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Rapid Analysis of Drugs: A Tool to Detect Drug Overdose Spikes, Build Trust Among People Using Drugs and Reduce Overdoses – Maryland, November 2021 – August 2022



Erin Russell, Edward Sisco, Allison Thomson, Jasmine Lopes, Dana Heilman, Margaret Rybak, Malik Burnett, Meghan Appley, Matthew Gladden


Maryland overdose deaths increased 16%, to a record high of 2,912 deaths during the 12-month period from July 2020 to June 2021. Illicitly manufactured fentanyl and/or fentanyl analogs* contributed to 84% of these overdose deaths.† Timely public health response was impeded by limited data on whether fentanyl or other drug exposures were intentional or linked to adulterated drug products and delays in identifying illicit drug market changes. Specifically, findings from death investigations, including the drugs contributing to drug overdose deaths, were typically available three-months after the death. To address these issues, the Department of Health, in June 2021, partnered with the National Institute of Standards and Technology (NIST)§ to rapidly initiate a statewide pilot program to test drug residue from used drug paraphernalia sampled by syringe service program staff. During November 19, 2021 – August 31, 2022, NIST tested 496 samples submitted by eight Maryland syringe service programs. Results were reported to the syringe service programs typically within 48 hours after sample receipt. Fentanyl was detected in 365 of 367 samples that tested positive for an opioid, with 80% of fentanyl-positive samples also testing positive for xylazine (1), a drug used in veterinary medicine as an animal sedative. Client's reports of the drug(s) they intended to buy were collected for 50% of samples. Most clients exposed to fentanyl intended to use fentanyl, but the presence of heroin was substantially overestimated, and the pervasiveness of xylazine was a surprise. The pilot demonstrated the feasibility and utility of rapid, high-quality drug testing at a statewide scale. Findings informed expansion of wound care treatment at syringe services programs and improved program participant awareness of fentanyl and xylazine, which furthered harm reduction program impact.
CDC Mortality and Morbidity Weekly Report


Public Health, Drugs, Mass Spectrometry


Russell, E. , Sisco, E. , Thomson, A. , Lopes, J. , Heilman, D. , Rybak, M. , Burnett, M. , Appley, M. and Gladden, M. (2023), Rapid Analysis of Drugs: A Tool to Detect Drug Overdose Spikes, Build Trust Among People Using Drugs and Reduce Overdoses – Maryland, November 2021 – August 2022, CDC Mortality and Morbidity Weekly Report, [online],, (Accessed June 16, 2024)


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Created April 28, 2023, Updated May 5, 2023