Is Wastewater Surveillance an Effective Use of Opioid Settlement Funds?

By Tricia Christensen & Abby Winiker

The 2026 National Drug Control Strategy recognizes wastewater-based surveillance as a tool for monitoring community drug consumption patterns, and some jurisdictions have invested opioid settlement funds in this strategy. As interest grows, decision makers should be asking whether wastewater testing is an effective use of limited opioid settlement funds. Specifically, does it generate information that can meaningfully reduce overdose deaths?

To answer this question, we reviewed the existing research on wastewater-based epidemiology (WBE) for drug surveillance and developed a Frequently Asked Questions guide. We find that wastewater testing can provide population-level information about drug consumption trends and, in some cases, detect the emergence of known substances. However, the evidence also demonstrates important limitations to relying on WBE as the basis for a comprehensive public health strategy. Wastewater data cannot determine who precisely is using drugs and how they are using them, and to date, no study has assessed how WBE could lead to behavior changes that reduce overdose risk. The FAQ also discusses ethical considerations, implementation challenges, and complementary approaches that may provide more direct benefits for overdose prevention.

We determine that wastewater surveillance should not be viewed as a standalone overdose prevention strategy. Pairing wastewater surveillance with community-based drug checking programs, which provide people who use drugs with timely information about drug contents, may offer a more actionable approach.

Opioid settlement funds remain a finite resource, and communities must carefully prioritize investments that are supported by evidence and can meaningfully reduce overdose deaths. Every investment should do more than simply observe the crisis; it should generate information that can be translated into concrete actions that save lives.

Tricia Christensen, MPP is an independent consultant specializing in harm reduction and drug policy. Her work bridges the gap between policy and practice, and she has over a decade of experience facilitating collaboration among government and community partners and standing up programs for low-barrier access to life-saving supplies and broader support systems. As a national opioid settlement expert, she advocates directing funds toward evidence-based, locally led interventions to save lives and heal communities from decades of regressive policies. Tricia is an alumna of Johns Hopkins Bloomberg School of Public Health, earning her MPP in 2017.

Abigail Winiker, PhD, MSPH, is an Assistant Scientist in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Program Director for the Bloomberg Overdose Prevention Initiative. Her work and training in harm reduction and health education inform her public health practice, and she strives to conduct research with direct translational implications to improve outcomes for at-risk populations.