One of the challenges for public health officials and other agencies trying to deal with the opiate epidemic in the U.S. is that drug-use behavior, trends and terminology at the “street” level are constantly changing, and at a rapid pace.
Monitoring emerging drug trends to enable health experts, researchers and others across the country to respond quickly to illicit drug outbreaks is the mission of the National Drug Early Warning System (NDEWS), a nationwide public health surveillance system.
NDEWS began in 2014 as a collaborative project of the National Institute on Drug Abuse (NIDA) and the University of Maryland’s Center for Substance Abuse Research (CESAR). CESAR received a five-year grant from NIDA. NDEWS has worked with White House Office of National Drug Control Policy (ONDCP) to implement the Community Drug Early Warning System (CDEWS), designed to identify emerging substance abuse trends in local criminal justice populations.
Being able to complete drug trend studies more quickly is crucial in the age of lab-synthesized, designer drugs, Wish notes. “I’ve been studying drug epidemiology for over 30 years and I’ve never seen anything like this. The nature of drugs changes so fast that drug testing companies can’t even keep up, and the people taking them have no idea what they are getting. Many of the drugs are made in clandestine labs that are often not in this country, so there are no controls.”
Using national and local data sources, NDEWS monitors and reports on drug trends in 12 “sentinel sites” across the U.S.: Maine, New York City, Philadelphia, Detroit, Chicago, Atlanta, Miami, Texas, Denver, Los Angeles, San Francisco and Seattle. NDEWS also reports on drug trends across the U.S. as new issues emerge.
NDEWS has established the NDEWS Network, a virtual community of scientists, government officials, public health experts, law enforcement representatives, and others for sharing information and assisting with local research. Methods developed for information collection include scanning social media and news media, developing a collaboration with the American Association of Poison Control Centers (AAPCC) and conducting site visits to local communities experiencing emerging drug problems or changes in drug use trends.
“When we started this NDEWS electronic network, we couldn’t have predicted that it would be such a big hit,” says Dr. Eric Wish, director of the Center for Substance Abuse Research. “We have more than 1,700 people connected on the network,” who can share research, share other findings and ask questions of each other.
NDEWS combines scientific data and anecdotal information from local sources, such as first responders, hospitals and other “people reporting what they are seeing on the street,” Wish says.
After a rash of fentanyl-related deaths in New Hampshire, NIDA asked Wish and his colleagues to do a “hot spot” study . ‘We met with scientists who put together a report on what available data showed about the problem. Then we contracted with two scientists at the University of Maine and Dartmouth to do additional studies.”
The Maine scientist accessed medical examiners’ records of about 500 drug-relateed deaths in the state. The study also included analysis of 136 urine samples collected by toxicology labs to find out what drugs people had been using. “One of the main findings was that people who died of fentanyl-related overdoses tended to have an average of six different drugs in them at the time of death,” Wish says.
“We do a lot of research on biological specimens of people who have been using fentanyl or other drugs. Although we blame most of the overdoses on opiates, the truth is, people who overdose are using a lot of different drugs,” he says.
The Maine study also included interviews with first responders and “people on the street,” Wish says. One of the primary needs identified was more availability of Narcan, and more education in the use of Narcan. “The hot spot study was really successful,” Wish says. “It was done in a relatively short time” about nine months, compared to one, two or more years to complete most, similar studies.
As another way to keep up with changing street drug patterns, Wish and his colleagues have also been working with linguistic experts at the university, “to help us track and analyze drug-related tweets.” Geographic scientists at the school are helping map the locations of current drug problem areas. “And we can bring other scientists in, as needed.”