NIDA National Early Warning System Network (iN3)

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The study is a collaborative, multi-Principal Investigator effort involving scientists and physicians in Center for Interventions, Treatment and Addictions Research (CITAR), Ohio Center of Excellence in Knowledge-enabled Computing (Kno.e.sis), University of Massachusetts Medical School and The Toxicology Investigator’s Consortium to decrease the burden of substance abuse in the United States by establishing a national emerging drug surveillance network.



To accelerate the response to emerging drug abuse trends, this recently awarded, NIH-funded study (9/15/14 – 9/14/15) is designed to establish iN3, an innovative NIDA National Early Warning System Network that will rapidly identify, evaluate, and disseminate information on emerging drug use patterns. Two synergistic data streams will be used to identify emerging patterns of drug use. The first data stream will be derived from the Toxicology Investigators Consortium (“ToxIC”), a network of medical toxicologists who specialize in recognizing and confirming sentinel events involving psychoactive substances. ToxIC investigators are located at 42 sites across the U.S, and of these, we have selected 11 to serve as sentinel surveillance sites. The research team will analyze reports from ToxIC investigators’ assessments of patients with acute, subacute, and chronic effects of emerging drug use. The second involves measures of drug use derived from social media (Twitter feeds and web forums).

Data from semi-automated content analysis will be disseminated among ToxIC investigators to identify patterns related to emerging psychoactive drug use. Conversely, information from ToxIC investigators’ bedside interviews will improve the analytical precision of the Semantic Web platform.

The Specific Aims of the study are to:

  1. Identify new episodes of emerging drug use in multiple community-level indicators; and
  2. Disseminate information about occurrence, identity, clinical, and adverse effects of emerging drug use.

iN3 will have a public health impact by providing a tool that can inform efforts to truncate and potentially prevent outbreaks of emerging drug use as well as inform research needs and policy.


Principal Investigators: Robert Carlson, Ph.D (CITAR), Amit P. Sheth, Ph.D (Kno.e.sis), Edward Boyer, M.D., Ph.D (UMass)
Co-Investigators: Raminta Daniulaityte Ph.D (CITAR), Jeff Brent, M.D., Ph.D, Director (ToxIC), Paul Wax, M.D., Co-Director (ToxIC).
Graduate Students: Sanjaya Wijeratne (Kno.e.sis)


  1. Collin Tebo, Maryann Mazer-Amirshahi, Sharan Campleman, Edward Boyer, Jeffrey Brent, Amit Sheth, Paul Wax, Robert Carlson. Characterizing trends in synthetic cannabinoid use from structured patient interviews during medical toxicology consultation. Abstract.North American Congress of Clinical Toxicology 2019, 23 - 27 September 2019


Background: Synthetic cannabinoid receptor agonists (SCRAs), currently among the most prevalent new psychoactive substances, have seen considerable growth in popularity over the past two decades. Data on subjective experience as well as behaviors surrounding the use of SCRAs has been mainly limited to case reports and series with few studies examining larger trends. The present study sought to characterize current trends in SCRA use by using standardized interviews in a population of individuals receiving medical toxicology consultation due to SCRA intoxication.

Methods: Patients receiving medical toxicology consultation at 10 designated sites within the Toxicology Investigators Consortium in the United States with reported or suspected exposure to a new psychoactive substance were interviewed by treating medical toxicologists. Investigators collected clinical data as well as expanded qualitative data including knowledge, attitudes and beliefs, as well as practices related to the use of novel psychoactive substances. Interviewers utilized a primarily open ended style of questioning and answers were reviewed for data quality and completeness by the study’s program manager. At the completion of the data collection phase, responses were categorized and enumerated to determine the presence of trends.

Results: Of the124 cases entered into the study between October 2014 and early 2016, the majority of cases (N=86) involved exposure to SCRAs. The majority of identified SCRA users were single (72.1%), white (45.3%) and African American (43%), males (93%) with a mean age of 31.1 years, and incomplete high school education (47.7%). Over half (58.1%) reported at least one psychiatric comorbidity, the most common being depression (28%), anxiety (26%), and bipolar disorder (22%). The majority of patients (68.8%) had used SCRAs at least once before the presenting episode with most patients reporting extensive prior use. Patients were evenly divided between using SCRAs with friends and alone (40.7% vs 41.9%). Nearly half of patients (47.7%) considered SCRAs to be very easy to obtain, reporting that they are generally acquired free from a friend or acquaintance (39.4%) or by purchasing from a gas station or a convenience store (22.1%) (Table). Nearly half (48.8%) of patients reported that their primary reason for use was the high they experienced from smoking it while only a small proportion mentioned using it to avoid testing positive on drug screening (6.9%), current addiction (5.8%), as an alternative to marijuana (4.6%), or for experimentation (4.6%). Approximately one third (34.9%) of users described their experience as primarily positive while the remaining patients found it either primarily negative (24.4%) or mixed positive and negative (19.8%). Under half (44.2%) reported paying for the substances while nearly a third (32.6%) acquire it for free, with a small proportion (3.5%) reporting to barter for it with other drugs.

Conclusion:Of 86 reported SCRA exposures, most patients reported having used it extensively prior to presentation and using it primarily for the subjective effects associated with the drug. These results support the view that an independent and stable culture is developing around the use of SCRAs separate from their appeal as an “undetectable” alternative to marijuana.

Related Projects

Concurrent Projects

Prior Projects


Funded through the NIH/National Institute on Drug Abuse R56 “Short-Term, High Priority, Bridge Award mechanism,” the study is a collaborative, multi-Principal Investigator effort involving scientists and physicians in CITAR (Robert G. Carlson, Ph.D., contact PI; Raminta Daniulaityte, Ph.D., Co-I); Kno.e.sis (Amit Sheth, Ph.D., PI); University of Massachusetts Medical School (Edward Boyer, M.D., Ph.D., PI); and the Toxicology Investigator’s Consortium (Jeff Brent, M.D., Ph.D., Co-I, Director; and Paul Wax, M.D., Co-I and Co-Director). NIH/NIDA Grant No. R56DA038366 -01. Period: 9/15/2014 – 9/14/2016, Amount: $300,000