Substance use disorders (SUDs) continue to pose a significant public health challenge across the U.S. With new resources becoming available, such as opioid settlement funds (OSF), the Behavioral Health Services Act (BHSA) in California, and youth vaping settlements (e.g., JUUL), state and local agencies are reevaluating how to deliver prevention, treatment, and recovery services. Effective use of these funds requires a nuanced understanding of local trends and a commitment to data-driven, community-specific solutions. In this post, we’ll explore substance use funding trends in California, Colorado, and Florida as case studies to suggest some lessons that might be learned.
Understanding Substance Use Disorders (SUDs)
According to the CDC, SUDs occur when the recurrent use of alcohol or drugs causes clinically significant impairment, including health problems, disability, or failure to meet major responsibilities at work, school, or home. Many individuals with SUDs also face co-occurring mental health disorders, trauma, unstable housing, or chronic physical conditions, making integrated, person-centered care essential.
Substances involved in SUDs include:
- Opioids (fentanyl, heroin, prescription painkillers)
- Stimulants (methamphetamine, cocaine)
- Nicotine (including vaping)
- Alcohol
- Cannabis and others
National Substance Use Trends: Snapshot
Substance use remains a significant public health concern nationwide.
Health and Economic Impacts
- According to the 2022 National Survey on Drug Use and Health (NSDUH), 29.5 million people aged 12 or older had alcohol use disorder in the previous year, 27.2 million have experienced a drug use disorder (including illicit and prescription drugs), and 8.0 million people had both an alcohol use disorder and a drug use disorder.
- CDC’s provisional data indicate about 87,000 drug overdose deaths from October 2023 to September 2024, down from approximately 114,000 the previous year, representing a nearly 24% decline (CDC). Excessive alcohol use is responsible for 178,000 deaths in the United States each year (CDC).
- The use and misuse of alcohol, nicotine, illicit drugs, and prescription drugs cost Americans more than $700 billion annually in increased health care costs, crime, and lost productivity (NIH).
Demographic Impacts
- Highest illicit drug use occurs among those aged 18–25 (39% prevalence) (NCDAS).
- 5% of people in non-metropolitan, rural counties have used illicit drugs, compared to 20.2% of those in larger metropolitan counties (NCDAS).
- Early drug use (before age 13) greatly increases SUD risk.
- The opioid epidemic now affects a broader range of racial and ethnic groups, with rising impacts in Black, Hispanic, and American Indian/Alaska Native communities (Johns Hopkins University).
The Impact of Naloxone
Naloxone (Narcan, Kloxxado) has proven to be one of the most effective tools for reversing opioid overdoses and is a cornerstone of harm reduction. Increased access to naloxone, primarily through community-based distribution, can significantly reduce opioid-related deaths. A recent study found that a supply-based naloxone distribution approach could reduce overdose deaths by about 6.3%. A demand-based approach targeting high-risk areas could achieve an 8.8% reduction (University of Minnesota).
Why Evaluating Local Trends Matters
Nationwide data indicates the urgency of programs to address SUDs, but knowing community-specific data can help local agencies spot trends and develop programming that is aligned with local needs and, ultimately, more effective.
Substance use trends shift rapidly. For example, youth vaping, fentanyl, and stimulant use patterns can change year to year. Rigorous evaluation ensures services match community needs and highlights gaps in care, especially for underrepresented groups like LGBTQ+ youth, rural residents, and justice-impacted individuals. Good evaluation helps:
- Identify service gaps
- Track who is and isn’t accessing care
- Measure what’s working and adjust quickly
- Monitor funding impacts and guide decisions about ongoing funding streams
Aligning evaluation across funding streams (OSF, JUUL, BHSA) creates a more complete, actionable picture of the SUD landscape.
State-Level Substance Use Trends
We analyzeD snapshots of SUD issues in California, Colorado, and Florida to demonstrate the importance of identifying community-specific trends. These states each have different local needs and require different types of programming as a result.
*2023 values are provisional estimates based on the latest data. Source: CDC
California Substance Use Trends
California continues to face rising overdose deaths, particularly from fentanyl, which accounted for 90% of the state’s 7,530 opioid overdose deaths in 2023. The 2023 California Department of Health Care Services Statewide Needs Assessment and Planning (SNAP) Report is the most comprehensive and authoritative source for California substance use trends, statistics, and demographics:
- Youth: Alcohol and prescription drug misuse among high schoolers has declined since 2017. Marijuana use among youth is stable.
- Adults: Young adults (18–25) have the highest illicit drug use. Marijuana use is up slightly; prescription painkiller misuse is down to 2% of adults.
- Heroin and methamphetamine: Slight increases in use since 2017.
- There remains higher misuse among males, unemployed individuals, and sexual/gender minorities.
- Geographic trends:
- Rural Northern Counties (Lake, Humboldt, Mendocino, Shasta, Modoc): Highest opioid and amphetamine overdose rates.
- Urban Centers (San Francisco, Los Angeles): More fentanyl- and heroin-related deaths.
- Southern/Central Counties: Lower per-capita rates but higher total deaths due to larger population size.
Efforts to expand naloxone access are ongoing, including state-supported initiatives aimed at making naloxone more affordable and widely available (Estus et al., 2025). In correctional settings, naloxone administration has saved over 1,600 lives in 2023 alone, with a more than 2,300% increase in naloxone events since 2018 (CDCR).
Community-based naloxone distribution programs and access to pharmacies have also expanded. However, the overall impact at the population level is still being evaluated as overdose deaths continue to rise, especially in large cities like Los Angeles and San Francisco.
Florida Substance Use Trends
Florida has faced significant challenges related to substance use, particularly with opioids and synthetic drugs. In 2022, the state reported 7,827 drug overdose deaths, giving Florida an overdose death rate of 37.5 per 100,000 individuals, the 18th highest in the nation. Opioids, especially synthetic variants like fentanyl, are responsible for the majority of these deaths. Urban centers like Miami-Dade are hubs for cocaine and synthetic opioids. At the same time, rural areas in the Panhandle see higher rates of methamphetamine and prescription misuse (Statewide Drug Policy Advisory Council).
However, Florida’s substance use landscape is evolving:
- After a 42% spike in overdose deaths during the COVID-19 pandemic, the state is now seeing improvement.
- Between January and June 2023, there were 3,640 opioid-related deaths, an 8% decrease from 2022; opioid-caused deaths dropped by 7% (Florida Medical Examiners Commission).
- Pain reliever misuse among youth dropped to 1.9% in 2022; youth heroin and cocaine use are also at historic lows (2024 Florida Youth Substance Abuse Survey).
- Among adults, marijuana use is rising (17.8% in the past year), but youth marijuana use is at its lowest in years (2024 FADAA Annual Update).
Source: Florida Medical Examiners Commission
Expanded naloxone access is widely credited for the state’s recent decline in opioid deaths. Naloxone is now available to first responders, laypersons, and community organizations, thanks to statewide initiatives such as the Helping Heroes program, which ensures broader access (Office of the Attorney General).
In 2023, Florida distributed over 405,000 naloxone kits, a 112% increase, and reported more than 16,000 overdose reversals (Florida Medical Examiners Commission).
Colorado Substance Use Trends
Colorado has seen one of the nation’s most dramatic reductions in overdose deaths, with total drug overdose fatalities dropping by 18% and opioid-related deaths falling by nearly 29% between December 2022 and November 2024 (CDC).
Substance use and overdose rates in Colorado still vary widely by county, reflecting differences in drug type, demographics, and geography:
- Overdose rates: 12+ counties have overdose death rates above 20 per 100,000 (Baca, Bent, Conejos, Adams, Denver, Pueblo, Delta, Jackson).
- Drug profile: Opioids and fentanyl account for 72.3% of all drug overdose deaths; fentanyl alone caused 59% of deaths (2023). Methamphetamine remains a significant driver, especially in certain counties.
- Demographics: In recent years, the 35–44 and 45–54 age groups have shown the highest rates of drug overdose deaths. In 2023, males accounted for approximately 65% of all drug overdose deaths in the state. This overdose death rate is double that of females (CDPHE).
State leaders and public health experts directly attribute recent decreases in opioid-related deaths to the widespread availability of naloxone. Colorado’s comprehensive approach includes distributing naloxone to first responders, community organizations, and the public, as well as deploying mobile health units to rural areas. The state has also invested opioid settlement funds to expand harm reduction and treatment programs further.
Cross-State Comparison: Using Data to Drive Local Strategy
While all three states have experienced the devastating impacts of opioids, particularly fentanyl, how these impacts manifest and how effectively states are responding vary considerably. These differences offer critical lessons for state and local agencies striving to deploy limited resources strategically.
From 2019 to 2023, Colorado and Florida saw meaningful declines in overdose deaths following pandemic-era spikes, while California’s rates have remained persistently high. These divergent patterns may point to differences in local drug supply dynamics, health system capacity, and the timing and scale of policy interventions, especially the distribution and uptake of naloxone:
- California must address high rates of fentanyl-related deaths in both urban and rural areas and explore why naloxone distribution hasn’t reversed the trend as effectively as in other states.
- Florida demonstrates how large-scale naloxone distribution and community engagement can reduce deaths, even in high-use areas, suggesting replicable models.
- Colorado demonstrates the impact of coordinated harm reduction strategies and data-informed investments in rural access through mobile units and local partnerships.
By triangulating trends across multiple states, evaluators and public health leaders can:
- Identify which interventions (e.g., targeted naloxone distribution, youth prevention campaigns) yield measurable impact and where.
- Compare demographic-specific impacts to ensure strategies are responsive to racial, geographic, and age-based disparities.
- Use strategic funding sources (e.g., OSF, BHSA, JUUL settlements) to prioritize high-need populations and address care gaps.
Enhancing Public Health Responses
Substance use remains a complex crisis, but targeted funding, robust evaluation, and expanded access to Narcan are driving progress. Florida and Colorado are seeing marked declines in overdose deaths, while California continues to expand harm reduction efforts.
As opioid settlement funds become available, there is strong potential for these resources to enhance public health responses. Experts recommend using these funds to expand naloxone distribution, support interventions that increase the likelihood of overdoses being witnessed, and improve access to treatment and prevention programs (University of Minnesota). Policymakers can leverage settlement funds to implement evidence-based strategies, such as:
- Scaling up naloxone distribution, especially in high-risk communities
- Supporting harm reduction and overdose prevention education
- Increasing access to medication-assisted treatment (MAT) and recovery services
- Addressing social determinants of health that contribute to substance use
These targeted investments, informed by research and local data, can help sustain and amplify the positive trends already seen with expanded naloxone access and comprehensive intervention strategies. Sustained, data-driven action is essential to build on these gains and save more lives.