Why fluctuating overdose trends make testing more important than ever.
After more than a decade of steady increases driven largely by illicit fentanyl, U.S. overdose deaths have begun to shift – underscoring both progress and continued risk. According to the Centers for Disease Control and Prevention (CDC), overdose deaths climbed sharply from 2013 through 2022, peaking at nearly 110,000 deaths. Synthetic opioids, primarily fentanyl, accounted for the majority of those fatalities. But beginning in mid-2023, the trend started to change. Provisional data shows overdose deaths declined significantly in 2024 – marking the largest drop ever recorded – with synthetic opioid deaths falling by more than one-third compared to the previous year.
Despite these encouraging signs, public health experts caution that the situation remains volatile. Overdose deaths, while declining, still remain historically high. The illicit drug supply continues to evolve rapidly, with fentanyl often mixed unpredictably with other substances such as xylazine, again increasing risk of overdose. As a result, this reinforces the importance of continued vigilance – including reliable testing, monitoring, and prevention strategies – to help identify emerging threats and protect community health.
Addressing the gap
Despite the prevalence of fentanyl – and more recently, xylazine – in overdose deaths, relatively few laboratories routinely test for them. Standard drug screens often focus on substances such as cocaine, amphetamines or cannabis, meaning fentanyl exposure can easily go undetected. Identifying fentanyl and other emerging drugs can help detect and diagnose substance use disorder (SUD), guide treatment decisions and connect patients with the resources they need to prevent future relapse.
For example, new guidance from the Association for Diagnostics and Laboratory Medicine (ADLM) underscores the need for closer collaboration between laboratories and emergency departments. The organization recommends that laboratories work with emergency department leadership, medical toxicologists, and poison control centers to maintain clinically relevant test menus that reflect local drug trend patterns. This may include adding tests such as fentanyl, oxycodone, xylazine or EDDP, while removing less prevalent drugs such as propoxyphene or heroin. ADLM also emphasizes the importance of ongoing drug education so that emergency department providers understand which substances are detectable, limitations of assays and how testing can best support patient care.
Addressing the crisis also requires faster insight into drug trends. Current national reporting systems often involve 6-to-12-month delays, making it difficult for communities to quickly respond to overdose spikes or emerging drug threats. Expanding drug testing and sharing results with local authorities and public health agencies could support near-real-time monitoring of local drug trends. In some communities, laboratories are already combining testing data with geographic information to identify overdose “hot spots,” helping guide targeted interventions such harm reduction strategies and evidence-based treatment strategies.
Better data, coordinated action
Reducing fentanyl-related deaths will require a multi-pronged strategy that combines expanded testing, improved surveillance and collaboration among healthcare providers, laboratories and public agencies.
As the illicit drug landscape evolves, drug testing and coordinated action will lead to better outcomes that will help communities respond more quickly – ultimately saving lives and improving overall community health.