About the Project
Overdoses from opioids and stimulants continues to rise. A significant unaddressed issue in the overdose epidemic is the lack of knowledge on non-fatal overdoses in the United States. In 2017 alone, approximately 970,000 patients were treated for non-fatal overdoses emergency departments across 29 states in the United States. Additionally, approximately 37% of nonfatal overdoses are estimated to involve multiple substances.
However, we currently lack an understanding of the social determinants of overdose deaths compared to nonfatal overdoses. We also lack understanding on the evolving polysubstance use epidemic and its role in drug overdoses. To address this knowledge gap, we created the Drug Overdose Toxic-Surveillance (DOTS) Reporting Program which utilizes our multi-center network of sites to collect detailed clinical information on cases presenting to the ED with overdose to opioids, stimulants, and undifferentiated illicit drugs.
The DOTS project will assess the sociodemographic characteristics, clinical information, contextual data on opioid and/or stimulant overdoses, and obtain biological specimens in patients presenting to 17 participating medical centers around the United States. This project will link patient interviews, chart reviews, and laboratory confirmation of which drugs were used by the patient in order to inform potential regulatory activities and future public health messaging.
Funding
This initiative was made possible through funding provided by the FDA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the FDA; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.
Principal Investigators
Jeffrey Brent, MD, PhD, DFACMT
University of Colorado School of Medicine
Aurora, CO
Paul Wax, MD, DFACMT
ACMT
Center for Forensic Science Research and Education Clinical Reports
A partnership between the American College of Medical Toxicology (ACMT) and the Center for Forensic Science Research and Education (CFSRE) was established to comprehensively assess the role and prevalence of NPS among suspected overdose events in the U.S
This report provides new information regarding comprehensive drug testing of toxicology specimens collected in clinical settings after suspected non-fatal opioid, stimulant, and other drug-related overdoses in cities across the United States (U.S.).
2026
1. Culbreth R, Brent J, Aldy K, Falise AM, Campleman S, Krotulski AJ, Mazer-Amirshahi M, Wax P; On Behalf of the ToxIC DOTS Study Group. The Toxicology Investigators Consortium Drug Overdose Toxico-Surveillance Reporting Program for Emergency Department Opioid and Stimulant Overdoses. Public Health Rep. 2026 Aug 20:333549261477055. doi: 10.1177/00333549261477055. View Publication
2. Kent JT, Culbreth R, Lebin JA, Burkhart K, Hendrickson RG, Dezman ZDW, Aldy K, Brent J, Falise A, Campleman S, Logan BK, Levine M, Chary M, Krotulski A, Perrone J, Wax P; On behalf of the ToxIC DOTS Study Group. Interpreting fentanyl and norfentanyl concentrations among patients seen in the emergency department after a nonfatal opioid overdose: A multicenter study. J Med Toxicol. 2026;22(2):286-295. View Publication
3. Stang B, Kent J, Walton S, Aldy K, Culbreth R, Falise A, Campleman S, Logan B, Brent J, Wax P, Krotulski A; On behalf of the ToxIC DOTS Study Group. Comprehensive Toxicological Characterization and Quantitation of Drugs Identified Among Nonfatal Opioid and Stimulant Overdose Presentations to U.S. Emergency Departments. J Anal Toxicol. 2026;50(6):bkag036. View Publication
4. Stolbach A, Culbreth R, Falise A, Aldy K, Perrone J, Liss D, Krotulski A, Logan B, Walton S, Campleman S, Buchanan J, House S, Rogers B, Wax P, Schwarz E, Pizon AF, Brent J; On behalf of the ToxIC DOTS Study Group. Medetomidine-involved overdoses among emergency department patients: Results from a US multicenter sentinel surveillance program. J Addict Med. 2026; doi:10.1097. View Publication
2025
1. Cembellin-Kao A, Aldy K, Brent J, Culbreth R, LaBozzetta C, Turcios MA, Wax P, Yonamine C, Stolbach A, Abston S, Buchanan J, Campleman S, Chary M, Falise A, Ford J, Goldfine C, Hendrickson R, Jang D, Jorgenson D, King A, Lebin J, Levine M, Liss D, Mazer-Amirshahi M, Marlin MB, McCabe D, Monte A, Nguyen H, Olives T, Perrone J, Pizon A, Schwarz E, Smollin C, Spyres M, Krotulski A, Logan B; On behalf of the ToxIC DOTS Study Group. Occult bromazolam exposure in patients presenting with opioid or stimulant overdose. Clin Toxicol (Phila). 2025;63(4):357-365. View Publication
2. Falise A, Sutphin A, Culbreth R, Aldy K, Burkhart K, Brent J, Campleman SL, Day H, Wills A, Krotulski A, Wax P; On behalf of the ToxIC DOTS Study Group. Detected substances among patients with confirmed bromazolam exposure who present to the emergency department following a suspected opioid and/or stimulant-related non-fatal overdose. Drug Alcohol Depend. 2025;274:112776. View Publication
3. McCabe DJ, Gibbs H, Falise A, Hagemann J, Kroll C, Culbreth R, Hendrickson R, Campleman S, Wax P, Brent J, Aldy K; On behalf of the ToxIC DOTS Study Group. Level of care following suspected opioid or stimulant overdose with self-harm intent. Am J Emerg Med. 2025;99:264-269. View Publication
2026
1. Aldy K, Abston S, Kent J, Schwarz ES, Buchanan J, Spungen H, Krotulski A, Campleman S, Wax P, Brent J; On behalf of the ToxIC DOTS Study Group. Comparison of self-reported drug use and adjudicated causality in polydrug overdose presentations. J Med Toxicol. 2026;22:29. View Abstract
2. Culbreth R, Brent J, Aldy K, Falise A, Perrone J, Stolbach A, Krotulski A, Campleman S, Wax P; On behalf of the ToxIC DOTS Study Group. Concordance between self-reported drugs and blood toxicology results: Findings from the ToxIC DOTS program. J Med Toxicol. 2026;22:30. View Abstract
3. Dowis T, Tirado D, Culbreth R, Wax P, Brent J, Aldy K, Falise A, Krotulski A, Hendrickson RG; On behalf of the ToxIC DOTS Study Group. Characteristics of overdoses in patients who obtain opioids from an unfamiliar/atypical source versus a usual/typical source. J Med Toxicol. 2026;22:23. View Abstract
4. Hendrickson R, Culbreth R, Brent J, Aldy K, Falise A, Perrone J, Krotulski A, Campleman S, Wax P; On behalf of the ToxIC DOTS Study Group. Naloxone blood concentrations after treatment of presumed opioid overdose among patients presenting to emergency departments at 17 U.S. medical centers. J Med Toxicol. 2026;22:22. View Abstract
5. Tirado D, Culbreth R, Falise A, Aldy K, Wax P, Brent J, Krotulski A, Hendrickson RG; On behalf of the ToxIC DOTS Study Group. Fentanyl-overdose patients reporting self-harm or suicide intent versus those seeking euphoria: A comparison. J Med Toxicol. 2026;22:16. View Abstract
2025
1. Aldy K, Culbreth R, Campleman S, Falise AM, Abston S, Krotulski AJ, Brent J, Wax P; On behalf of the ToxIC DOTS Study Group. Xylazine Knowledge and Beliefs in Patients Presenting to the Emergency Department with an Opioid or Stimulant Overdose. J Med Toxicol. 2025;21:79-80. View Abstract
2. Culbreth R, Falise AM, Aldy K, Brent J, Campleman S, Wax P; On behalf of the ToxIC DOTS Study Group. Repeat Overdoses and Addiction Treatment History among Patients Presenting to Emergency Departments after a Non-Fatal Overdose across the US. CPDD Annual Scientific Meeting, June 14-18, 2025. New Orleans, Louisiana. View Abstract
3. Falise AM, Culbreth R, Aldy K, Campleman S, Brent J, Krotulski A, Wax P; On behalf of the ToxIC DOTS Study Group. Sociodemographic Characteristics Associated with Reported Heroin Use and Discrepancies between Heroin Use and Toxicological Drug Detection among ED Patients Experiencing Non-Fatal Overdose. CPDD Annual Scientific Meeting, June 14-18, 2025. New Orleans, Louisiana. View Abstract
4. Falise AM, Culbreth R, Aldy K, Campleman S, Krotulski AJ, Abston S, Brent J, Wax P; On behalf of the ToxIC DOTS Study Group. First Intranasal Naloxone Dose Among Patients With Confirmed Opioid-Related Overdoses Doesn’t Predict Naloxone Response. J Med Toxicol. 2025;21:48. View Abstract
5. Gaetani SL, Culbreth R, Spyres M, Aldy K, Perrone J, Campleman S, Falise AM, Krotulski AJ, Wax P, Brent J; On behalf of the ToxIC DOTS Study Group. Buprenorphine Administration and Addiction Treatment after Non-Fatal Opioid Overdoses: A Multicenter Study. J Med Toxicol. 2025;21:54. View Abstract
6. Reddy K, Kalinina E, Culbreth R, Aldy K, Perrone J, Campleman S, Falise AM, Wax P, Brent J, Pizon AF; On behalf of the ToxIC DOTS Study Group. Evaluation of Sociodemographic Differences in Xylazine Versus Non-Xylazine Exposures. J Med Toxicol. 2025;21:51-52. View Abstract
7. Schwarz ES, Culbreth R, Aldy K, Perrone J, Campleman S, Falise AM, Krotulski AJ, Burkhart K, Brent J, Wax P; On behalf of the ToxIC DOTS Study Group. Xylazine Blood Concentrations Are Not Associated With Clinical Severity After an Opioid Overdose. J Med Toxicol. 2025;21:38-39. View Abstract
8. Smith JD, Hendrickson RG, Culbreth R, Campleman S, Falise AM, Aldy K, Krotulski AJ, Abston S, Brent J, Wax P; On behalf of the ToxIC DOTS Study Group. Opioid Overdose Among People Who Intend to Only Use Illicit Stimulants. J Med Toxicol. 2025;21:41. View Abstract
9. Sutphin A, Wax PM, Culbreth R, Falise AM, Brent J, Aldy K, Campleman S; On behalf of the ToxIC DOTS Study Group. Treatment history among patients with recurrent opioid overdoses: A multicenter study. J Addict Med. 2025;19(5):e47.16. View Abstract
10. Walton SE, Krotulski AJ, Aldy K, Campleman S, Falise AM, Culbreth R, Wax P, Brent J, Logan BK; On behalf of the ToxIC DOTS Study Group. Regional Trends for Drugs and Novel Psychoactive Substances (NPS) from Emergency Department Patients in the United States. J Med Toxicol. 2025;21:31. View Abstract
2024
1. Chary M, Wax P, Culbreth R, Aldy K, Campleman S, Falise A, Hendrickson R, Krotulski A, Burkhart K, Jimoh O, Meyn A, Brent J; On behalf of the ToxIC DOTS Study Group. Characteristics of toxicological exposures among unhoused individuals compared to patients with secured housing. Clin Toxicol (Phila). 2024;62:25-26. View Abstract
2. Chary M, Wax P, Culbreth R, Burkhart K, Campleman S, Dezman Z, Naples J, Aldy K, Abston S, Krotulski A, Brent J; On behalf of the ToxIC DOTS Study Group. The ratio of serum fentanyl to norfentanyl is associated with the level of care needed after nonfatal opioid overdose. Clin Toxicol (Phila). 2024;62:35-36. View Abstract
3. Jimoh O, Culbreth R, Aldy K, Brent J, Campleman S, Krotulski A, Wax P, Naples J, Dezman Z, Burkhart K; On behalf of the ToxIC DOTS Study Group. Clinical characteristics after naloxone administration in patients with confirmed methamphetamine and cocaine exposures in the Drug Overdose Toxico-Surveillance (DOTS) reporting program. Clin Toxicol (Phila) .2024;62:37. View Abstract
4. Jimoh O, Wax P, Aldy K, Brent J, Culbreth R, Campleman S, Krotulski AK, Meyn A, Abston S, Burkhart K; On behalf of the ToxIC DOTS Study Group. Preliminary Results From the Drug Overdose Toxico-Surveillance (DOTS) Reporting Program: Admission Status by Sociodemographic Characteristics. J Med Toxicol. 2024;20:81. View Abstract
5. Laub D, Amirshahi M, Stolbach A, Aldy K, Campleman S, Brent J, Culbreth R, Krotulski A, Burkhart K, Wax P; On behalf of the ToxIC DOTS Study Group. Synthetic cathinones among patients presenting to emergency departments with life-threatening or severe overdose. Clin Toxicol (Phila). 2024;62:58. View Abstract
6. Lebin J, Culbreth R, Wax P, Burkhart K, Dezman Z, Naples J, Aldy K, Campleman S, Brent J, Falise A, Levine M, Chary M, Krotulski A, Perrone J; On behalf of the ToxIC DOTS Study Group. Fentanyl and norfentanyl blood concentrations among severe/life- threatening opioid overdose patients stratified by self-reported opioid use patterns. Clin Toxicol (Phila). 2024;62:22-23. View Abstract
7. Perrone J, Culbreth R, Aldy K, Brent J, Krotulski A, Naples J, Dezman Z, Burkhart K, Wax P; On behalf of the ToxIC DOTS Study Group. Quantitative xylazine and fentanyl concentrations following nonfatal opioid overdose from the Toxicology Investigators Consortium Drug Overdose Toxico-Surveillance (DOTS) reporting program multicenter study. Clin Toxicol (Phila). 2024;62:12. View Abstract
8. Sutphin A, Falise A, Aldy K, Campleman S, Culbreth R, Burkhart K, Brent J, Krotulski A, Abston S, Meyn A; On behalf of the ToxIC DOTS Study Group. Bromazolam blood concentrations in patients presenting to the emergency department after an opioid or stimulant overdose. Clin Toxicol (Phila). 2024;62:23. View Abstract
9. Wax P, Aldy K, Burkhart K, Diak I, Lopez A, Naples J, Culbreth RE, Krotulski AK, Campleman S, Brent J; On behalf of the ToxIC DOTS Study Group. Incorporating Quantitative Drug Analysis Into Non-Fatal Drug Overdose Surveillance: The Toxicology Investigators Consortium Drug Overdose Toxico-Surveillance (DOTS) Reporting Program. J Med Toxicol. 2024;20:85. View Abstract