Clinical Drug Test Dashboard: Key Findings

About

  • The Clinical Drug Test Dashboard reports fentanyl, heroin, cocaine, and methamphetamine detected in clinical urine drug tests. Urine drug tests are ordered by clinicians as part of clinical care for patients diagnosed with a substance use disorder.
  • Results from urine drug tests are analyzed quarterly. This data covers only a small number of people who use illegal drugs.
  • The key findings on this page provide data insights across the four United States census regions from over 650,000 specimens tested during October 2024-December 2025.
People looking over data charts and graphics.

What to know

On this page you'll see key findings from the CDC Clinical Drug Test Dashboard. Visit our dashboard page for an in-depth description of clinical urine drug test data in these analyses and its limitations.

The CDC Clinical Drug Test Dashboard analyzes clinical urine drug tests for fentanyl, heroin, cocaine, and methamphetamine conducted during October 2023-December 2025. Data are displayed by U.S. Census Regions and quarter (e.g., January – March). Fentanyl, cocaine, and methamphetamine are commonly involved in fatal overdoses in the U.S.

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Map of the four U.S. census regions.
Key findings data are displayed by U.S. Census Regions: Midwest, Northeast, South, and West.

Findings are not generalizable to the U.S. because this is a convenience sample.A This data covers only a small number of people who use illegal drugs.

Fentanyl

Declined in the Midwest and South

-30.1%
The percentage of urine specimens positive for fentanyl declined 30.1% in the South and 15.5% in the Midwest from October–December 2024 to October–December 2025 (South: 8.3% vs. 5.8%, Midwest: 8.9% vs. 7.5%).B

Implication: Decreases in fentanyl detection in urine specimens is consistent with decreased use of illegally made fentanyl in the South and Midwest and historically is correlated with decreased overdose deaths involving synthetic opioids.1

Increased in the West

+10.1%
The percentage of urine specimens positive for fentanyl increased  10.1% in the West from October–December 2024 to October–December 2025 (19.1% vs. 21.0%).B

Implication: Illegally made fentanyl entered and began replacing heroin in the West later than other regions and may explain continued increases in fentanyl urine positivity in the West.23

Illegal stimulants commonly co-detected

84.6%
Overall, most fentanyl positive urine specimens (84.6%) also tested positive for cocaine or methamphetamine during October–December 2025.B

Implication: This data is consistent with common co-use of fentanyl with illegal stimulants.4 Exposure to fentanyl with illegal stimulants increases overdose risks and complicates treatment.56

Heroin

Declined substantially

-44.1%
Overall, the percentage of urine specimens testing positive for heroin decreased by 44.1% from October–December 2024 to October–December 2025 (4.6% vs. 2.6%).B

Implication: The substantial decline in the detection of heroin in urine specimens is consistent with fewer law enforcement seizures of heroin since 2020 and increased distribution of illegally made fentanyl.7

Detected less than fentanyl

Overall, heroin was detected much less frequently than fentanyl in urine specimens during October–December 2025 (2.6% vs. 12.8%).B

Implication: This finding is consistent with illegally made fentanyl surpassing heroin as the dominant illegal opioid distributed in the U.S.7

Cocaine

Increased in 2024, stabilized in 2025

+11.5%
Overall, the percentage of cocaine positive urine specimens increased 11.5% from October – December 2023 to October – December 2024 (7.4% to 8.2%) but remained similar from October – December 2024 to October December 2025 (8.2% vs. 8.5%).B

Implication:

  • This trend is consistent with cocaine use increasing in 2024 then staying about the same in 2025.
  • Enhanced support may be needed to reduce stimulant misuse because stimulant use disorder has limited tailored interventions and the most effective intervention, contingency management,C is underused. 568

South: more often detected without illegal opioids

+38.0%
A 38.0% increase in urine specimens testing positive for cocaine without fentanyl or heroin from October–December 2024 to October–December 2025 (6.1% vs. 8.4%). This coincided with a 39.0% decrease in cocaine positive specimens testing positive for cocaine with fentanyl or heroin from October–December 2024 to October–December 2025 (4.2% vs. 2.6%).B

Implication:

  • Findings suggest a shift towards use of cocaine without fentanyl or heroin in the South. Further investigation of factors driving this trend is needed such as people co-using fentanyl and cocaine moving to just using cocaine or new people using cocaine.
  • Similar increases were reported for methamphetamine detections without fentanyl or heroin in the South. (See Methamphetamine findings).

Methamphetamine

Increased in the South, stable in the Midwest, Northeast, and West

+17.2%
In the South, the percentage of specimens positive for methamphetamine increased 17.2% from October–December 2024 to October–December 2025 (11.2% vs. 13.1%). Methamphetamine detection was stable in the Midwest, Northeast, and West.B

Implication:

  • The trends suggest stable use of methamphetamine in the Midwest, Northeast, and West, but highlight a concerning increase in the South.
  • Enhanced support may be needed to reduce stimulant misuse because stimulant use disorder has limited tailored interventions and the most effective intervention, contingency management,C is underused. 568

South: more often detected without illegal opioids

+24.3%
In the South, the percentage of specimens positive for methamphetamine increased 24.3% from October–December 2024 to October–December 2025 (8.1% vs. 10.0%) while detection of methamphetamine with fentanyl or heroin remained stable (3.1% vs. 3.1%).B

Implication:

  • Findings suggest a concerning increase in the use of methamphetamine without fentanyl or heroin in the South. Further investigation of factors driving this trend is needed such as people co-using fentanyl and methamphetamine moving to just using methamphetamine or new people using methamphetamine.
  • Similar increases were reported for cocaine detections without fentanyl or heroin in the South (See cocaine findings).
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Content Source:
National Center for Injury Prevention and Control
  1. The urine drug test data are not representative of people using drugs in the U.S. or in specific census regions because the data are a convenience sample. First, the data only includes urine drug tests analyzed by one company, Millennium Health. Second, the data only includes urine drug tests from people with a substance use disorder under clinical care who receive a urine drug test. The percentage of people testing positive for fentanyl, heroin, cocaine, and/or methamphetamine should not be compared across regions due to differences in the types of patients tested across regions. For instance, higher percentages of specimens testing positive for fentanyl in the West versus Northeast does not mean fentanyl use is more common in the West. Patients characteristics such as age, sex, and the specialty of the submitting clinician (e.g., addiction medicine versus primary care physician) vary across region and may correlate with the severity of their substance use disorder or drug use patterns.
  2. Where 95% confidence intervals for drug positivity between two quarters do not overlap, the quarters are statistically different at p < 0.05. A conservative testing method was selected to reduce the likelihood of false positives and account for the large number of samples tested.
  3. Contingency management is a behavioral intervention that positively reinforces recovery-related behaviors (e.g., abstinence).
  1. Whitley P, LaRue L, Fernandez SA, Passik SD, Dawson E, Jackson RD. Analysis of Urine Drug Test Results From Substance Use Disorder Treatment Practices and Overdose Mortality Rates, 2013-2020. JAMA Netw Open. 2022 Jun 1;5(6):e2215425. doi: 10.1001/jamanetworkopen.2022.15425. PMID: 35657623; PMCID: PMC9166618.
  2. Pardo B, Taylor J, Caulkins JP, Kilmer B, Reuter P, Stein BD. The future of fentanyl and other synthetic opioids. Santa Monica, CA: Rand Corporation; 2019. https://www.rand.org/pubs/research_reports/RR3117.html.
  3. Tanz LJ, Stewart A, Gladden RM, Ko JY, Owens L, O'Donnell J. Detection of Illegally Manufactured Fentanyls and Carfentanil in Drug Overdose Deaths — United States, 2021–2024. MMWR Morb Mortal Wkly Rep 2024;73:1099–1105. DOI: http://dx.doi.org/10.15585/mmwr.mm7348a2
  4. Ciccarone D. The rise of illicit fentanyls, stimulants and the fourth wave of the opioid overdose crisis. Curr Opin Psychiatry. 2021; 34(4): 344–350. https://doi.org/10.1097/YCO.0000000000000717
  5. Centers for Disease Control and Prevention. A Stimulant Guide: Answers to Emerging Questions about Stimulants in the Context of the Overdose Epidemic in the United States. National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, 2022.
  6. Substance Abuse and Mental Health Services Administration. Treatment for Stimulant Use Disorders. Treatment Improvement Protocol (TIP) Series 33. SAMHSA Publication No. PEP21-02-01- 004. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021.
  7. Drug Enforcement Administration. 2025 national drug threat assessment. Washington, DC: US Department of Justice, Drug Enforcement Administration; 2025. https://www.dea.gov/documents/2025/2025-05/2025-05-13/national-drug-threat-assessment .
  8. Tanz LJ, Miller KD, Dinwiddie AT, et al. Drug Overdose Deaths Involving Stimulants ― United States, January 2018–June 2024. MMWR Morb Mortal Wkly Rep 2025;74:491–499. DOI: http://dx.doi.org/10.15585/mmwr.mm7432a1.