CARE Series: Landscape of Emerging Drug Threats in Vermont

Vermont’s illicit drug supply continues to shift in composition, potency, and patterns of use, creating new challenges for clinicians, public health professionals, and harm reduction providers. This session will review current national trends in the illicit drug market and examine Vermont-specific data sources used to monitor emerging threats, including drug seizure data, drug-checking services, and State of Vermont surveillance systems.

Participants will receive an updated overview of substances identified in the national, regional and Vermont drug supply, including sedatives, nitazenes, stimulants, and other novel psychoactive substances. The session will explore patterns in Vermont’s drug supply and use, including geographic distribution of seizures and trafficking activity, prevalence of single-substance versus polysubstance combinations, regional source patterns, temporal and seasonal trends, and shifts in routes of administration and their implications for overdose risk and wound care.

Finally, the presentation will address the challenges of the ever evolving illicit drug market, and discuss strategies for mitigating the public health and public safety risk associated with substance use.

Presenters

Chief James G. Downes III, Ret.
Drug Intelligence Officer
Overdose Response Strategy
New England High Intensity Drug Trafficking Area 
Office of National Drug Control Policy

Stephanie N. Thompson, MPA
Public Health Analyst – Vermont
Overdose Response Strategy
New England High Intensity Drug Trafficking Area 
Office of National Drug Control Policy

1. Recognize two current national, regional or Vermont-specific trends in the illicit drug supply.
2. Isolate one illicit drug geographic, temporal, or polysubstance use pattern in Vermont as extrapolated from drug seizure, drug-checking program, and/or state surveillance system data.
3. Identify one prevention effort or strategy to reduce health risks associated with emerging and polysubstance drug exposures.

In support of improving patient care, Dartmouth Health is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team. 

American Medical Association (AMA)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 AMA PRA Category 1 Credits^TM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

American Nurses Credentialing Center (ANCC)
Dartmouth Health designates this Enduring Material for a maximum of 1.00 ANCC contact hours. 

All other learners may claim CME-designated participation credit. Consult your professional licensing board regarding the applicability and acceptance of CME-designated participation credit for programs certified for credit by organizations accredited by Joint Accreditation for Interprofessional Education.

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Bibliographic Material

• Brain Sciences, From Veterinary Medicine to Illicit Drug Supply, February 2025; Appalachia HIDTA, Emergence of Azaperone in the Tennessee Illicit Drug Supply, May 2026.

• Centers for Disease Control and Prevention, National Center for Health Statistics, Provisional Drug Overdose Death Counts, April 2026.

• Centers for Disease Control and Prevention, Overdose Prevention, What You Should Know About Xylazine, May 2024; National Institute on Drug Abuse (NIDA), Xylazine (“Tranq”), September 2024.

• Center for Forensic Science Research & Education, An Update on the Presence of BTMPS in the Drug Supply and the Discovery of Tetramethylfentanyl Related Substances, May 2025.

• Center for Forensic Science Research & Education, Chlorphine, 2024; American Council on Science and Health, Meet the drug war’s latest creation: Cychlorphine, April 2026.

• Center for Forensic Science Research & Education, Toxic Adulterant Alert: Medetomidine/Dexmedetomidine, December 2023; Centers for Disease Control and Prevention, Health Alert Network, Medetomidine in the U.S. Illegal Fentanyl Supply Increasing Risk for Overdose and Severe Withdrawal Syndrome, April 2026.

• Department of Justice Drug Enforcement Agency, 2025 National Drug Threat Assessment, April 2026.

• Drug Enforcement Administration, Nitazenes: The Next Wave of Synthetic Opioids, June 2024; Centers for Disease Control and Prevention, Fentanyl and Synthetic Opioids, June 2025.

• Drug Enforcement Agency, Benzodiazepines Fact Sheet, March 2025; University of Virginia, ToxTalks, Designer Benzodiazepines, April 2025.

• National Research Board, National Drugs Library. https://www.drugsandalcohol.ie/13119/

• New England HIDTA Drug Arrests, 2025. (these law enforcement data are not publicly available)

• National Institute on Drug Abuse. DrugFacts. https://www.drugabuse.gov/publications/drugfacts

• U.S. Drug Enforcement Administration. Fact Sheets. https://www.dea.gov/factsheets.

• Vermont Community Drug-Checking Program Data Summary: Year 1. Vermont Department of Health. March 2026.

• Vermont Department of Health, 2025 Fatal Overdose Report, May 2026.

• Vermont Department of Health, Methods of Use in Fatal Overdoses in Vermont Based on Scene Evidence and Witness Accounts, January 2026.

• Vermont Department of Health, Monthly Opioid Overdose Dashboard, June 2026

• Vermont Department of Health, Vermont Social Autopsy Report: Identifying Patterns in Drug Overdose Deaths, September 2025. https://www.healthvermont.gov/sites/default/files/document/dsu-2025-vermont-social-autopsy-report.pdf

Provider Contact Information
Provider contact information for questions regarding accreditation of the activity:

Center for Learning and Professional Development
ACE Office
Dartmouth Health
[email protected]

Mitigation of Relevant Financial Relationships

Dartmouth Health adheres to the ACCME’s Standards for Integrity and Independence in Accredited Continuing Education.  Any individuals in a position to control the content of a CE activity, including planners, faculty, authors, or others are required to disclose all financial relationships with ineligible companies^.  All relevant financial relationships have been mitigated prior to the commencement of the activity.

^Ineligible Company is any entity whose primary business purpose is producing, marketing, selling, re-selling or distributing healthcare products used by or on patients.