Fentanyl Overdose Deaths Plummet but Unchecked Illicit Stimulant Use Threatens to Reshape America’s Drug Use Epidemic

Millennium Health Signals Report shows Illicit stimulant use increased virtually everywhere in the U.S. from 2024 to 2025

SAN DIEGO, CA, UNITED STATES, February 17, 2026 /EINPresswire.com/ -- After more than twenty years of rising fatal drug overdoses in the United States, new data show the most sustained national decline in overdose deaths in two decades. But according to the newly released Millennium Health Signals Report^®, Volume 8, the drug use landscape remains fluid—highlighted by the continued widespread rise of illicit stimulant use, which threatens to undercut recent progress.

Drawing from more than 1.69 million clinical urine drug tests collected from 2016–2025, the report reveals meaningful declines in fentanyl detection beginning in 2023 that mirror national decreases in fentanyl-involved overdose deaths. However, the findings also illustrate persistent and accelerating increases in methamphetamine and cocaine use across the country.

“The overdose crisis remains a humanitarian challenge as much as a public health one,” said Scott Walton, CEO of Millennium Health. “Even as we see encouraging declines in fentanyl-related deaths, the growing prevalence of stimulant use—and the clinical complexities that come with it—make clear that we must remain vigilant, adaptive, and deeply committed to supporting clinicians, researchers, public health officials, and policymakers who are working to save lives.”

Key Findings from Millennium Health’s 2026 Signals Report
Illicit Stimulant Use Continues to Surge Among People Who Use Fentanyl
• In 2025, 85% of people testing positive for fentanyl also tested positive for an illicit stimulant—the highest proportion ever recorded in Millennium Health’s datasets.
• Illicit stimulant use increased among people using fentanyl in all U.S. Census regions from 2024-2025, with fentanyl-methamphetamine co-use jumping 40.7% in the South and fentanyl-cocaine co-use rising 19.3% in the Northeast.
• The detection of cocaine and methamphetamine together in the population using fentanyl grew in all U.S. Census regions, with triple digit increases in the West (249%), Northeast (239%), and South (154%) between 2020 and 2025.
• In 2025, every U.S. state saw methamphetamine or cocaine detected more frequently than heroin or prescription opioids among people using fentanyl—a first in Millennium Health’s reporting history.
Stimulant Use Is Rising Even in the Absence of Fentanyl Use
• Among individuals not using fentanyl, methamphetamine detection increased 4.5% nationally in 2025, and cocaine detection rose 13.5%—with the South showing the steepest gains.
Fentanyl Supply Remains Highly Volatile
• Urine drug testing data showed significant drops in fentanyl detection in 2023–2024, followed by a rapid
rebound in late 2024 into early 2025—mirroring overdose death data.
• A spike in heroin and other opioid detections in mid 2024 suggests the occurrence of a potential fentanyl supply shock, consistent with recent reporting from multiple sources.

The report underscores a growing gap between the scale of stimulant use and the clinical options available to treat stimulant use disorders—especially in the absence of FDA-approved medications. While contingency management remains the most effective evidence-based intervention, implementation barriers persist.

“Clinicians are managing increasingly complex patterns of polysubstance use without adequate therapeutic tools,” said Angela Huskey, PharmD, CPE, Senior Vice President & Chief Clinical Officer. “Real-time drug testing insights are essential to guide care and inform policy—especially at a moment when the drug landscape continues to evolve so rapidly.”

A copy of the full report can be accessed here.

Methodology
The 2026 Millennium Health Signals Report is an analysis of clinical urine drug testing specimens collected between January 1, 2016, and November 30, 2025. The specimens included were collected in health care practices located in all 50 states from patients aged 18 years or older with a substance use disorder diagnosis. More than 1.69 million urine specimens representing 530,000 unique patients were included in the analysis.

Further detail on the drugs analyzed and statistical methods is provided in the report.

About Millennium Health
Millennium Health is an accredited specialty laboratory with over 15 years of experience in drug testing. We provide objective information about patients’ recent use of prescription medications and/or illicit drugs which helps clinicians monitor and treat millions of Americans living with chronic pain, substance use disorders, mental health disorders or other health conditions. Our ability to monitor drug use trends allows us to alert clinicians, health agencies and others to real-time drug use changes to help inform more targeted drug overdose prevention and response strategies to save lives.

Aaron Cohen
Millennium Health
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