Fact Sheets

October 7, 2024 | Controlled Substances, Fact Sheets, Fentanyl, Novel Psychoactive Substances, Opioids, Substance Misuse

“Tusi” is the name given to a new synthetic drug combination that first emerged in the 2010s in Latin America and Europe and is becoming increasingly popular in the United States. The name is a play on “2C,” a group of psychedelic drugs common among clubgoers, which tusi is rarely found to contain. Also called “pink cocaine,” though it usually does not contain cocaine, it is a powder that is dyed with pink food coloring that smells of strawberries. It is typically snorted, pressed into pill form, or mixed with water (called “happy water”). Because tusi is new on the drug scene, not much is currently known about the effects of the drug on those who use it. People who use drugs should be aware of the dangers of using tusi due to confusion regarding the names by which it is known as well as the different drugs used to make it and should use harm reduction practices to prevent adverse effects from its use....

July 12, 2024 | Fact Sheets, Medication Assisted Treatment (MAT), Novel Psychoactive Substances, Opioids, Recovery, Substance Misuse, Treatments

Methadone is one of the three medications approved by the U.S. Food and Drug Administration used for the treatment of opioid use disorder (OUD). Evidence shows that for patients who suffer a nonfatal overdose, subsequent methadone treatment reduces the likelihood of a future fatal opioid overdose by over 50 percent. In 2024, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued the first substantive changes to its federal methadone regulations in over 20 years. This final rule updated and modified several aspects of existing regulations with the goal of expanding the use of methadone for OUD treatment. As part of the revisions, SAMHSA clarified that a hospital, long-term care entity, or correctional facility, if appropriately registered with the Drug Enforcement Administration, can provide and initiate methadone as a treatment for OUD to those with a primary diagnosis other than substance withdrawal or OUD. In this fact sheet the Legislative Analysis and Public Policy Association details changes to the definition of "primary diagnosis" other than OUD regulation. The fact sheet also covers the federal regulatory scheme for methadone to treat OUD and explains what led SAMHSA to revise its regulations. ...

June 28, 2024 | Fact Sheets, Novel Psychoactive Substances, Opioids, Stimulants, Substance Misuse, Synthetic Drugs

The Legislative Analysis and Public Policy Association is monitoring the emergence of novel psychoactive substances appearing on the illicit drug market in the United States. The term “novel” does not denote a new, never-before-seen substance but rather a substance that is newly available in the drug market. This fact sheet examines medetomidine, a powerful veterinary sedative that has been appearing as an adulterant in fentanyl mixtures in the U.S. Medetomidine is a synthetic alpha-2 agonist that is used as a sedative in veterinary medicine and sold under the brand name Domitor®. Medetomidine belongs to the same drug class as xylazine, but its potency is 200 times greater, and has a longer duration of action, than xylazine. The U.S. Food and Drug Administration has only approved medetomidine for use in veterinary medicine, and information about the use of the substance in humans is limited. The effects of medetomidine on humans are not well understood but include prolonged sedation, slow heart rate, slowed breathing, and low blood pressure. Similar to xylazine, the combination of medetomidine with other substances, like fentanyl, can enhance or prolong the effects of the substance and place the individual at a higher risk of overdose than from the...

March 26, 2024 | Controlled Substances, Fact Sheets, Opioids, Prescription Drugs, Public Health, Public Safety

The first U.S. reports of counterfeit pills containing fentanyl emerged in a handful of jurisdictions in 2015 and by October 2019, all U.S. jurisdictions reported them. One reason for the proliferation is the ease with which drug traffickers can enter this market. With only a few thousand dollars, a person can purchase a pill press, pill molds, and dies that mimic trademarked pharmaceuticals and enough illicitly imported fentanyl to generate $5 to $20 million in sellable counterfeit pills. Given the simple manufacturing process and low startup costs, counterfeiting is an attractive area for drug traffickers, albeit one that creates substantial health risks to consumers. Despite this, however, there are relatively few federal or state laws governing access to pill press machines, and those that exist do not provide for substantial oversight or assessment. In this fact sheet, the Legislative Analysis and Public Policy Association reviews: (1) what pill presses are and how people obtain them; (2) why fentanyl is an often-used drug in counterfeit pills and the health concerns this poses; and (3) the limited, currently-in-force, applicable state and federal laws....

March 18, 2024 | Fact Sheets, Novel Psychoactive Substances, Opioids, Public Safety, Stimulants, Substance Misuse, Synthetic Drugs

The Legislative Analysis and Public Policy Association is monitoring the emergence of novel psychoactive substances appearing on the illicit drug market in the United States. The term “novel” does not denote a new, never-before-seen substance but rather a substance that is newly available in the drug market. This fact sheet,  examines xylazine, a powerful veterinary sedative increasingly appearing as an adulterant in heroin and fentanyl mixtures in the U.S., particularly since 2020. Xylazine has a chemical structure similar to compounds called phenothiazines and operates by decreasing the release of norepinephrine and dopamine in the central nervous system, resulting in analgesia, sedation, and muscle relaxation. Xylazine intoxication can result in central nervous system depression, low blood pressure, and slow heart rate. Respiratory depression can also occur, which increases the risk of overdose when combined with opioid-induced respiratory depression. ...

November 15, 2023 | Criminal Justice, Fact Sheets, Stimulants, Substance Misuse

This fact sheet examines the racial disparities and stigma surrounding crack cocaine, established in the late 1980s, that continue to this day. The Fair Sentencing Act has helped to lessen the sentencing disparity between crack and powder cocaine, yet gaps remain. Passage of certain legislation, like the EQUAL Act, which was introduced in the 118th Congress in 2023, would eliminate both the sentencing and racial disparity in cocaine sentencing still seen today in U.S. courts....

October 31, 2023 | Fact Sheets, Novel Psychoactive Substances, Substance Misuse, Synthetic Drugs

The Legislative Analysis and Public Policy Association is monitoring the emergence of novel psychoactive substances appearing on the illicit drug market in the United States. The term “novel” does not denote a new, never-before-seen substance but rather a substance that is newly available in the drug market. This fact sheet examines bromazolam, a novel benzodiazepine that is structurally related to alprazolam (Xanax), which has been a Schedule IV controlled substance in the U.S. since November 1981. Bromazolam is typically found in tablet or powder form and sold mainly via online drug markets under its own name or as “XLI-268.” It has been found mixed with opioids, including fentanyl, and in counterfeit Xanax pills. There is not much information about the illicit use of bromazolam and its effects on the human body in scientific literature, so most of the information currently available about the substance is anecdotal. ...

October 30, 2023 | Controlled Substances, Fact Sheets, Recovery, Substance Misuse, Treatments

This fact sheet summarizes a recent increase in the use of contingency management, a behavioral therapy that reinforces or rewards positive behavioral change. Often, mental health professionals use contingency management alongside other methods of treatment. In the context of substance use disorder treatment, patients typically receive something of monetary value to incentivize abstinence from drug use. Contingency management is a well-studied and effective method for treating substance use disorder, but until recently, received little support....

September 18, 2023 | Fact Sheets, Novel Psychoactive Substances, Substance Misuse, Synthetic Drugs

The Legislative Analysis and Public Policy Association is monitoring the emergence of novel psychoactive substances appearing on the illicit drug market in the United States. The term “novel” does not denote a new, never-before-seen substance but rather a substance that is newly available in the drug market. This fact sheet examines nitazenes, a group of synthetic opioids more powerful than fentanyl. Scientists developed nitazenes in the 1950s as analgesics, but the U.S. Food and Drug Administration never approved the compounds for therapeutic use....