Medical examiner: fentanyl now fuels most opioid deaths in DeKalb; office seeks settlement funds for testing and staff

The medical examiner’s office told DeKalb County commissioners that fentanyl is now the leading contributor to opioid deaths in the county and urged using settlement funds to expand toxicology capacity and staffing.

At a committee meeting the county’s medical examiner (presenting to the board) said about 2,300 cases were reported to the office last year and that toxicology cases represent a large share of the work. “We had a little over 200 toxicology‑related deaths last year,” the presenter said, adding that 114 deaths were opioid‑related and 107 of those were fentanyl‑specific in the most recent full year of data.

The presenter reviewed long‑term trends — prescription opioid waves in the 1990s, a spike in heroin in the 2010s and the current fentanyl wave, which frequently arrives mixed with stimulants such as cocaine and methamphetamine. The office staff described county heat maps for 2020–2024 and clarified the maps track where an incident originated or where death occurred rather than a decedent’s home address.

Commissioners pressed for more disaggregated demographic and population‑change data. The presenter said the county’s Bureau of Vital Statistics delayed some 2024 data releases, but the office will provide exact race‑and‑sex percentages on request and expects more detail from an overdose fatality review team now being stood up.

The office told commissioners that county staff have completed agreements to participate in an overdose fatality review board that will include public health, probation and other agencies; organizers hope the review can begin this month. The presenter said those reviews typically produce actionable case‑level insights that can guide prevention and intervention strategies.

On costs, the medical examiner warned the state toxicology lab has a lengthy backlog, which would delay death investigations and certificates. The office relies on private labs for faster turnaround; the presenter named National Medical Services as one vendor and said private contracts usually produce results within about two weeks. The presenter estimated toxicology expenditures at about $7,585,000 a year (stated as an office estimate) and said expanded “extended” tox panels are far more expensive than basic screens.

To address those needs, the office discussed possible uses of opioid‑settlement or abatement funds: continuing a public ACOR dashboard (about $15,000 a year), expanded forensic toxicology testing (office estimate $85,000), funding Morehouse fellowship salaries (one fellowship salary cited at $150,000) and hiring another investigator (roughly $65,000–$70,000). The presenter described a combined package of proposals that could total in the neighborhood of $300,000 depending on final choices.

The presenter also described facility and staffing constraints: the building that houses the office is nearing 30 years old, office space is tight, and adding fellows or new investigators would require upgraded office space. Building an accredited in‑house toxicology lab would be “millions” of dollars for equipment and staffing, the presenter said, and the department suggested continuing to use private labs while pursuing modernization and targeted investments.

Next steps: commissioners asked the office to provide the specific demographic breakdowns and to follow up with the fatality‑review timeline and proposed budgets tied to opioid settlement scenarios. The office agreed to provide the requested figures and to return with more detailed cost estimates and implementation plans.