“…Over the past decade, wastewater surveillance in Europe, Australia, and Canada has proven successful in providing large-scale spatiotemporal data sets on population-level consumption of opioids, amphetamines, cocaine, cannabis, and other substances of concern. Wastewater surveillance in these regions has also demonstrated its potential to function as a warning system for detecting the emergence of new psychoactive substances despite their constantly changing profiles and lower prevalence of use compared to traditional drugs of abuse. , To date, most WBE studies in the U.S. have focused on assessing the mass loads and/or consumption rates of priority opioids and stimulants, , therapeutic drugs, , and lifestyle chemicals, , although recent efforts have sought to investigate the occurrence of emerging psychoactive substances. , Taken together, these studies have gathered important baseline data on substance consumption by diverse communities in the U.S. and underscored the opportunity to leverage ongoing or planned wastewater surveillance initiatives in supporting substance use assessment. From a practical standpoint, pivoting current wastewater surveillance initiatives, particularly those with broad spatiotemporal sampling regimes, to incorporate substance use assessment requires a phased approach to evaluate operational feasibility before the programs are scaled to reach their full potential.…”