The Office of National Drug Control Policy (ONDCP) has published its first ever wastewater drug testing report. It offers an unprecedented look at how illicit substance use is shifting across American communities. Released in July 2026 by ONDCP’s Office of Data and Research, the newsletter draws on samples from more than one hundred counties. That covers roughly eighteen per cent of the US population, making it the country’s largest wastewater based drug monitoring initiative to date.

Unlike traditional survey data, which can lag months or years behind real world use, wastewater drug testing measures what is actually flowing through community sewage systems. The approach quantifies more than twenty drugs. It also detects traces of over five hundred substances, giving public health officials, parents, teachers and law enforcement a near real time picture of what is circulating locally.

National Trends Show Declines, But the Picture Is Not Simple

According to the report, national wastewater levels of fentanyl, cocaine and methamphetamine all fell between January and April 2026. Fentanyl, tracked through its metabolite norfentanyl, peaked in 2023 and has been declining since. Cocaine followed a more erratic path. It peaked in 2023, dipped in early 2024, climbed again through 2025, then fell once more in early 2026. Methamphetamine levels have stayed relatively steady since 2023.

Administration officials point to these national declines as part of a wider fall in overdose deaths. The wastewater data itself measures use rather than mortality, though, and the sampled counties are not statistically representative of the country as a whole.

Regional patterns complicate the national story. In the most recent period, fentanyl and methamphetamine concentrations were highest in the West. Cocaine use, by contrast, was concentrated in the South. It is a reminder that wastewater drug testing findings can vary sharply depending on where you look.

Hotspots Emerge at the State and County Level

State level data collected through the wastewater based drug monitoring network sharpens the picture further. In April 2026, Washington State recorded the highest fentanyl concentrations. Texas topped the list for cocaine, while Colorado and Nevada led on methamphetamine. That state alone accounted for three of the five counties with the highest cocaine readings that month. The pattern points to local supply chains or demand rather than a broader regional shift.

Looking across a longer sixteen month window from January 2025 to April 2026, a smaller group of states appeared consistently in the top twenty per cent for each drug. California, Nevada, North Carolina and Washington led for fentanyl. Maryland, Colorado, Illinois and Texas led for cocaine. Colorado and Nevada led for methamphetamine throughout.

Notably, the report found no clear overlap between states with high fentanyl signals and those with high concentrations of naloxone or medication assisted treatment drugs. That means wastewater drug testing data on illicit substances cannot simply be read against treatment availability.

Emerging Substances Signal New Threats

Perhaps the most striking findings concern seven additional substances the report tracked qualitatively rather than quantitatively. Their potency or prevalence makes precise measurement difficult. Acetyl fentanyl, carfentanil, ketamine, medetomidine, para fluorofentanyl, tianeptine and xylazine were all detected in every one of the four US census regions during 2026.

Ketamine turned up in every single county tested, a stark illustration of how widespread its presence has become. Tianeptine, sometimes called gas station heroin, was found in seventy seven per cent of tested counties. Acetyl fentanyl was the least common substance, appearing in just seventeen per cent.

Six counties, spread across the Midwest, South and West, showed detections of at least six of the seven substances tracked. One county in the South registered all seven. Public health teams say that kind of polysubstance activity warrants closer monitoring.

Why the Data Matters Beyond the Numbers

The value of wastewater drug testing lies less in any single data point and more in what it reveals about direction and speed. A community can be alerted to a rising synthetic opioid, or a veterinary sedative like medetomidine, long before that substance shows up in emergency rooms or overdose statistics. For families, schools and local health services, that lead time matters. It can shape earlier conversations, earlier interventions and, ideally, prevented harm rather than managed crisis.

The ONDCP report stops short of prescribing solutions. It focuses on documenting where the concerning trends are and which emerging substances deserve greater attention. That gap between detection and response is where community education and prevention efforts carry the most weight. It matters most for young people, who may encounter these substances without understanding what they actually contain.

This analysis draws on ONDCP’s Office of Data and Research newsletter, Wastewater Analytics: A Powerful Window into Shifting Drug Use Trends, published July 2026. It also draws on the accompanying White House statement announcing the report’s release.

Source: dbrecoveryresources