Data indicates Knox County in Tennessee is a primary area for emerging compounds, believed to be 10 to 40 times more potent, which are now being found in the illegal drug market nationwide.
However, Chris Thomas, Chief Administrative Officer at the Knox County Regional Forensic Center, suggests that Tennessee’s overdose data primarily shows where drug testing occurs, rather than the actual locations of fatalities. He clarified, “Knox County is not necessarily the epicenter of the epidemic.” He added that “other counties simply lack the funding to test for substances such as nitazenes or other new synthetic drugs, only possessing the budget for fundamental analyses.”
This concerning revelation highlights a widespread national oversight. Throughout the nation, medical examiner and coroner offices, crucial for identifying causes of death in America, frequently cannot identify numerous compounds driving the escalating overdose crisis. Nevertheless, straightforward modifications could bring significant change.
A public health emergency that is not immediately apparent
A significant portion of our nation continues to use toxicology screens designed for past drug environments. While these tests are effective at identifying heroin, oxycodone, and fentanyl, they often miss nitazenes, brorphine, or other contemporary synthetic equivalents. This deficiency leads policymakers and public health experts to focus on obsolete patterns.
Concurrently, drug producers capitalize on regulatory weaknesses, avoiding detection and consistently staying ahead. This exact scenario occurred with the emergence of substances unresponsive to Narcan, greatly complicating overdose interventions nationwide. It took several years, and a tragic number of fatalities, before xylazine screening became a somewhat routine procedure.
Our data, while seemingly detailed—categorized by county, substance, and year—still suffers from significant oversights. For instance, a death involving both cocaine and a nitazene could be mistakenly categorized as a “cocaine death” if the nitazene was not identified or verified. Consequently, national statistics suggest cocaine is increasingly responsible for overdoses, yet this can be deceptive if numerous such incidents actually involve cocaine mixed with undetected nitazenes or other synthetic opioids.
Without a precise understanding of the disease’s spread, we cannot discern the trajectory of the epidemic or how to halt its progression.
Why is this not being monitored?
Thomas clarified that the primary role of most medical examiner and coroner offices was established to support the criminal justice system, identifying causes and manners of death for legal and administrative reasons. Their funding, allocated by counties or municipalities rather than health departments, is not set up to facilitate the monitoring of new drug dangers.
Identifying nitazenes and other novel compounds necessitates costly equipment, such as liquid or gas chromatography and mass spectrometry, along with highly skilled staff capable of locating these substances despite their minimal molecular weight. Numerous offices, particularly in rural regions, possess neither the necessary infrastructure nor the financial resources for this.
Although the Drug Enforcement Administration (DEA) has collaborated with the University of California, San Diego, on a promising initiative to, its scope remains extremely limited. During the final quarter of 2024, the program processed and examined only. According to Thomas, simply preserving, archiving, documenting, preparing, and transporting samples demands resources and personnel that are unavailable to many offices.
This results in a fractured, unfair national monitoring system—where the substances identified are largely dictated by the location of death. Our insufficient knowledge hinders our capacity to proactively address the drug supply.
The solution: Boost funding for a clearer understanding of the crisis
The financial resources needed to resolve this issue are already available. Over —originating from pharmaceutical companies, distributors, and pharmacies—are currently being disbursed to states. These funds were allocated to prevent and lessen additional damage from the opioid crisis, but individual states distribute their portions distinctly among various agencies, counties, and local initiatives. Furthermore, a recent agreement this month with Purdue Pharma and the Sackler family contributed up to , with a segment of this sum destined for state and local authorities.
While the majority of funds are directed towards treatment, prevention, and harm reduction—all vital efforts—minimal support is allocated to forensic and toxicology systems, despite their critical role in comprehending the crisis. These departments are frequently so consistently underfunded that even a small financial injection could dramatically improve our ability to address the crisis before it intensifies further.
Numerous states maintain a, which permits strategic and flexible deployment. These allocations can be used for diverse purposes, and its discretionary portion was utilized to initiate a.
Federal lawmakers could advance this by requiring states to allocate a minor segment of their flexible funds to enhance forensic capabilities nationwide. Such funding would enable states to expand toxicology panels to identify new synthetic opioids and other evolving dangers; recruit and retain forensic toxicologists to interpret findings and update testing databases; support personnel and logistical needs for submitting samples to DEA or university reference laboratories for supplementary analysis; and integrate death investigation data with public health systems instantly.
The consequences of remaining uninformed
We cannot resolve what we cannot quantify; therefore, let us utilize opioid settlement funds to assist. Thorough toxicology testing would allow us to foresee future crises rather than reacting to past ones. Analyzing the drug supply is more than a legal or administrative duty; it is a fundamental element of public health.
