A new Millennium Health Signals Alert reveals compelling evidence that illicit stimulant use (cocaine and methamphetamine) is rising sharply across the United States, marking a concerning shift in substance use patterns and signaling critical implications for clinical care, public health strategy, and addiction treatment systems.
Stimulants Detect More Frequently Than Fentanyl
Analysis of over 1.6 million urine drug testing (UDT) specimens from adults with a diagnosed substance use disorder (SUD) shows that stimulants were detected at almost twice the rate of fentanyl in 2025 — 26 % versus 14 % respectively. Importantly, stimulant detection includes both methamphetamine and cocaine, reflecting broad availability and high levels of consumption in the illicit drug market. These findings extend beyond overdose statistics, offering a more nuanced view of real-world consumption trends that traditional overdose data often underestimate.
Polysubstance Use and Co-Detection Trends
The Signals Alert also highlights the growing intersection of stimulant and fentanyl use. In 2025, over 85 % of individuals who tested positive for fentanyl also tested positive for a stimulant. This trend aligns with broader research on the “fourth wave” of the overdose crisis — a phase defined by the rising co-involvement of non-opioid stimulants in drug use and overdose deaths.
Interestingly, while stimulant use without fentanyl had generally declined since 2016, it began increasing again in 2024 and by 2025 was detected at the same rate as fentanyl alone (14 %). These trends underscore the complexity of current substance use landscapes and suggest that demand for cocaine and methamphetamine continues to grow independently of opioid use.
Public Health and Clinical Implications
The rapid rise in stimulant detection — both with and without fentanyl — has critical implications for clinicians, policymakers, and treatment providers:
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Underrecognized Burden: Traditional overdose data may not fully capture the scope of stimulant use, meaning strategies focused solely on opioids risk overlooking a major driver of morbidity and mortality.
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Severe Health Risks: Beyond fatal overdose, stimulant use is associated with a range of acute and chronic health harms including psychosis, cardiovascular disease, and infectious disease transmission.
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Need for Evidence-Based Interventions: There remains an urgent need for enhanced screening and treatment modalities tailored to stimulant use disorders, such as contingency management, as well as integrated approaches that address opioid-stimulant co-occurring disorders.
A Call to Action for Providers and Policymakers
The updated Signals Alert provides actionable intelligence that should inform clinical decision-making, harm-reduction programs, and policy development. As stimulant detection continues to outpace fentanyl, healthcare systems must adapt existing infrastructures to respond to evolving drug use patterns — including expanded access to comprehensive screening, culturally appropriate interventions, and multidisciplinary care pathways.
Addressing this emerging stimulant trend is essential to strengthening the overall public health response to substance use disorders and minimizing the human toll of the evolving overdose crisis.
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