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Stimulants 2026: Why Cocaine and Meth Deaths Keep Rising While Opioid Deaths Fall — and What Treatment Looks Like Without a Medication

Stimulant-involved deaths have followed a different trajectory than fentanyl deaths. Here is the science of why, and where the treatment field stands today.

ByThe Rize NewsroomMay 22, 20262 min readStimulants

The divergence nobody expected

When overdose data for 2024 and 2025 showed opioid deaths declining sharply, the public health response was cautious optimism. But embedded in those statistics is a different story: stimulant-involved deaths — 57,500 in 2022 combining cocaine and methamphetamine, approximately 70% of which involved fentanyl — have tracked a separate, more stubborn trajectory.

The difference comes down to pharmacology. Naloxone reverses opioid overdoses because it displaces fentanyl from the same receptor. There is no equivalent antidote for stimulant toxicity. And unlike opioid use disorder, stimulant use disorder has no FDA-approved maintenance medication.

Where the disease lives

Methamphetamine use disorder is primarily a Western and Midwestern phenomenon — Arizona, California, Oregon, Nevada, and the Mountain West have the highest prevalence. Cocaine use disorder concentrates in urban areas in the South and East. The polysubstance pattern — stimulants combined with fentanyl, sometimes known and sometimes not — is nationwide and growing.

What contingency management actually is — and why it is hard to access

Contingency management is the most evidence-supported intervention for stimulant use disorder. Participants receive small tangible rewards for drug-free urine screens. Dozens of RCTs show consistent positive outcomes. The VA has implemented CM broadly.

Only California and Washington have Medicaid section 1115a waivers authorizing CM programs. Elsewhere, a person with Medicaid seeking the most effective behavioral treatment for stimulant use disorder is likely to find it uncovered.

Where the field disagrees

Does mirtazapine translate to the U.S.? The Australian Phase 3 RCT was conducted in government-funded clinics with populations who may differ from American methamphetamine users. The 8% risk reduction is real but clinically modest.

Is residential treatment necessary for severe methamphetamine use disorder? The clinical consensus leans yes for severe cases. But residential slots are scarce and expensive.

Recent developments

The FDA draft guidance for stimulant use disorder trials is the clearest regulatory signal that pharmacotherapy approval infrastructure is being built. Two active Phase 3 trials mean that by 2027-2028 there may be data sufficient to file an NDA.

If you or someone you care about is navigating stimulant use disorder, help is available:

  • 988 Suicide and Crisis Lifeline: Call or text 988. Available 24/7.
  • SAMHSA National Helpline: 1-800-662-4357 (free, confidential, 24/7)
  • Find treatment near you on Rize — our matching algorithm includes CM-capable facilities and stimulant-specialized programs.

Sources Cited

  1. 01.A
    FDA Takes Steps to Advance Development of Novel Therapies for Stimulant Use DisordersFDA
  2. 02.B
    Contingency Management for Stimulant Use Disorder and Opportunities for State Medicaid CoverageHealth Law and Policy Brief
  3. 03.A
    CDC Reports 14% Drop in U.S. Overdose Deaths for 2025US News

Filed Under

trendstreatmentpolicyMethamphetamineCocaineTreatmentPolicyTrends

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