Millennium Health Signals Report^® Volume 8

Overdose deaths have fallen dramatically at the national level and have been projected to continue to decline through 2025. While these decreases are encouraging, overdose mortality data continue to highlight the increasing co-involvement of stimulants like methamphetamine and cocaine in fentanyl-related deaths. Our previous work has shown corresponding increases in the detection of illicit stimulant use in the population using fentanyl, a trend that has continued to escalate through 2025. We analyzed more than 1.6 million urine drug test results from patients across the U.S. with a substance use disorder diagnosis to evaluate the everchanging landscape of America’s overdose and drug use epidemic.

The report centers around four key questions:

1. What are the latest trends for fentanyl-involved overdose deaths in the U.S. and have those changes been consistent across different regions of the country?
2. How have trends in the detection of other opioid (i.e., heroin, prescription opioids) use changed recently among people who use fentanyl, what do these changes tell us about the illicit opioid supply, and how do they potentially relate to changes in overdose deaths?
3. What are the latest trends for methamphetamine and cocaine use at the national level, are there regional differences in patterns of illicit stimulant use, and how do rates of stimulant use compare between people who use fentanyl and those who do not?
4. What are the negative consequences of illicit stimulant use, what tools are available to clinicians for treating stimulant use disorders, and what are the larger public-health implications of rising rates of illicit stimulant use?

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