Federal initiatives aim to expand prevention and recovery efforts as communities grapple with evolving drug trends, increased risks and ongoing stigma around treatment.
Drug use among teenagers and adults remains a national crisis, with lingering impacts of the COVID-19 pandemic intensifying the nation’s current drug epidemic.
Substance use disorder (SUD) is impairment caused by repeated use of alcohol or other drugs. Among individuals aged 12 and older, 48.4 million people (or 16.8% of the population) had a SUD within the past year in 2024, according to Substance Abuse and Mental Health Services Administration (SAMHSA) survey data.
The misuse of alcohol, tobacco, illicit drugs and prescription medications affect the health and well-being of millions of Americans, according to the Centers for Disease Control and Prevention (CDC).
For many that are struggling, their addiction often goes unaddressed, with nearly 8 in 10 people with substance use disorder forgoing treatment in 2024.
“National data show that the United States continues to face a sustained substance use and overdose crisis,” said Christopher Carroll, SAMHSA Principal Deputy Assistant Secretary. “While recent data show a decline in overdose deaths, we must come together to continue to change the trajectory of addiction and loss of life in our communities.”
Progress and continued efforts
Recent national data suggests that trends in substance use are beginning to change after several years of fluctuation during and after the pandemic.
While rates of use for tobacco and cocaine, binge drinking, prescription opioid misuse and alcohol use disorder have all declined or remained stable since 2021, according to SAMHSA’s National Survey on Drug Use and Health, the nation has continued to face an ongoing illicit drug use crisis.
“Over the past four years, we have seen increases in overall illicit drug use, mainly due to increases in use of marijuana and hallucinogens, as well as increases in drug use disorders and rising polysubstance use, which illustrate ongoing challenges,” said Carroll.
While young adults aged 18-25 have historically had the highest rates of drug use across the board, drug use among adults aged 26-49 has been on the rise – marijuana, cocaine, methamphetamine, and prescription and illicit opioids are among the drugs with the highest usage for this age demographic, according to SAMHSA.
Substances such as cocaine, methamphetamine, and prescription and illicit opioids are highly addictive, involve a significant risk of overdose death, and can cause a wide variety of serious symptoms such as bowel decay, anxiety, brain damage, paranoia and more following an overdose or chronic use.
“America’s communities are now seeing more potent and lethal drugs in the illicit market,” said Carroll. “Among the main drivers of overdose, synthetic opioids, such as illicitly manufactured fentanyl commonly found in fake pills, have made substance use more dangerous than ever.”
Illegally made fentanyl (IMF) refers to fentanyl that is produced by clandestine laboratories instead of the pharmaceutical industry. IMF cannot be obtained from a doctor or pharmacy; it instead comes in forms such as powder, pills, or blotter paper, according to SAMHSA. On the other hand, opioid misuse includes the misuse of prescription opioids or the use of heroin.
“With fentanyl and other highly potent synthetic opioids becoming more prominent in communities across the country, people receiving medication treatment for opioid use disorder or who need opioid overdose reversal medication during an acute overdose may require higher doses of those medications,” said Carroll.
Drug overdose death rates, including those involving synthetic opioids (such as fentanyl) and stimulants (such as cocaine and methamphetamine) have risen over the past several decades in the U.S. In 2024, 79,384 drug overdose deaths occurred, resulting in an age-adjusted rate of 23.1 deaths per 100,000 standard population, according to the CDC.
“Adding to the complexity of the overdose crisis, fentanyl also is increasingly mixed with illicit stimulants such as cocaine and methamphetamine – which substantially increases the risk for overdose, especially when people do not know they are being exposed to fentanyl or other synthetic opioids.”
Substance use disorders
Substance use disorders (SUDs) are a treatable, chronic medical disease. SUDs involve complex interactions among brain circuits, genetics, the environment and an individual’s life experiences, according to the American Society of Addiction Medicine. People with addiction use substances or engage in behaviors that become compulsive and often continue despite harmful consequences.
SUDs are characterized by impairment caused by the recurrent use of alcohol or other drugs (or both) – including health problems, disability and failure to meet major responsibilities at work, school, or home. Repeated drug use changes the inner workings of the brain and leads to addiction.
SUDs can range from mild to severe and can affect people of any race, sex, income level or social class, according to the CDC.
“It is important to note that there is no single cause of substance use and addiction. The risk for substance use disorder (SUD) is influenced by multiple factors, including early initiation of substance use, underlying mental health conditions, trauma, family substance use and community norms,” said Carroll. “Social media can add complexity by being a source of access to illicit substances or glamorizing use, but it also presents opportunities for prevention and education.”
The dual role of social media highlights the need for early SUD intervention and prioritizing proper messaging online.
Proper messaging should emphasize that addiction is a chronic disease, and therefore treatment is available and recovery is possible. Outpatient counseling, inpatient rehabilitation, behavioral healthcare, and medications for opioid use disorder (MOUD) and medications for alcohol use disorder (MAUD) are all safe and effective ways to address a SUD, according to the CDC.
“Despite available treatments, however, gaps remain, including provider shortages, access barriers and persistent stigma,” said Carroll. “And we know many people who could benefit from treatment do not seek care for a variety of reasons, including cost, stigma, shame, they do not feel ready for treatment, or believing they can manage on their own.”
Among people aged 12 or older in 2024 who were classified as needing substance use treatment in the past year, only about 1 in 5 received substance use treatment.
Addressing drug abuse
To address the escalating illicit drug crisis and encourage SUD recovery and treatment, organizations such as SAMSHA, the National Institute of Health’s National Institute on Drug Abuse and the Department of Health and Human Services (HHS) have worked to prevent substance misuse, abuse and addiction across the U.S.
Through campaigns such as “Talk. They Hear You.” ®, Communities Talk and awareness events such as SAMHSA’s Prevention Day, National Prevention Week, and Substance Use and Misuse Prevention Month, SAMSHA aims to educate and inform communities on the dangers of drug abuse and encourage individuals to seek treatment.
“SAMHSA has also made significant investments through programs such as the State and Tribal Opioid Response Grants to expand access to medications for SUDs and opioid overdose reversal medications, peer and other recovery supports, and wraparound services, including recovery housing,” said Carroll.
Additionally, on Feb. 2, 2026, HHS Secretary Robert F. Kennedy, Jr. announced a comprehensive plan to strengthen prevention, expand treatment, and carry out an executive order for a $100 million investment to solve long-standing homelessness issues, fight opioid addiction, and improve public safety by “expanding treatment that emphasizes recovery and self-sufficiency,” according to a HHS press release.
“Federal efforts such as the recently announced Great American Recovery Initiative are galvanizing action across the government and with multiple sectors across communities,” said Carroll. “This bold new initiative is focused on expanding access to evidence-based prevention and treatment and strengthening long-term recovery supports.”
Policies under the initiative are focused on preventing drug use and treating individuals – and The Safety Through Recovery, Engagement, and Evidence-based Treatment and Supports (STREETS) Initiative from HHS will fund targeted outreach, psychiatric care, medical stabilization and crisis intervention, while connecting Americans experiencing homelessness and addiction to stable housing with a clear focus on long-term recovery and independence.
These initiatives and many more from other organizations aim to reduce illicit drug abuse nationally and save lives. According to Carroll, “SAMHSA, under the Great American Recovery Initiative, will continue to be laser-focused on supporting states, tribes, and communities with the resources, training and technical assistance they need to save lives, restore families, strengthen our communities and build the Great American Recovery.”
Key points
- Widespread, under-treated: ~48M Americans have SUD; most aren’t getting care
- Fentanyl risk is everywhere: Often hidden in fake pills or mixed with other drugs
- Patient mix is shifting: Use is rising in adults 26–49—not just younger patients
- Chronic but treatable: Counseling + medications are effective, but stigma blocks access
- Clinical takeaway: Physicians need support identifying, treating, and discussing SUD openly