Public Alerts

Clonazolam (also called clonitazolam) first emerged in the recreational drug supply in 2014 (Europe) and 2016 (United States). Like many NPS, clonazolam was first synthesized during drug development in 1971 but was never approved for therapeutic use. Clonazolam is the triazolo– counterpart to clonazepam (Klonopin, Rivotril). Clonazolam appears in various drug preparations, including powders, tablets (i.e. counterfeit pharmaceuticals), liquids, and blotters. Clonazolam has been linked to adverse events resulting in hospitalization or death and is commonly reported in combination with other drugs and/or NPS, including benzodiazepines and opioids. Trend reports developed by NPS Discovery previously indicated a decline in clonazolam positivity in Q3 2020. However, recent developments show that the positivity of clonazolam is currently increasing based on new data collected after testing for its metabolite.

Assessments of drug prevalence and positivity are contingent on accurate characterization of drug targets within specific samples. These assessments include consideration of the analytical methods used for drug testing and the drug species (e.g. parent drug, metabolite) targeted during method development and/or data processing. Nitro–group–containing benzodiazepines (e.g. clonazolam, clonazepam) are metabolized in the body to amino– counterparts (e.g. 8-aminoclonazolam, 7-aminoclonazepam). Additionally, instability of these drugs can lead to the production of these same amino– species. Therefore, data-mining for 8-aminoclonazolam was conducted on all samples analyzed in 2019 and 2020 to re-evaluate the positivity of clonazolam in our sample populations. The results indicate that the positivity of clonazolam was previously underreported when targeting only the parent drug and 8-aminoclonazolam appears to be a more appropriate biomarker for accurate determination of clonazolam use.
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Xylazine was discovered as an antihypertensive agent in 1962 by Farbenfabriken Bayer in Germany. Due to its hazardous side effects, including sedation, hypotension and bradycardia, it was not approved by the Food and Drug Administration (FDA) for human use. The FDA did however approve it for veterinary use, and it is now used as an animal tranquilizer and a sedative, analgesic and muscle relaxant. It may be sold under the trade names Rompun®, Anased®, Sedazine®, and Chanazine®. Xylazine is not a controlled substance in the United States and only requires a veterinary prescription to obtain. It has emerged as an adulterating agent in many illicit drug products, including cocaine, heroin, fentanyl and combinations of these substances. Xylazine can be used as a drug of abuse alone and as a drug for attempted sexual assault or poisoning. Xylazine is referred to as “Tranq Dope” on the street in the United States or “Anestecia de Caballo” in Puerto Rico. The drug has been implicated as a cause, or contributing cause, of death in several cases both alone and in combination with other drugs.
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MDMB-4en-PINACA was first identified in toxicology casework in the United States in September 2019; however, its emergence dates back earlier to seized drug testing from Europe in June 2018. MDMB-4en-PINACA is structurally similar to the popular synthetic cannabinoid 5F-ADB (5F-MDMB-PINACA), differing by the removal of the fluorine atom and replacement with a terminal alkene. MDMB-4en-PINACA is a potent activator of the cannabinoid receptor system and its toxicity has been demonstrated through medicolegal death investigations paired with comprehensive toxicology findings. In the United States, MDMB-4en-PINACA has been identified in at least 51 toxicology specimens associated with post-mortem (PM) death investigations, driving under the influence of drugs (DUID) investigations, and clinical investigations. Internationally, MDMB-4en-PINACA has been identified on several continents including North America, Europe, Asia, and Oceania.
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Levamisole was initially developed in the mid-1960s as a veterinary and human anti-worming drug. In 1990, it was approved by the United States Food and Drug Administration (FDA) as a therapy for the treatment of colorectal cancer, however, by 2000 it had been withdrawn from the market due to severe adverse effects described below. Since the early 2000’s, levamisole has been in widespread use as an adulterating agent for illicit street drugs, especially cocaine, heroin, and fentanyl. Although its prevalence varies over time and geographically, LEVAMISOLE HAS AT TIMES BEEN DETECTED IN UP TO 79% OF THE COCAINE STREET SUPPLY AT VARYING PERCENTAGES, UP TO 74% BY WEIGHT.
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Brorphine is a potent synthetic opioid with structural resemblance to fentanyl and its analogues. However, brorphine is not controlled in the U.S. under core-structure scheduling of fentanyl related substances. Recent detections in drug related deaths leads us to believe this new synthetic opioid has the potential to cause widespread harm and is of public health concern. As of mid-July 2020, brorphine was confirmed in seven blood specimens associated with fatalities in the U.S.; brorphine has also been reported in Europe (Belgium).
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Between 2017 and 2019, the substituted cathinone N-ethyl pentylone (ephylone) was the most commonly encountered emergent synthetic stimulant to appear in forensic casework. Due to its prevalence and contributions to mortality, N-ethyl pentylone was federally scheduled by the United States Drug Enforcement Administration (DEA) in August 2019. This statute created a shift in the NPS drug market, noted by proliferation of two new synthetic stimulants: Eutylone and Benzylone.
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Flualprazolam has been confirmed in at least 44 biological specimens associated with postmortem (PM) death investigations and driving under the influence of drugs (DUID) investigations in the United States since June 2019. The objective of this public announcement is to notify public health and public safety officials, law enforcement, clinicians, medical examiners and coroners, laboratory personnel, and all other related communities about information surrounding the emergent benzodiazepine flualprazolam — a novel psychoactive substance (NPS).

NPS benzodiazepines, sometimes referred to as designer benzodiazepines, are synthetically manufactured drugs, often associated with unknown biological effects and health risks, a dangerous combination for any recreational drug user. NPS benzodiazepines resemble traditional benzodiazepines, such as diazepam and alprazolam, but differ with the addition of new elements or functional groups. NPS benzodiazepines are often prepared in powder or tablet form and can be mixed with street level drugs, including traditional benzodiazepines and opioids. NPS benzodiazepines are of public health and safety concern due to high potency at low doses producing strong sedation and amnesia. Additional adverse effects include loss of coordination, drowsiness, dizziness, blurred vision, slurred speech, and, in some cases, death.
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Isotonitazene has been identified in eight blood specimens associated with postmortem death investigations in the United States since August 2019. Isotonitazene was first reported in August 2019 based on the results from seized drug and toxicology casework in Europe (Belgium) and Canada (Alberta); the Canadian toxicology case was collected in March 2019.
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The objective of this public announcement is to notify public health and public safety, law enforcement, clinicians, medical examiners and coroner, laboratory personnel, and all other related communities about new information surrounding the emergent synthetic cannabinoid 4F-MDMB-BINACA.
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The Center for Forensic Science Research and Education at the Fredric Rieders Family Foundation received notification over the weekend from July 20 to 22, 2018, that hospitals in the Greater Philadelphia Area were seeing increased numbers of admitted patients for suspected opioid overdose.
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