A nationwide wastewater monitoring pilot to identify legal and illegal substances and enable future substance use research.

Wastewater-based epidemiology has been proposed as a faster, near real-time window into community substance use, but national-scale implementation in the United States has been elusive. A National Institute on Drug Abuse-funded pilot with Biobot Analytics spanning 76 sites across 41 states demonstrates that harmonized, near-real-time wastewater surveillance of opioids and adulterants is not only feasible but actionable, offering public health officials data weeks or months ahead of traditional reporting systems.