SUMMARY OF PARENT GRANT AND PROPOSED SUPPLEMENT Parent Study: Through our parent U01, our National Drug Early Warning System (NDEWS) Coordinating Center aims to provide NIDA and the field with the most timely, salient, and valuable information on emerging substance use trends. By expanding data collection to include both former NDEWS sentinel sites as well as former Community Epidemiology Workgroup (CEWG) sites, and by incorporating novel surveillance methods to ensure early detection of signals of new psychoactive substances and known substances, our Early Warning Network extends geographic representation and provides a more complete picture of the size, direction, and depth of substance use patterns in all US Census regions. We use novel surveillance methods to ensure early detection of signals indicating emerging drug trends and harmonize surveillance data across sentinel and CEWG sites. We will also conduct on-the-ground epidemiologic investigations on topics of immediate crisis or need in order to provide functional feedback to impacted communities towards optimizing current and future response, and we will disseminate results rapidly to the scientific community and the public alike. Proposed Supplement: As an Early Warning System, NDEWS must be on the forefront of new trends in drug use, and drug-related morbidity and mortality. There is a lack of current or recent drug-related mortality data because processing of death information is lagged by months. Poison Control data, however, would allow us to detect emerging trends in both poisonings and deaths (‘exposures’) related to drug use in 48 states in almost real time. We will obtain Poison Control data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System and examine trends in exposures related to use of heroin, fentanyl and its analogs, cocaine, methamphetamine, and various new psychoactive substances, by month, for 12 months, to alert scientists and the public about trends in hotspots in near real time. Rates will be based on sex, Census age group, severity of effects (i.e., none, minor, moderate, major, death), route of drug administration, intent (e.g., intentional misuse, suicide attempt), and co-drug use. For Aim 1, we will acquire Poison Control data, monthly, and examine current trends in drug-related exposures and deaths, in near-real-time. For Aim 2, we will obtain data going as far back as 2015 and examine trends retrospectively. For Aim 3, we will rapidly disseminate statistics (monthly) on drug-related exposures to the scientific community and to the public through NDEWS listservs and media outreach and disseminate retrospective trends through peer-reviewed publications. We believe this is an extraordinary opportunity to quickly and frequently analyze drug exposure data and disseminate findings.