The cost of chaos: A cracking windshield on substance use in the US

A core public health function is to assess the scope, distribution, impact, and root causes of population health challenges to inform programs and policies in real time. In the United States, programs to prevent substance use, provide treatment, support recovery, and reduce related health harms require functional, up-to-date dashboards that monitor critical metrics. A good example is the Performance Review System (PRS), which the Biden-Harris administration used to track progress toward the national goals outlined in the 2022 National Drug Control Strategy.

The gaps in substance use data systems have been well-known for years. For example, the Arrestee Drug Abuse Monitoring (ADAM) program measured illicit substance use among recently arrested individuals. It provided policymakers with critical insights into drug markets and spending on illicit drugs that general population surveys cannot capture. However, ADAM ended in 2014, and nothing has meaningfully replaced it.

Such data limitations are like cracks in a car windshield, obscuring our ability to see the road ahead. This is acutely important now for two reasons. First, 2025 and 2026 are truly pivotal years: Will the well-known progress in lowering fatal drug overdoses observed between 2023 and 2024 continue, stagnate, or reverse? Since stagnation or reversal is unacceptable, timely, reliable data are essential. These data will help to forge a pathway to sustain the recently observed declines in drug fatalities.

Second, some of the central substance use metrics that the public health field has relied upon (even if they have limitations) are at risk. Some have been ended, such as the Drug Abuse Warning Network (DAWN). Others were paused for months and later reinstated, like the National Vital Statistics System reports on drug fatalities. Still others face an uncertain future, including the National Survey on Drug Use and Health, under the current administration.

The uncertain future of congressional appropriations for Substance Abuse and Mental Health Services (SAMHSA) and the Centers for Disease Control and Prevention (CDC) grants adds to the instability in the nation’s response to substance use. Take, for example, the SAMHSA grants that the administration terminated and then abruptly restarted within 24 hours. The same abrupt termination and subsequent restart affected CDC public health infrastructure grants over the weekend of January 24, 2026.

The current conditions create incremental cracks in the national substance use windshield. Here, we examine what must be done to repair them as quickly as possible, to inform today’s policies and prevent an unclear future. We also identify key national metrics that, to our knowledge, have never been part of a national goal related to substance use.

Needed national goals and concomitant metrics

Each new presidential administration is required to issue a statement of drug priorities in its first year in office (which the current administration has done) and to issue a national drug control strategy, including national goals, beginning in its second year in office. Because this administration has not yet published a comprehensive national drug control strategy, there are no quantitative national substance use goals currently in place. In 2022, the Biden-Harris administration set a goal that fatal drug overdoses in the United States would not exceed 81,000 by the end of 2025; this goal was met approximately one year early. In other writing, we have suggested that the nation should build on this historic achievement by setting a new goal of reducing domestic fatal drug overdoses by at least 50% by 2030, relative to the year ending December 2024. This would help sustain the progress in addressing drug fatalities. Without quantitative national goals, the challenge is not just having a cracked windshield for setting drug policy, but more akin to having no precise destination to put into the GPS.

Central metrics paused or ceased

Mortality data

Some central substance use data sets have recently been updated—for instance, the State Unintentional Drug Overdose Reporting System has been updated by the CDC for 2024. However, other key metrics have been paused or ceased. Persons working on substance use policy issues know that the CDC’s National Center for Health Statistics (NCHS) updates drug fatality numbers at 10 a.m. Eastern time 10 days after the first Sunday of every month. These updates include state-level breakdowns and data on the types of drugs present at the time of death.

Clearly, this information provides bellwether data for the United States. We note this obscure formula for the monthly unveiling of these data because it illustrates the long-standing and systematic approach to carefully collecting, analyzing, and communicating this information from the CDC. Sadly, in October, November, and December 2025, these centrally important data were not updated on the CDC NCHS website. We cannot be certain if federal layoffs, the government shutdown, or a conscious choice has led to this lack of updating. Yet, whatever the reasoning, this information is sorely needed in as near real-time as possible.

These updates resumed in January 2026, but time passed without this key information. Pauses in data reporting can be damaging to informing policies and programs. Some states (such as Maine) publish monthly overdose updates, but not all states do. Without the NCHS update, there is no national windshield for drug fatalities. More states could issue monthly reports, and perhaps a privately funded organization could weave state reports to paint a national picture, but providing a national outlook is a federal responsibility. Ensuring that accurate, timely updates from NCHS will not be threatened by future government shutdowns will allow for better methodological consistency across jurisdictions, more rapid dissemination, and better efficiency of efforts.

Again, missing three updates might not seem like a major issue, but even that can interfere with data needed for real-time policymaking. In the United States, we see that the decline in stimulant-related fatal overdoses appears to be flattening, and for some states like New York, the number of drug fatalities involving opioids and those involving cocaine is nearly converging, indicating a substantial amount of lethal polysubstance use. These types of data-driven observations require programmatic consideration and intervention as quickly as possible.

Prevalence data

The Biden-Harris National Drug Control Strategy, which the current administration no longer uses, included several goals related to the prevalence of specific substance use conditions, such as opioid, cocaine, and methamphetamine use disorders. It also addressed associated behaviors, including alcohol use and vaping among adolescents. Tracking such objectives requires the use of data from multiple sources, including the National Survey on Drug Use and Health (NSDUH), a survey that has been overseen by SAMHSA. While the NSDUH has its limitations as a general population survey, when combined with other CDC surveys, it provides insight into illicit substance use trends nationwide. The 2024 NSDUH report was issued in late summer 2025.

In the latest NSDUH release, data on racial and ethnic groups were not included. SAMHSA reports that more detailed analyses are underway and will be forthcoming. These data are critical for examining disparities in the impact of substance use across communities. The SAMHSA staff responsible for the ongoing administration of the NSDUH were terminated due to reductions in force. While SAMHSA contracts with a company to conduct the NSDUH survey, questions remain about the survey’s future. State officials, as well as federal policymakers, rely on NSDUH for prevalence data as well as trends. Other CDC data sets, such as the Behavioral Risk Factor Surveillance System, are relatively limited in scope on substance use topics and, therefore, they are not a substitute for NSDUH data should it be paused, diminished, or ended. State and congressional leaders should, at a minimum, receive clarification about the NSDUH’s future status. Members of Congress on both sides of the aisle have declared their commitment to robust public health responses to the overdose epidemic. Therefore, they should make certain that the NSDUH survey continues and makes its data available to researchers in a timely manner.

Emerging threat metrics paused or ceased

The nation’s illicit drug supply is ever evolving, making data on emerging drug threats critically important to informing rapid public health responses. Identifying new synthetic drugs in the illicit drug supply is an ongoing challenge and an area where improved data collection and analysis—even before recent budget cuts occurred—are sorely needed. Important innovations such as the drug checking lab at the University of North Carolina lend an important eye on drug trends. Numerous states and major cities convey information on emerging threats on their websites; one instance is New York State, which provides public information on drug checking results. However, in some states, drug checking violates the law.

The federal government is uniquely situated to spot drug trends that transcend state borders and to engage both public health and public safety sectors in a rapid response. This is an area where backsliding on data collection can cost lives, and where even the limited data collection we currently have threatens the development of a national “windshield” to spot national trends.

One important data set for learning about such threats via emergency department experiences was the Drug Abuse Warning Network (DAWN) operated by SAMHSA. DAWN reflects data from 53 hospital emergency departments where recent alcohol and other drug use is either a direct or contributing factor to the emergency department visit. However, the DAWN website now contains this disclaimer:

“DAWN Discontinuing New Data Collection

Effective June 13th, 2025, the Drug Abuse Warning Network (DAWN), operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), will discontinue new data collection as part of a broader effort to align agency activities with agency and administration priorities. DAWN provided information on emergency department visits related to recent substance use and emerging substance use trends across the country. Reports and statistical products using DAWN data will remain available on SAMHSA’s website.”

While the Drug Enforcement Administration’s annual National Drug Threat Assessment provides important information about emerging drug threats, its periodicity and focus are not the same as the more frequent updates previously provided by DAWN.

Some potential time-sensitive solutions

To address these concerns about the cracking of the national windshield for viewing substance use, we propose some urgently needed actions. We welcome discussion of these and other pathways forward. In keeping with the declaration of the nation’s opioid crisis as a public health emergency, rigorous, near-real-time data systems are vital.

First, paused or discontinued federal data sets and dashboards should be brought back online as quickly as possible. This would improve efficiency and ensure that comparisons across jurisdictions remain as methodologically meaningful as possible. Congress could help by prioritizing and funding key federal data sets and dashboards, including the NSDUH and DAWN, are prioritized and supported.

Second, even in times of tight budgets, state and local jurisdictions can develop or maintain their own dashboards. For instance, New York State publishes online an annual streamlined set of key tracking indicators covering eight domains (fatal and non-fatal overdoses, emergency department visits, hospitalizations, substance use disorder prevalence, substance use treatment and harm reduction service coverage, and high-risk opioid prescribing patterns). Of course, this has jurisdictional, not comprehensive, national relevance.

Third, coordinated multi-jurisdictional efforts can help maintain these data snapshots in the absence of federal action (even if they are not a true substitute). A number of coalitions of state and local health departments, as well as some state governors, are collaborating on approaches to public health challenges in the current environment. Much of these coalitions’ early work has focused on vaccine scheduling, but other joint work seems possible.

For instance, two or more states or cities could combine their jurisdiction-specific data dashboards. This would provide insight into substance use and emerging threat patterns in their areas or along drug trafficking routes. While desirable, such an undertaking would be resource-intensive and require peer jurisdictions to agree on methodological approaches without federal guidance on data quality standards and analytic approaches.

However, a cross-jurisdiction coalition approach may be more promising for sharing information on emerging drug threats. After all, identifying an emerging threat is essentially raising a red flag, urging diligence and caution, all while developing locally-relevant action plans. Knowing whether other jurisdictions are seeing similar detections of new drugs, adulterants, or patterns of use—such as nitazines, BTMPS, medetomidine, and xylazine, to name a few—could allow for more focused investigations in one’s own locale. Awareness that a particular threat is emerging nearby can help jurisdictions anticipate risks before they arrive. It can also facilitate the exchange of best practices, including the development of action plans to address specific emerging threats, such as care strategies for wounds or the severe withdrawal syndromes associated with some fentanyl adulterants.

Fourth, and quite obviously, we need national goals to be reestablished (such as a 50% or more reduction in drug fatalities by 2030 relative to 2024). Without such goals, accountability is lost, our destination unclear, and midcourse corrections difficult to undertake.

Fifth, we must be aspirational in developing metrics at the national, state, and local levels that go beyond traditional measures, such as fatal and nonfatal overdoses, prevalence, and service delivery coverage. (These measures are important if gathered and analyzed in near real time, but are inadequate.) The field is missing a systematic measurement of comprehensive well-being and wellness among persons who use drugs gathered at a large-scale level. Here, we could envision the field following the example of HIV, in which measures of quality of life were developed specifically for persons with lived experience. Such attempts at measuring overall well-being should consider concomitant health issues (such as cardiovascular disease, which is often seen in fatal drug overdose cases), co-occurring conditions (especially relating to mental health conditions), and key social determinants of health.

Sixth, relatedly, it is important to include measures that go beyond services delivered by health care professionals and instead are delivered by community bystanders. This would include further development and publication of naloxone distribution and administration by community members (as provided in Maine’s monthly report). Also, a key national dashboard on non-fatal drug overdoses, based on data collected by emergency medical services (EMS) professionals, includes data on persons not transported to the emergency department (for any number of reasons). Examining why EMS is called but transport does not occur could provide useful insights for program planning.

Seventh, the field generally does not set large-scale goals to address community-level impacts, such as the number of children who have lost a family member to substance use. While some studies assess this metric, we are not aware of any national goal aimed at reducing this impact.

Eighth, it is critical to assess health equity across each of the measurement types noted above. For instance, in New York, between 2023 and 2024, the number and rates of drug fatalities lessened for most communities, but disparities in the rates per 100,000 population persisted. Further, “small cell size” data suppression rules tended to obfuscate the impact of drug fatalities, especially in Tribal Nations. Measuring health equity is not a single metric but rather must be considered carefully for all metrics. This is clearly an area where setbacks in data collection can exacerbate conditions in communities already experiencing disproportionate rates of overdose death and other social impacts.

Conclusion

While the national substance use data “windshield” has long had imperfections, the cracks are spreading and endangering our outlook at a critical historical moment in the epidemic. When a windshield begins to crack, you don’t know how quickly, how much, or where it will spread. This is the situation we’re currently facing with substance use data. Data sets might be cancelled or reinstated, their form may change or remain the same. Certain demographic communities may be left out, and a data set may be funded without sufficient staff to manage it.

All of these uncertainties hinder the clear road ahead. We urgently need to (re)set national goals, restore key measures now paused or ended, and creatively expand the field beyond still-important, traditional overdose-related measures. Doing so would allow us to more comprehensively assess the wide-ranging effects of America’s rapidly evolving and lethal drug supply. When we speak of the future of substance use efforts in the United States, goals, metrics, data systems, and timely reporting structures are generally not the first topic discussed. However, without them, our overall direction is unclear, our progress muddled, and our needed midcourse corrections confused. Without the clarity of vision that such rigorous, timely data systems offer, we are fumbling in the dark when lives and well-being are literally at stake.

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