JAMA Network Open Study

New Study Reveals Unprecedented Increases in Fentanyl and Stimulant Concentrations in Urine Drug Test Results

SAN DIEGO, Calif. – October 24, 2024A study published in JAMA Network Open, led by Andrew Huhn, PhD, MBA, Associate Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine, Kelly Dunn, PhD, MBA, Professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine, and co-authored by Millennium Health researchers, illustrates striking increases in the amounts of illicit fentanyl, methamphetamine, and cocaine detected in urine drug testing (UDT) specimens since 2013. The analysis showed that the concentrations of fentanyl and methamphetamine were 8.3 and 5.2 times higher, respectively, in 2023 compared to 2013 (Figure). Cocaine concentrations also doubled across this time period, whereas those for heroin fell by more than half.

The JAMA Network Open article can be accessed here.

“Fentanyl, methamphetamine, and cocaine concentrations are higher now relative to any time in the past decade suggesting that the people who are using these drugs are doing so in larger quantities and/or with greater frequency now,” said Huhn. “The findings also demonstrate that aggregated, quantitative UDT data offer a scalable surveillance method that can provide swift and nimble feedback on real-time changes in drug exposure levels as well as emerging threats, like xylazine, that are not routinely captured by other methods,” he added.

The analysis of 921,931 unique patient UDT specimens collected in substance use disorder treatment settings across the U.S. also evaluated how these concentrations have changed in different parts of the country. With a few exceptions (e.g., greater methamphetamine concentrations in the West and part of the South, largely stable heroin concentrations in the West), changes in drug exposure concentrations have been relatively similar across the U.S. over time.

“These findings reveal that the drug use epidemic is evolving not only in terms of what drugs are being used but how much drug is being used,” said Millennium Health Chief Clinical Officer Angela Huskey, PharmD, CPE. “This is the most granular assessment of drug use patterns in the U.S. to date and highlights an important, underappreciated nuance about drug use that may affect overdose risk and other clinically relevant phenomena.”

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.

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Jody Schneider, Millennium Health
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Jody.Schneider@millenniumhealth.com