Clinical Drug Test Dashboard

This dashboard uses a convenience sample of urine drug test results that cannot estimate drug use rates nationally or regionally. The dashboard data covers only a small number of people who use illegal drugs. However, the large number of urine drug test results may help quickly identify national and regional changes in drug use because results are available within two weeks of the date of the test. Specifically:

• Because most fatal drug overdoses involve fentanyl in the United States, tracking changes in urine drug test results for fentanyl may provide valuable information on current fentanyl use.

• Trends in drugs detected in urine drug tests may provide early warning of potential changes in overdose deaths as urine drug results are correlated with trends in fatal overdose and available within two weeks of the urine drug test.12

• Urine drug test data can detect and track co-use of fentanyl with illegal stimulants such as cocaine and methamphetamine. Exposure to fentanyl with illegal stimulants increases overdose risks and can complicate treatment.34

• Tracking the percentage of urine specimens positive for cocaine and methamphetamine is also important as the use of these stimulants is associated with substantial health risks including fatal overdose without opioids. 34

• Drug markets across the U.S. vary and may have different trends in drug use. Thus, the data on the four U.S. Census Regions (Midwest, Northeast, South, and West) allows you to track trends in drug positivity within a region (e.g., understand changes in the positivity of fentanyl from 2024 - 2025 in the South).

• All tests were conducted by Millennium Health, an accredited laboratory that provides drug testing services using liquid chromatography tandem mass spectrometry (LC-MS/MS), to help clinicians monitor use of prescription medications, illegal drugs, and effectiveness of treatment plans.
• Urine drug test results are only included for:
  • adult patients, 18 years of age or older
  • patients with a reported substance use disorder diagnosis excluding alcohol, cannabis, and tobacco (See Important Data Considerations for a list substance use disorders included)
  • patients not prescribed fentanyl or methamphetamine. Patients with prescriptions for fentanyl or methamphetamine were excluded because the dashboard focuses on illegal drug use
    
• All urine specimens were tested for the parent drug and/or metabolites: fentanyl (i.e., fentanyl and/or a norfentanyl), heroin (i.e.,6-monacetylmorphine [6-MAM] and/or morphine), cocaine (i.e., benzoylecgonine) and methamphetamine (i.e., methamphetamine). Because some drugs are quickly metabolized when used (e.g., cocaine has a short half-life and is quickly metabolized into benzoylecgonine and heroin is rapidly metabolized into 6-MAM), urine is often tested for metabolites to better detect recent drug use. Other drugs may have been tested for and detected but results are not included in this analysis.
• For more information about the data including important data limitations, please read Important Data Considerations.
  

• All visualizations will responsively adjust to your selections of "Region", "Drug", and "Time Frame" at the top of the dashboard.
  • Select a Region: Click on the box to select the desired geographic region from the drop-down. You can select Overall or one of the four U.S. census regions (Midwest Census Region, Northeast Census Region, South Census Region, and West Census Region).
  • Select a Drug: Click on the box to select from a drop-down list of four drug options: fentanyl, heroin, cocaine, or methamphetamine.
  • Select Time Frame: Click on the box to select the desired time frame (Quarterly or 6 months). If you select quarterly, the data will display: Jan–Mar (January–March); Apr–Jun (April–June); Jul–Sep (July–September); and Oct–Dec (October–December). If you select 6 Months, data will be displayed for the first half of the year, Jan–Jun (January–June), and second half of the year, Jul–Dec (July–December).
• Simplify the Trend Graph: If the trend graph appears too busy, please 1) use the "labels off" toggle button to view a simplified version without labels or 2) remove a line by clicking on a button next to a drug category.
  
• Analyze Percentage Change: Using the percentage change toggle, you can view the data in two ways. First, if you select "% Chg Off", hovering over the data point will show the percentage value and the 95% confidence interval. The 95% confidence interval was calculated using Wilson intervals. Second, if you select "% Chg On", the data displayed will display how much the percentage changed from the most recent time point (e.g., October–December 2025) to the time point preceding it (e.g., July–September 2025) and the same time point a year earlier (October–December 2024). For more information on how to use this function, please read Important Data Considerations.

View the accessible version of this dashboard.

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

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.56

• 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 obtained from 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. This data covers only a small number of people who use illegal drugs.
• 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. These characteristics may correlate with the severity of their substance use disorder or drug use patterns. Thus, regional differences in percentage of drugs detected in urine specimens are likely partially related to differences in the characteristics of patients tested.
  
• When analyzing changes in small percentages (e.g., less than 5%), large yearly, half year, and quarterly changes should be interpreted cautiously as they may represent small absolute changes in detection. For instance, an increase of 50% from 1% to 1.5% may have limited public health impact. Also, small percentages are expected to fluctuate over time because a small number of drug detections are driving estimates. You can assess the precision of estimates by reviewing the 95% confidence interval of an estimate (displayed on the dashboard by rolling over the data point on a figure with "% Chg Off" selected).
• Urine drug test data cannot distinguish whether the person intentionally or unintentionally used the drug.
• Co-detection of drugs in a urine drug sample can indicate co-use of the drugs at the same time (e.g., injecting both cocaine and fentanyl together) or use of the drugs at different times (e.g., use of cocaine after the effects of fentanyl wear off).

• Patients with the following substance use disorders as defined by the Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnoses codes were included in the dashboard: opioid related disorders (F11), sedative, hypnotic, or anxiolytic related disorders (F13), cocaine related disorders (F14), other stimulant related disorders (F15), hallucinogen related disorders (F16), inhalant related disorders (F18), and other psychoactive substance related disorders (F19).
• Urine specimens were limited to one specimen per patient during a given 30-day period to avoid detecting drugs from the same episode of use.78 In nearly all cases, fentanyl, heroin, cocaine, and methamphetamine will not be detected by a urine drug test 30 days after the initial drug screen, ensuring patients single instance of exposure will not be captured twice in the dashboard.

• When used, heroin rapidly metabolizes into 6-MAM. Because 6-MAM is a metabolite specific to heroin, its detection is considered definitive evidence of heroin use. 6-MAM, however, only remains detectable for less than 8 hours after use and thus reliance on 6-MAM would underestimate heroin use. Because 6-MAM metabolizes into morphine and morphine is detectable day(s) after use, tests for morphine are often used to detect heroin use.9 Classifying specimens testing morphine positive as heroin, however, has the potential to overestimate the presence of heroin because morphine detection may be related to use of prescription morphine or diverted non-prescribed morphine; patients known to be prescribed morphine were excluded from analyses.
• Since the types of patients tested in a census region tend to be relatively stable overtime, comparisons within a region can provide insight into trends in drug detection within a census region.

Analyze Percentage Change:  Using the percentage change toggle, you can view the data in two ways. First, if you select "% Chg Off", hovering over the data point will only show the percentage value and the 95% confidence interval. The 95% confidence interval was calculated using Wilson intervals. Second, if you select "% Chg On", the data displayed will display how much the percentage changed from the most recent time point (e.g., October–December 2025) to the time point preceding it (e.g., July–September 2025) and the same time point a year earlier (October–December 2024).

• If you select "Time Frame: Quarterly", hovering over the five most recent data points will show "Yearly Change" (this is the change from the selected quarter to the same quarter in the previous year) and "Quarterly Change" (this is the change from the selected quarter to the previous quarter).B For instance, if you hover over the October–December 2025 quarter, "Yearly Change" will show the percentage change from October–December 2024 to October–December 2025 and "Quarterly Change" will show the percentage change from July–September 2025 to October–December 2025. For the other data points except the oldest data point, only quarterly change is reported because data from the previous year is not displayed in the Figure. For the oldest data point, change is not reported because data from the previous quarter and the previous year are not displayed in the Figure. Differences between the selected quarter and previous quarter may be affected by seasonal effects. Thus, most comparisons focus on the change from the selected quarter to the same quarter in the previous year.

• If you select "Time Frame: 6 Months", hovering over the three most recent data points will show "Yearly Change" (this is the change from the selected 6-month timeframe to the same 6-month timeframe in the previous year), and "6 Month Change" this is the change from the selected 6-month timeframe to the previous 6-month timeframe.C For instance, if you hover over July–December 2025, "Yearly Change" will show the percentage change from July–December 2024 to July–December 2025 and "6 Month Change" will show the percentage change from July–September 2025 to October–December 2025. For the other data points except the oldest data point, only change from the previous half year is reported because data from the previous year is not displayed in the Figure. For the oldest data point, change is not reported because data from the previous half year and the previous year are not displayed in the Figure. Differences between the selected 6-month period and previous 6-month period may be affected by seasonal effects. Thus, most comparisons focus on comparing the selected 6-months to the same 6-month period in the previous year.