Medical examiner: fentanyl now dominant contributor in DeKalb drug deaths; office seeks sustained funding for testing and data tools

The DeKalb County Medical Examiner's Office reported roughly 2,300 deaths reported to the office last year and a little over 200 toxicology-related deaths, with fentanyl implicated in a large share of opioid fatalities.

The medical examiner's representative told the Board that of the approximately 200 drug-related deaths in the previous year, 114 were opioid-related and 107 of those were fentanyl-specific. The office said fentanyl has displaced prescription opioids and heroin as the leading cause of opioid deaths and that an increasing number of deaths involve fentanyl mixed with stimulants such as cocaine or methamphetamine.

The medical examiner's representative said toxicology cases generally require an examination and therefore make up a substantial share of cases the office investigates. The office also presented demographic breakdowns and county heat maps, noting concentrated clusters of overdose deaths in parts of the county and that Black males represented the highest-rate demographic group in DeKalb's drug-related deaths.

Why it matters: Fentanyl's potency makes even small amounts highly lethal, and mixtures with stimulants complicate treatment and public-health response. The medical examiner urged better data collection and faster, more comprehensive toxicology testing to support investigations, family notifications and prevention work.

Key details and next steps - Case counts and testing costs: The office reported about 2,300 reported deaths in the county during the prior year and “a little over 200” drug-related deaths. The presenter estimated the office spends roughly $75,000–$85,000 annually on outsourced toxicology testing. Advanced or expanded toxicology panels that detect designer drugs cost significantly more and can introduce lab backlogs if routed to the state lab. - Data and heat maps: The office displayed five-year heat maps (2020–2024) showing shifts in overdose locations across the county. The maps use the incident location—where the death occurred or where the overdose/EMS incident originated—to place dots, not the decedent’s residence. - Demographics: The presenter said Black males had the highest overdose rate in DeKalb, followed by Black females, then White males and White females. The office does not collect education or income data during routine death investigations; those factors would be examined during an overdose fatality review. - Overdose fatality review board: The office confirmed agreements are executed and the county will participate in a multi-agency overdose fatality review, which is expected to start within weeks. The review will bring public health, probation, treatment and other partners together to analyze individual deaths and aggregate findings for prevention planning. - Data modernization and public dashboard: The office is building a public-facing dashboard via an ACOR grant; maintaining the ACOR database after the grant ends would cost about $15,000 per year. The office also provides real-time overdose data to local outreach partners (named in the presentation as Claretel) to target Narcan distribution and community outreach. - Potential uses for opioid settlement funds: The office listed possible priorities for abatement or settlement money, including maintaining the ACOR public dashboard ($15,000/year), funding expanded toxicology panels, supporting a Morehouse fellowship position (estimated $150,000 salary), and hiring an additional investigator (estimated $65,000–$70,000). The presenter estimated the package of priorities could approach $300,000 depending on scope.

Constraints and capacity The presenter said the state Bureau of Vital Statistics' staffing and delays make obtaining timely county-wide death totals more difficult and that sending some tests to the state toxicology lab can create long backlogs. To avoid delays in family notifications and death certifications, the office often uses a private laboratory (named in the presentation) that typically returns results within about two weeks, at greater cost than the state lab.

Questions raised by commissioners included requests for exact demographic counts (which the office agreed to provide by follow-up email), clarification of heat-map methodology (the office confirmed incident location is used), and whether the office could build an in-house tox lab (presenter said full in-house toxicology capability would likely cost millions for equipment, accreditation and staff).

What the office will do next The medical examiner said it will provide requested demographic breakdowns and follow up on data gaps, participate in the county’s overdose fatality review, and continue to pursue data modernization and community outreach partnerships. The office asked commissioners to consider opioid settlement funding to sustain data capacity, expand tox testing and support staff positions.

Ending note: The medical examiner called fatality review “long overdue” for overdose deaths and emphasized that better, timely toxicology and cross-agency review can yield prevention opportunities and guide community interventions.