The report focuses on quantitative data for fentanyl, cocaine and methamphetamine as well as qualitative data for seven novel psychoactive substances (NPS) selected by ONDCP: acetyl fentanyl, carfentanil, ketamine, medetomidine, para-fluorofentanyl, tianeptine and xylazine. Quantitative analysis refers to the concentration of a substance relative to the size of the population using that sampling site, which isn’t necessarily possible for those that are less prevalent or more potent than fentanyl, cocaine or meth. The data represent about 18 percent of the United States population, and according to ONDCP is the country’s largest wastewater drug-monitoring project to date.

After first analyzing the seven NPS by census region, the agency decided to hone in on individual counties where at least six of the seven had been identified.

“Counties where at least six drugs were detected may signal broader polysubstance activity, making them important areas for closer monitoring,” the report states. It also labels counties as “hotspots” for fentanyl, cocaine and meth use.

Similarly, the report points out that medetomidine, para-fluorofentanyl, carfentanil and acetyl fentanyl were identified in all census regions, “signaling potential emerging and re-emerging threats.” But there’s no indication of scale for any of the NPS data, even in the report’s accompanying supplement.

For some states, the data really reflect a single county. Other states have data from up to nine counties. And within the county-level data, there’s no standardization in how many sampling sites were included, or whether multiple sites were spread out versus concentrated in one location. 

The government isn’t required to get the public’s consent to test wastewater because, legally speaking at least, property is no longer private once we’ve thrown it away; it’s the same concept behind why cops don’t need a warrant to go through trash cans on the curb.

Biobot Analytics, the first commercial wastewater-testing company, began contracting with ONDCP in January. (The National Institutes of Health has already been working with Biobot for wastewater drug-testing since 2020.) In May, the new National Drug Control Strategy called for the establishment of a “national wastewater-based monitoring system,” and referenced wastewater testing as a means of confirming AI analyses of emerging drug trends on social media.

Notably, wastewater data doesn’t distinguish between regulated and unregulated versions of a substance. This means that Adderall use, whether prescribed or not, is getting categorized as methamphetamine.

The utility of wastewater testing mostly depends on whether the data is going to public health or to law enforcement. However anonymized the samples might be initially, it’s not difficult for law enforcement to trace the information back to a specific toilet if they really want to.

“Unlike many sources, wastewater is unbiased by household income, race or gender, ensuring equal representation,” Biobot stated in a 2023 blog post about wastewater testing in the context of allocating opioid settlement funds. “With 80 percent of American households and almost all public restrooms included, wastewater analysis offers insights into where substances are used.”

Wastewater itself isn’t biased by income, but it’s harder to say that about wastewater analysis, which is entirely contingent on access to indoor plumbing.

Top and inset images (cropped) via Office of National Drug Control Policy/X.com

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Though the 2026 Strategy does not mention the recent rescheduling of medical marijuana, nor the ongoing process to potentially reschedule non-medical marijuana, it makes many dubious claims about the plant’s risks and harms. This includes heavily conflating medical marijuana with high-potency THC as well as with synthetic cannabinoids, both regulated and unregulated.

For example, the ONDCP suggests that the public can better understand “some of the medical risks associated with cannabinoids” by looking to the FDA labeling for dronabinol (Marinol), a synthetic cannabinoid prescribed for severe nausea that hasn’t responded to other treatments.

“The label warns of neuropsychiatric adverse reactions, cardiovascular instability, seizures, substance use disorder, and paradoxical symptoms such as nausea and vomiting,” the Strategy states. “Reviewing these official warnings may help individuals better understand the potential dangers of medical or non-medical marijuana use.”

The Strategy also claims that marijuana legalization has been largely taken over by “Chinese criminal groups.”

The previous Strategy was released in May 2024, under the Biden administration. In that version the focus on marijuana was minimal, and largely related to racial disparities in the criminal-legal system. These have now been replaced by warnings about cancer, cognitive impairment, scromiting—”due to the associated screaming and vomiting”—fungal pathogens, pesticides, pediatric poisonings, money laundering, “poly-crime involving human trafficking of exploited laborers,” youth suicide and, above all, drug-induced psychosis.

“The varying legal status of marijuana across the United States notwithstanding, it remains a fact that there are Americans who are suffering from addiction and side effects of marijuana and its associated products such as psychoactive derivatives of hemp or other high-THC products, and they deserve help,” the Strategy states. “Cannabis-induced psychosis, if diagnosed and addressed early, may mitigate the potential impact on progression towards schizophrenia or other severe mental illness.”

Cannabis-induced psychosis is a narrative that dovetails conveniently with the administration’s “Treatment First” model for people trying to access housing services, but also with its ongoing fearmongering about youth substance use.

The Strategy leans heavily on misleading claims that adolescent marijuana use, “particularly of high-potency products,” leads to schizophrenia and bipolar disorder. By contrast, the 195-page document says almost nothing about methamphetamine, which for years has been the go-to for scaring the public about drug-induced psychosis. Cocaine is mostly mentioned in the context of Coast Guard seizures.

“It is critically important to identify people who are experiencing psychosis for the first time, as it may be related to drug use,” the Strategy states. “Additionally, convergent evidence from multiple sources suggests that cannabis exposure increases the risk of psychosis, and the prevention of marijuana use could serve to reduce the prevalence of psychosis, in addition to reducing cannabis use disorder and other consequences.”

In 2019, New Yorker writer Malcolm Gladwell wrote a wildly irresponsible article cherry-picking data about youth schizophrenia prevalence to suggest that marijuana use was often the cause, and ever since that belief was brought into the mainstream lawmakers have made similar claims about marijuana without acknowledging that correlation is not causation. For example, the Strategy states that drug use is associated with suicide, and that in one study of toxicology reports from the suicide deaths of people under age 25 the most common substance detected was marijuana—”more than alcohol or any other drug.” In no way does this show that marijuana is associated with suicide.

Top image via California State Auditor. Inset graphic via the White House.

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“Under [Trump’s] leadership, we will reassert our fundamental right to live healthy lives,” Carter stated following her confirmation. “We will hold accountable the narco-terrorists who infringe upon this right, participating in the deliberate poisoning of tens of thousands of Americans each year. They will no longer kill our families, friends, neighbors and even children with impunity. At the same time, I will ensure that every parent, family member and child have the resources they need to prevent and combat addiction. I will stand with our brave law enforcement officials, and with every family who has lost a loved one to drug overdose.”

This rhetoric aligns with a series of Trump administration actions over the past year that position the drug war as a legally sanctioned war, including designating fentanyl as a weapon of mass destruction, transnational drug-trafficking organizations (DTOs) as terrorist groups and using military resources for drug interdiction operations previously confined (more or less) to law enforcement. Carter’s confirmation also comes just days after the US extraction of ousted Venezuelan leader Nicolás Maduro and his subsequent indictment for “narco-terrorism.”

This is Carter’s first appointment to public office. Her reporting for Fox and other primarily right-wing outlets has focused on DTOs, work she described during her 2025 Senate Judiciary Committee nomination hearing as “mapping the enemy.”

“This is not just a public health crisis,” she told senators during that hearing, “it’s a chemical war being waged against the American people.”

At publication time her website is inactive, but she has previously used it to advance a range of pro-Trump conspiracy theories about fentanyl and the southern border, including widely debunked myths like “fentanyl-laced” gummy bears.

Trump slashed ONDCP funding by more than half in his 2026 budget submission.

As drug czar Carter is legally required to oppose legalization of any Schedule I controlled substance. But she is expected to support Trump’s executive order calling for the rescheduling of marijuana under the Controlled Substances Act, as she’s an avid proponent of medical cannabis programs and has previously stated that she’s not against legalization.

“I don’t have any problem if it’s legalized and it’s monitored,” she said on her podcast in 2024, according to Marijuana Moment. “I mean, I may have my own issues of how I feel about that, but I do believe that cannabis for medicinal purposes and medical reasons is a fantastic way of handling—especially for people with cancer and other illnesses, you know—of handling the illness and the side effects of the medication and those illnesses. So I’m not saying we’ve gotta make it illegal.”

The ONDCP is the federal agency that oversees the nation’s drug policy agenda. The drug czar advises the president directly, and influences how funding is allocated to law enforcement and public education campaigns.

Trump, however, slashed ONDCP funding by more than half in his 2026 budget submission, requesting just $21.785 million and shunting the office’s marquee grant programs to other agencies. This includes the High Intensity Drug Trafficking Areas (HIDTA), which would be transferred to the Department of Justice, and Drug-Free Communities Support Program, which would be transferred to the Department of Health and Human Services. Congress has not yet finalized the appropriations. The transfer of HIDTA to DOJ has been proposed multiple times by previous administrations, including under Trump during his first term and by then-president George W. Bush in 2005.

The ONDCP has existed in its current form since 1989, with nine drug czars prior to Carter as well as half a dozen acting directors who served brief terms during periods of transition to a new administration.

Carter’s predecessor Rahul Gupta, appointed in 2021 by then-president Joe Biden, was the first medical doctor to serve in the position. Gupta stepped down in January 2025, since when ONDCP official Jon Rice has served as acting director.

Image via Senate Judiciary Republicans/Twitter

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