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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
Acetamiprid
Xylazine & (dex)medetomidine
Carfentanil
Nitazenes
2-fluoro-2-oxo-PCE + fentanyl
Shift to smoking

Also, check out our running list of newly detected substances:

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.

You can see all the samples we've received at the link below.

We also did a FOIA request for the manufacturer's toxicity studies. Historical documents below.

Insecticide: Acetamiprid

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 popper 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.

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

If you're into academic commentaries, this is a good primer on xylazine. If video is more your speed, this great webinar 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 of xylazine masking benzo withdrawal.

How does it show up in the drug supply? Here's our take on the 5 ways we've seen it in our samples.

This is live report for NC xylazine samples:

Our partner lab at UNC also discovered that xylazine is a kappa opioid agonist.

This is our explainer thread for dex(medetomidine). The CSFRE alert 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

Carfentanil

It's around, 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.

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.

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. (Here's how harm reduction drug checking 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

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. Yes, sterile syringes and preventing HIV/hepatitis remain important. But glass smoking supplies are going to become increasingly important.

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

UNC Watchlist