Surveillance and Testing to Stem the Tide of the Next Opioid Drug Crisis

Aegis recent panelist, Alex J. Krotulski, PhD, released an op-ed that is an exploration into the identification of new and emerging synthetic opioids.

Over the last few years, fentanyl has become a defining force in modern drug markets and is now the main driving factor in our country’s overdose crisis. Fentanyl is ending up alongside everything from heroin to counterfeit pills of medications like Adderall and Xanax, to street stimulants like cocaine and methamphetamine. It remains a hidden threat that the public is becoming increasingly aware of.

The reality, however, is that fentanyl is just one small part of an ever-evolving puzzle. Synthetic drugs are constantly emerging, created to mimic all kinds of existing drugs. These drugs, also known as designer drugs or novel psychoactive substances (NPS), can be just as addictive as fentanyl, increasingly potent, and just as dangerous. But with the right surveillance tools and testing, we can identify these drugs and stem their spread before they turn into the next crisis.

I work at the Center for Forensic Science Research & Education (CFSRE), located outside of Philadelphia. We assist laboratories and public health organizations by surveilling and alerting the public about new and emerging synthetic opioids (and other NPS drugs) popping up in the U.S. and around the world. The CFSRE is constantly looking for the best sample populations to discover synthetic opioids and NPS in general. In our laboratory, we use several comprehensive methods to expand our search for drugs, including a library database with over 1,000 drugs and metabolites.

Little is known when a drug first emerges. That’s why the CFSRE developed its NPS Discovery program, which signals when a new drug is identified for the first time and includes any information we’ve discovered about it. NPS Discovery now operates as an open-access drug early warning system – the drug version of what meteorology uses for hurricanes, tornadoes, and other weather threats. We reference any literature that has been published, legal status, and trends around the world, when available.

But merely identifying these new drugs isn’t enough. In order to truly confront this community health concern, we must pair detection with education. This can only happen through partnerships and open collaboration – when testing and surveillance organizations collaborate with public health organizations in order to inform providers and patients about the drug landscape.

Our work is crucial because current testing devices on the street and at point-of-care clinics are often ineffective for identifying new or adulterated drugs. During my time in the forensic toxicology field, a constant trend I’ve seen is the rapid emergence and turnover of new synthetic opioids and NPS, often driven by global factors. Ten years ago, heroin dominated the drug supply, but now fentanyl has spiraled out of control. The emergence of drugs like xylazine demonstrate that this cycle will continue, producing new drugs that can be more potent and lethal.

Xylazine is a sedative used in veterinary medicine. It first appeared in Philadelphia’s drug supply prior to 2020 and has continued to spread. According to a recent study by Aegis Sciences Corporation, and our own internal studies, xylazine is much more widespread than initially conceived. Our organization identifies new threats like xylazine every day, and we work to notify the public in the hopes of stemming the tide before they spread throughout the community.

We’re not alone, though. I recently served on a panel for Aegis along with health experts from across the country to discuss the current state of synthetic drugs in the United States and the evolution of the drug market and to compare methods for detecting and identifying new drugs. The overall sentiment was that testing is a valuable tool for combating this issue. Testing aids in discovery, and through the work of the CFSRE, Aegis, law enforcement, and treatment centers, we can educate and warn the public and the medical community about new threats.

Education, surveillance, and collaboration can save lives.


Alex Krotulski, Ph.D., is the associate director at the Center for Forensic Science Research & Education.