1. Structured Session 2: Early Warning for NPS
National Drug Early Warning System (NDEWS): evolving drug early warning systems in a new world of drug production, distribution, and use
Addictions 2017
Structured Session 2: Early Warning for NPS
October 24, 2017
Presented by E. Erin Artigiani, MA;
Moira O’Brien, MPhil, NIDA Project Scientist;
Eric D. Wish, PhD, PI
NDEWS is supported by Cooperative Agreement DA from NIDA/NIH to the University of Maryland CESAR.
Opinions expressed in this presentation may not represent those of NIH or NIDA.

2. National Drug Early Warning System (NDEWS) Mission
National public health surveillance system that built upon and expanded beyond the Community Epidemiology WorkGroup (CEWG)
Addresses substance use and misuse, with a focus on emerging trends, in the U.S. through a network of experts harnessing the power of evidence to generate educated and practical action
Generates critically needed information about drugs and their public health consequences
Leverages resources and collaborations to harmonize approaches to analyzing and presenting data
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

3. NDEWS Components
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

4. The People: Scientific Advisory Group
Non-Federal Members (11)
Academic Researchers
Medical Doctors
W/B HIDTA Director
Federal Members (8)
National Institute on Drug Abuse (NIDA)
Office of National Drug Control Policy (ONDCP)
U.S. Drug Enforcement Administration (DEA)
U.S. Substance Abuse and Mental Health Services Administration (SAMHSA)
Centers for Disease Control and Prevention (CDC)
Armed Forces Medical Examiner System (AFMES)
Office of the Assistant Secretary of the Navy
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

5. NDEWS Network https://ndews.umd.edu/resources/join-ndews-network
The NDEWS Network is a virtual community of experts in medicine, toxicology, ethnography, epidemiology, law enforcement, and other fields as well as concerned citizens and others
Use the NDEWS Network to:
Get rapid access to information on emerging drugs and drug trends
Join cross-disciplinary discussions
Learn about new resources and successful local solutions
Ask others about drugs/emerging trends in your area
Membership is open and free
Mention unique collaborations: AAPCC, DEA, other researchers
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

6. Detecting & Monitoring: NDEWS Data Sources
National and Local
Valid, consistent, sensitive, assess change over time
Public health, Law enforcement, Self report surveys, Biological specimen testing, Sentinel surveillance
Special Collaborations
Special Testing and Research Lab: DEA Emerging Threats Reports
American Association of Poison Control Centers
This is an example of a quarterly report prepared for NDEWS as a result of our special collaboration

7. 12 NDEWS Sentinel Community Sites
States or areas from all regions of the U.S.
Experienced local experts
Committed local resources
Available data: mortality, treatment admissions, poison center
Annual honoraria provided
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

8. Sentinel Community Site Reports
3 Parts: Data Snapshot, Narrative, Indicator tables and graphics
Primary local data sources: treatment admissions, drug-related deaths, poison center calls
Focus on emerging drugs and changing drug trends
Also have opportunity to include information about changes in local laws and policies and results of recent local research
2015 and 2016 reports and the 2016 NDEWS Selected Findings report available at under Sentinel Sites
2017 reports underway now
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

9. Following Up: NDEWS New Hampshire HotSpot Study
Collect and review available data and information (May-June 2016)
Identify core contacts – e.g. local experts in public health, law enforcement, research, policy (May 2016)
Convene Planning Committee (May 27, 2016)
Conduct site visit (June 29 – July 1, 2016) and prepare report
Contracted with local experts to conduct 2 additional rapid studies to develop a more comprehensive understanding of current user of fentanyl and the people who have died from fentanyl-related overdoses
Source: NDEWS Coordinating Center, CESAR, October University of Maryland College Park.

10. NDEWS Dissemination NDEWS Network NDEWS Presents Reports
Drug Outbreak Testing Services (DOTS)
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

11. NDEWS Reports Site Specific Drug Specific In-depth scientific reports
Highlights/Summaries
NDEWS News
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

12. Types of Reports
Source: NDEWS Coordinating Center, CESAR, October University of Maryland College Park.

13. Drug Outbreak Testing Service (DOTS)
Pilot Study:
Drug Outbreak Testing Service (DOTS)
Offers FREE state-of-the-art urine drug testing to identify the drug(s) behind your local outbreak
(Supported by an NIH/NIDA grant to the University of Maryland)
Connect to
DOTS 1 2 3
Contact DOTS at
to obtain submission instructions
Send de-identified urine specimens for FREE testing for 250 licit and illicit drugs
Receive results in aggregate form (not for clinical or legal use)
Pilot Study of a new innovation;
We are exploring the feasibility, level of interest, starting with a couple local sites
Frame it as a research question
A pilot study by the National Drug Early Warning System (NDEWS), at the Center for Substance Abuse Research (CESAR) at the University of Maryland, College Park, October 2017

14. Lessons Learned All data has limitations
Partnerships and collaborations are invaluable
Utilize a combination of national sources, sentinel surveillance, and other sources
Sentinel and HotSpot surveillance allow for more flexible, in-depth assessments
Disseminate information in multiple formats
Be creative
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

15. www.ndews.org eartigia@umd.edu ndews@umd.edu @NDEWSNews
For More Information
@NDEWSNews
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

16. Source: NDEWS Coordinating Center, CESAR, June 2017
Source: NDEWS Coordinating Center, CESAR, June Univeristy of Maryland College Park.

17. What are the Challenges for the future?
Develop more real-time information: Launch Drug Outbreak Testing Service (DOTS)
Limits of self reports: Include biological testing to keep up with NPS (e.g. urine, wastewater)
Expand understanding of regional/local drug trends: Conduct additional HotSpot studies
Understand how people talk about drugs and drug use: Explore social media platforms
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.

18. Fentanyl-Related Deaths in New Hampshire More Than Doubled from 2014 to 2016
Source: NDEWS Coordinating Center, CESAR, June Univeristy of Maryland College Park.

19. NDEWS News Scans Conducted by NDEWS staff
Monthly scans of a LexisNexis Academic database of article references from more than 2,250 national and international English language newspapers
More than 30 drugs and drug terms
Conducted to provide a monthly snapshot of what local media are reporting about
Source: NDEWS Coordinating Center, CESAR, June University of Maryland College Park.

20. Implications for Public Health
Based on interviews and medical examiner case reviews, fentanyl appears to be the primary cause of increased overdose in New Hampshire, possibly due to fentanyl’s potency and inconsistency in fentanyl/heroin mixes.
Providers and responders must eliminate barriers to naloxone use and increase availability of treatment.
Although users expressed a fear of physical side effects from naloxone, neither users nor responders had observed any common side effects from naloxone administration other than precipitated withdrawal.
Providers must diagnose and treat multiple drug use disorders in fentanyl users and provide comprehensive treatment
Source: NDEWS Coordinating Center, CESAR, October University of Maryland, College Park.