind? Our colleagues in Kentucky weighed in on this. 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]
🍄 Psychedelics
Our friends over at Rocky Mountain Poison & Drug Safety have a new report 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%).
🍻 Bye Bye Booze?
This article in Vox 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, 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).
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 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 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 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 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 involvement (42%) than usual (20-31%). Fentanyl in marijuana is a myth: Fent rarely shows up unexpectedly in other drugs, only 2%. From Canada, side effect analysis on novel drug supply adulterants. Consistent drug supplier doesn't translate to consistent drug supply in terms of quality. Two-out-of-three people share drug checking results with family and friends. UPenn has a good webinar recording on managing medetomidine withdrawal. Xylazine's emergence led to a doubling of amputations in Philly. People who use drugs in Philadelphia don't like xylazine 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 and having reasons for doing so; they tended to be White women. In the general population, only 3.6% had purchased OTC naloxone.
😵💫 Hallucinations with medetomidine
Adams just published this open access paper 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.
Adams Sibley
📣 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 Mvuendy
📖 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]
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 of Dr. Melody Glenn’s new book Mother of Methadone: A Doctor’s Quest, A Forgotten History, And A Modern-Day Crisis. "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, 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.
Suboxone: Another good book is Shoshana Walter's Rehab 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 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
❤️🩹
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.
🤗 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.
Orange County, NC has multiple openings for Outreach Specialist position!
NC Institute of Medicine 2025 Annual Meeting is November 13th. Find out more here!
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!
Don’t miss the Breaking Barriers: Compassionate Care and Community Engagement in the Opioid Crisis Conference on September 15th in Charlotte, NC. Register 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. Send us more doodles and notes! They sustain us.
Thanks for reading!!!
