College Park, Maryland | 06/15/2018—The Center for Substance Abuse Research (CESAR) announced today the initial results of the Drug Outbreak Testing Service (DOTS), a one-year pilot study of the National Drug Early Warning System (NDEWS). Despite the geographic separation, the first two DOTS sites, Baltimore City emergency department overdose patients and King County, Washington overdose decedents, share one factor in common: nearly half of the urine samples submitted from both locations contain 10 or more substances, indicating significant polydrug use among the users.

DOTS seeks to identify the spectrum of substances involved in drug outbreaks in communities across the country through state-of-the-art urine testing that is unaffordable or unavailable in most localities. Each DOTS Bulletin is a concise report of test results of specimens obtained from drug treatment programs, medical examiners, and hospitals for epidemiologic purposes. DOTS provides the individual sites with statistical tables detailing the findings. 

“While the so-called ‘common wisdom’ suggests the epidemic of overdoses across the country is being caused by a single type of drug, opioids, that’s not accurate,” said Dr. Eric D. Wish, Principal Investigator of NDEWS and Director of UMD’s Center for Substance Abuse Research (CESAR). “The reality is that this sophisticated testing reveals that many people overdosing or seeking treatment are using many different types of drugs.”

Baltimore, Maryland experienced a 2-day spike in overdoses in May 2017 that led the health department to issue a warning to emergency personnel and police that increased numbers of patients were being seen, that they required higher than usual doses of naloxone, and were combative upon waking. In the 8 urine samples submitted to DOTS from Baltimore, it was not uncommon to find 10, 15 or even 17 different substances in the users’ systems, often along with fentanyl and fentanyl analogs.

The King County Medical Examiner’s Office sent DOTS urine specimens from persons who died of opioid overdoses and who initially tested positive for fentanyl, or who had inconclusive or discordant toxicology results. Beyond a high occurrence of methamphetamine found in three-quarters of the King County specimens, 9 of 20 submitted contained 10 or more substances–similar to the Baltimore specimens.

DOTS provides, at no cost to the site, urinalyses of specimens collected by public health organizations that, after being anonymized, are sent to an independent laboratory to be tested for approximately 240 licit and illicit drugs, including synthetic opioids and other new psychoactive substances.

"There is a lot of mystery, fear, and confusion in the current overdose crisis. The DOTS program is a brilliant corrective providing objective evidence about the drugs involved in these cases,” said Dr. Robert DuPont, member the NDEWS Scientific Advisory Group and the first director of the National Institute on Drug Abuse (NIDA). “DOTS not only gives answers it also assuages a dangerous fear-driven panic and confusion about new and unknown drugs. A useful reality check.”

An overview of the DOTS methodology and the complete DOTS bulletins are available here. For more information about future DOTS sites, or to become a DOTS site, contact: ndewsdots [at]



The National Drug Early Warning System (NDEWS) detects, monitors, and follows up on emerging drug use trends to enable health experts, researchers, and concerned citizens across the country to respond quickly and to develop a more complete and accurate understanding of drug use in our country. The Center for Substance Abuse Research (CESAR) in the College of Behavioral and Social Sciences at the University of Maryland, College Park, manages the NDEWS Coordinating Center with support from the National Institute on Drug Abuse at the National Institutes of Health. For more information, visit

NDEWS is supported by the National Institute on Drug Abuse of the National Institutes of Health under Award Number U01DA038360.


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10/12/2020 - 10:35 am