New drugs and drug use trends

New drugs and drug use trends often burst on the scene rapidly. NIDA’S Community Epidemiology Work Group (CEWG), which functioned through 2014, was a network of researchers in major metropolitan areas and some states across the United States that reported data on emerging trends and patters of drug use. 

NIDA’s National Drug Early Warning System (NDEWS) replaces the CEWG and reports on emerging trends and patterns of drug use in many of the same metropolitan areas and states as the CEWG, but also reports data from other areas of the nation, as problems arise. On this page we will provide periodic updates based on NDEWS reports and other reliable information, as well as links for where to go for more information.

"Flakka" (alpha-PVP)

Use of a dangerous synthetic cathinone drug called alpha-pyrrolidinopentiophenone (alpha-PDP), popularly known as "Flakka," is surging in Florida and is also being reported in other parts of the country, according to news reports.

Alpha-PVP is chemically similar to other synthetic cathinone drugs popularly called "bath salts," and takes the form of a white or pink, foul-smelling crystal that can be eaten, snorted, injected, or vaporized in an e-cigarette or similar device. Vaporizing, which sends the drug very quickly into the bloodstream, may make it particularly easy to overdose. Like other drugs of this type, alpha-PVP can cause a condition called "excited delirium" that involves hyperstimulation, paranoia, and hallucinations that can lead to violent aggression and self-injury. The drug has been linked to deaths by suicide as well as heart attack. It can also dangerously raise body temperature and lead to kidney damage or kidney failure.

U.S. and British Columbia Issue Alerts on Fentanyl

The U.S. Drug Enforcement Agency (DEA) has issued a nationwide alert about the dangers of fentanyl and related compounds (fentanyl analogues). Fentanyl, an opioid that is 50-100 times more powerful than morphine, is both abused on its own and commonly added to heroin to increase its potency. Fentanyl and fentanyl-laced heroin have been a concern for over a decade and have caused numerous overdose deaths among injection drug users in several U.S. cities.

Heroin is not the only drug that can be laced with fentanyl, however. Officials in Vancouver, British Columbia, Canada, recently issued public warnings about a wide range of fentanyl-laced drugs causing overdose deaths among users. They warn that fentanyl is now being concealed in non-injection drugs, including oxycodone and various "party drugs" in powder or pill form, as well as in marijuana (although no deaths have been confirmed from fentanyl-laced marijuana). Because of this new threat, British Columbia officials are urging all recreational drug users to "know their source."

HIV Outbreak in Indiana Linked to Abuse of Opana

Health officials in Indiana have announced a fast-spreading outbreak of new HIV cases in the southeastern portion of the state that are linked to injection drug abuse of the powerful prescription opioid painkiller Opana. Injecting drugs and sharing injection equipment is one of the main routes of transmitting HIV. Also, a few new HIV cases in southeastern Indiana were transmitted sexually.

Officials advise that people in southeastern Indiana who have engaged in needle sharing or unprotected sex should get tested for HIV and then re-tested after 2-3 months, as HIV may not appear on tests immediately when the virus is contracted. To reduce risk of contracting HIV, avoid injection drug use, sharing or re-using needles, and having unprotected sex or sex with commercial sex workers.

Warning from Europe: "Superman" pills

An alert was recently issued in The Netherlands warning about pills with a distinctive Superman logo, sold as MDMA (also called ecstasy or Molly) but actually containing a lethal dose of another substance, PMMA (paramethoxymethylamphetamine). These pills have not been reported in the U.S., but four people in the UK are thought to have died after taking these pills.

New Synthetic Cannabinoids—“Cloud 9,” “Mojo,” etc.

Makers of designer drugs that are chemically similar to marijuana’s active ingredient THC—called synthetic cannabinoids or colloquially “synthetic marijuana” or “synthetic pot”—are constantly creating new products to evade legal bans on older compounds. Despite the similarity on the molecular level, these drugs are much more dangerous than marijuana, and have resulted in very serious health consequences including overdoses and aggressive or suicidal behavior in users.

Some new compounds have recently emerged that are sending many users to the hospital in cities around the country. They include: 

AB-PINACA, AB-FUBINACA (sold as “Cloud 9,” “Relax,” or “Crown”) is sold as a liquid in eyedropper bottles and often used with vaporizing devices—e-cigarettes or “hookah pens.” Numerous hospitalizations in Michigan prompted the Macomb County Health Department to issue an emergency warning and ban on the sale of these drugs, which are reported to cause hallucinations, aggressive behavior, racing heartbeat, drowsiness, and vomiting. 

MAB-CHMINACA, ADB-CHMINACA (sold as “Mojo,” “Spice,” “K2,” and “Scooby Snax”) resulted in over 150 hospital visits in Baton Rouge and Lafayette, LA in October, prompting the governor to ban the drug in that state. It is reported to cause severe agitation, anxiety, and paranoia; raised heartbeat and blood pressure; nausea and vomiting; muscle spasms, seizures, and tremors; intense hallucinations and psychotic episodes, including suicidal fixations and other harmful thoughts. 

Caffeine Powder

The death of an Ohio high school senior caused by an overdose of powdered caffeine has prompted the FDA to issue a safety advisory about caffeine powders. Bulk bags of pure caffeine powder are readily available online, and these products may be attractive to young people looking for added caffeine stimulation or for help losing weight, but they are extremely dangerous. Just a teaspoon of pure caffeine powder is equivalent to about 25 cups of coffee—a lethal amount. Besides death, severe caffeine overdose can cause fast and erratic heartbeat, seizures, vomiting, diarrhea, and disorientation—symptoms much more extreme than those of drinking too much coffee or tea or consuming too many sodas or energy drinks.

Although caffeine is generally safe at the dosages contained in popular beverages, caffeine powder is so potent that safe amounts cannot be measured with ordinary kitchen measuring tools, making it very easy to overdose on them even when users are aware of their potency. The FDA thus recommends that consumers avoid caffeine powder altogether, and wishes to alert parents to the existence of these products and their hazards.