In Tennessee, data pins Knox County as the hotspot for emerging synthetic opioids known as nitazenes—compounds estimated to be 10 to 40 times stronger than fentanyl, now appearing in the illicit drug supply across the United States.
Yet, according to Chris Thomas, Chief Administrative Officer at the Knox County Regional Forensic Center, Tennessee’s overdose map is more reflective of where testing is happening, not necessarily where people are dying. “It’s not that Knox County is definitely the hardest-hit spot of the epidemic,” he explains. “Other counties simply don’t have the resources to test for drugs like nitazenes or other novel synthetics. They only have the funding to run basic panels.”
That chilling insight exposes a national blind spot. Across the country, medical examiner and coroner offices—our first line of defense in understanding what’s killing Americans—are unable to detect many of the compounds fueling the next phase of the overdose crisis. But simple changes could be transformational.
A public health crisis hidden in plain sight
Much of our country still relies on toxicology panels built for yesterday’s drug supply. These panels can reliably identify heroin, oxycodone, and fentanyl, but fail to catch nitazenes, brorphine, or other new synthetic analogs. This gap means that policymakers and public health professionals chase outdated trends…