Why this exists

The current lethal supply is not the one any prescribing policy was designed for. CDC surveillance across 45 states and the District of Columbia estimated that during 2023, approximately 72,000 drug overdose deaths — nearly seven in ten — involved illegally manufactured fentanyls. Across 2021–2023, illegally manufactured fentanyls were detected in 188,082 of 251,089 overdose deaths, 74.9%.

And the composition of that supply keeps moving. Carfentanil, which has no approved human therapeutic use, produced an outbreak of 1,181 deaths in Florida across 2016–2017 and then largely receded, before reappearing: 29 deaths in the first half of 2023 and 238 in the first half of 2024. CDC and DEA both describe carfentanil as far more potent than fentanyl — the published estimates are roughly 100 times fentanyl, or 10,000 times morphine — and both hedge those figures explicitly, because analog potency has not been evaluated in humans. We reproduce the hedge rather than dropping it.

The interval between a change like that entering a local supply and a jurisdiction knowing about it is measured in months. That interval is where people die who did not have to.

How it works

• Toxicology and overdose data assembled continuously rather than in reporting cycles, so a change in composition is visible as a change rather than as a revised annual figure.
• Corroboration across independent sources — toxicology, overdose events, and the vocabulary and geography signals from supply signal analysis. A single source is a hypothesis.
• Geographic resolution at the level a response can act on — a county, a corridor, a set of ZIP codes — never an individual.
• Output is a warning with a recommended action: what has changed, where, what it is being called locally, and what services and clinicians should do about it.