Signals Report Vol. 5

Fentanyl Is Widening Grip on the Nation as Western Presence and Detection with Other Drugs Increase to Record Highs, Millennium Health Signals Report™ Shows

Fentanyl co-detection in individuals using heroin, prescription opioids, methamphetamine or cocaine reached historic levels in 2022; Drug test data also show evolution of dangerous fentanyl analogues, with geographical differences

SAN DIEGO, Calif. – February 21, 2023 – Detection of fentanyl in urine drug test (UDT) specimens remains near historic highs and fentanyl co-detection in individuals using heroin, prescription opioids, methamphetamine, or cocaine has reached new heights, according to the Millennium Health Signals Report released today.

Between 2019-2022, drug tests positive for fentanyl increased 146% nationally and increased in nearly every U.S. census division, especially in the Pacific and Mountain regions, where fentanyl positive tests increased by over 875%. The report contains details on all U.S. regions.

More than 83% of fentanyl-positive specimens also contained additional drugs; approximately 30% were positive for one additional drug, over 43% were positive for 2-3 other drugs, and nearly 10% were positive for 4 or more other drugs.

Fentanyl Analogues/Synthetic Opioids

Another troubling trend identified in the report is the increase in positivity for fentanyl analogues, which are potent opioids that differ structurally from fentanyl. In 2022, 60% of fentanyl positive specimens tested by Millennium Health were also positive for one or more fentanyl analogues.

“Due to the fact that these fentanyl analogues differ from one another in potency and effect, knowing which ones have penetrated a local geography can be very important information for both caregivers and policymakers working to mitigate the overdose epidemic,” says Angela Huskey, PharmD, SVP, Chief Clinical Officer. “These findings suggest that America doesn’t just face one fentanyl problem – it faces several”.

The most recent Millennium Health Signals Report, an annual summary of America’s epidemic of illicit drug use, originates from Millennium Health’s Emerging Threat Intelligence (ETI) Program™. That program provides real-time surveillance of drug use trends to help clinicians, researchers, public health officials, and policymakers address the significant increase in drug overdose deaths.

Slight Moderation

There were some encouraging signals in the report: Positive tests for fentanyl, methamphetamine, prescription opioids, cocaine, and heroin reveal a downward national trend between 2021-2022. The decline in detection of fentanyl and other drivers of overdose suggest the explosion of use in the first two years of the COVID-19 pandemic may be subsiding.

“These results demonstrate that urine drug tests provide invaluable monitoring, in real-time, of the changing nature and threat of illicit drug use,” said Steven Passik, PhD, VP, Scientific Affairs and Head of Clinical Data Programs. “We can hope the decreases in positivity observed between 2021 and 2022 foreshadow a sustained decline in overdoses as well.”

Some states, such as Ohio, are using the data in their efforts to address the crisis.

“The Ohio Narcotics Intelligence Center (ONIC) is grateful for regular access to data about dangerous drug trends so we can issue warnings to the public, to our law enforcement partners, and to the treatment community to prevent overdoses and save lives,” said Ben Suver, Ohio Department of Public Safety Chief of Staff, who oversees ONIC’s operations.


The 2022 Millennium Health Signals Report™ is an analysis of urine drug test results from more than 4.5 million specimens collected between 2015-2022 from treatment centers in all 50 states. Millennium Health analyzed UDT positivity and fentanyl co-detection rates by U.S. Census Division in 2019 and 2022. This time period was chosen to evaluate how current drug use trends in 2022 compare to those before COVID-19 (i.e., 2022 vs. 2019). U.S. Census Regions and Millennium Health Statistical Methods are described on page 28 of the report.


About Millennium Health

Millennium Health is an accredited specialty laboratory providing medication monitoring via definitive urine and oral fluid drug tests to support improved clinical decision-making as part of treatment for millions of Americans with chronic pain, mental illness, substance use disorders, and other health conditions. Drug testing is used to obtain objective information about patients’ recent use of prescription medications and/or illicit drugs and helps monitor the effectiveness of treatment plans. We also conduct real-time tracking of emerging drug use trends to help researchers, public health officials, and policymakers address the significant increase in drug overdose deaths.

Media Contact

Jody Schneider, Millennium Health
(619) 917-6810