The answer depends on which drugs, which age groups, and how you measure it. Overall drug use among U.S. teens is near historic lows, and overdose deaths dropped sharply in 2024. But the drug supply has grown more dangerous, new synthetic substances are appearing at record rates, and 80% of people who need substance use treatment still don’t get it. The picture is more complicated than a simple yes or no.
Overdose Deaths Fell Sharply in 2024
After years of relentless increases, drug overdose deaths in the United States declined by nearly 27% in 2024 compared to 2023. That translates to roughly 81 fewer deaths per day. Deaths involving synthetic opioids, primarily fentanyl, dropped 33% in the 12-month period ending in October 2024, and heroin-related deaths fell about 37% over the same window.
These numbers represent a real turning point after overdose deaths peaked above 107,000 in 2023. Still, tens of thousands of people are dying each year. In 2023, synthetic opioids alone accounted for nearly 75,000 of the roughly 107,500 total overdose deaths, making them responsible for 69% of all fatal overdoses. The decline is meaningful, but the baseline was catastrophically high.
The Drug Supply Is More Synthetic Than Ever
Even as death tolls fall, the composition of what people are actually using has shifted dramatically. Fentanyl has effectively replaced heroin in the illicit opioid market. Five years ago, heroin was the primary substance in 66% of opiate samples submitted to the DEA. By 2024, that had flipped: fentanyl was the primary drug in 73% of those samples, with heroin making up just 27%.
This matters because fentanyl is far more potent and far less forgiving of dosing errors. Someone buying what they believe is one substance may be getting another, or getting a familiar drug laced with something stronger. Meanwhile, the DEA’s 2025 threat assessment identifies fentanyl and methamphetamine as the primary drivers of fatal overdoses nationwide, with cocaine, heroin, and diverted prescription opioids still contributing but playing a smaller role than they once did.
On top of established synthetics, entirely new substances keep appearing. In 2024, forensic authorities recorded a record high of 688 individual new psychoactive substances in drug samples, including 101 that had never been seen before. As of September 2025, a total of 1,396 new psychoactive substances from 153 countries have been reported to early warning systems worldwide. These novel compounds are difficult to test for, harder to treat in an emergency, and largely unknown in terms of long-term effects.
Teen Drug Use Is Near Record Lows
For parents and educators, the news is mostly encouraging. The Monitoring the Future survey, which tracks substance use among 8th, 10th, and 12th graders, found that use of most drugs either held steady or declined in 2024. Alcohol use dropped among 10th graders (from 30.6% to 26.1%) and 12th graders (from 45.7% to 41.7%). Cannabis use fell among 12th graders, from 29.0% to 25.8%. Nicotine vaping declined among 10th graders and held steady in the other grades.
Use of prescription narcotics other than heroin hit an all-time low among 12th graders: just 0.6% reported using them in the past year, down from a peak of 9.5% in 2004. Illicit drug use other than marijuana also declined among 8th graders, dropping from 4.6% to 3.4%.
There are a few exceptions worth watching. Nicotine pouch use roughly doubled among 10th graders (from 1.9% to 3.4%) and 12th graders (from 2.9% to 5.9%). And 2025 data showed small but statistically significant upticks in cocaine use among 8th graders (from 0.2% to 0.6%) and 12th graders (from 0.9% to 1.4%). Researchers at the National Institute on Drug Abuse flagged these increases in cocaine and heroin use as warranting close monitoring, even though the absolute numbers remain low.
Cannabis Use After Legalization
Cannabis occupies its own lane in this conversation because legalization has changed who uses it and how often. In states where recreational cannabis is legal, about 8.7% of users report daily or near-daily consumption. That frequency of use is associated with higher rates of cannabis use disorder, a pattern where people have difficulty cutting back despite wanting to.
Among teens specifically, cannabis use has not spiked in the way some predicted. Rates have been stable or declining across most grade levels, even as more states have legalized adult use. The bigger shift appears to be among adults who use more frequently now that access is easier and social stigma has faded.
The Global Burden Is Growing Unevenly
Globally, the burden of drug use disorders has increased since 1990, but not evenly. Opioid use disorder is the single biggest driver of rising disability and death worldwide, fueled in large part by the North American opioid crisis. A common pathway: patients prescribed opioid painkillers developed dependence, then shifted to illicit opioids when prescribing rules tightened. That transition from prescription pills to street fentanyl accounts for a significant share of the crisis.
Disparities between countries and regions have widened. Socioeconomic conditions, national drug policies, geographic location, and even genetic factors all shape how heavily a population is affected. Wealthier nations tend to have higher rates of opioid problems, while stimulant-driven crises look different in other parts of the world. The overall trend is toward greater inequality in who bears the consequences of drug use.
The Treatment Gap Remains Enormous
Perhaps the most striking number in all of this: 80% of Americans who needed treatment for a substance use disorder in 2024 did not receive it. That gap has persisted for years despite expansions in insurance coverage and the availability of effective medications for opioid addiction. Barriers include cost, stigma, long wait times, a shortage of providers in rural areas, and the simple fact that many people don’t recognize their use as a problem until it becomes a crisis.
So while overdose deaths are declining and teen drug use is low, the underlying vulnerability remains. Millions of people are using substances in ways that cause harm, the drug supply is increasingly unpredictable, and the vast majority of those who need help aren’t getting it. The trend lines are moving in the right direction on several fronts, but the gap between where things are and where they need to be is still enormous.