KNOXVILLE, Tenn.—On Monday, the Knox County Regional Forensic Center released its 2025 Drug-Related Death Report, a 23-page record that details the illicit drug use trends of the past year inside Knox and Anderson counties.
The data, according to the report, mirrors most of the previous year. Some numbers went up. Others dropped.
That means there is good news and there is bad news.
And for the team at the RFC, there also is a little bit of worry.
“Sadly, all stories have more detail, and they are always changing, more often than not, for the worse,” Dr. Darkina Mileusnic says.
The report is documented, studied, researched and compiled by a team of experts, perhaps the best in the country, Dr. Mileusnic notes in her opening letter. Each member is extraordinarily proficient and thoroughly trained in detecting and reporting the details, no matter how minor.
“They are beyond exceptional,” she says.
The Highlights
As outlined in the report (found here), the data from the drug-related death report is drawn from only Knox and Anderson counties between 2021 and 2025. Some key findings include:
Knox County experienced an 8 percent decrease in drug-related deaths in the past year. Drug related deaths in Anderson County decreased by 13 percent from 2024 to 2025.
Fentanyl and its analogues were the most frequently identified drugs in drug-related deaths. The five most common drugs identified in 2025 drug-related deaths were synthetic opioids, methamphetamine, cocaine, gabapentin and alcohol/ethanol.
Prescription opioid-related drugs continue to decrease in Knox and Anderson counties.
The presence of anxiolytic, anti-depressant and anti-psychotic medication was found in 25 percent of all drug-related deaths in Knox County and 41 percent in Anderson County.
“There is good and bad, and they are all hard realities,” says Chris Thomas, director and chief administrative officer for the KCRFC. “We still have an overdose epidemic in the communities we serve but, it’s not just here. The nation is battling it, too, and hopefully we can battle it together.”
A Deeper Dive Into the Numbers
Fentanyl was the main killer in the two counties, claiming 190 lives total. However, that is a decrease from 2024 – when the drug killed 246 people – and from 2023 (437).
Methamphetamine remains the stimulant drug of choice in East Tennessee and is frequently used in combination with other opioids and benzodiazepines. Cocaine is encountered often, but it still lags behind methamphetamine abuse. Xylazine, which frequently made the “top 10” list of most abused illegal drugs was not as present this year as in the past. In fact, it dropped from fourth spot to ninth.
In Knox County, individuals aged 35 to 64 comprised almost three quarters of the total deaths. Broken down further, more people aged 55 to 64 experienced the most drug-related deaths, which was up by 2 percent for that age bracket. Those aged 45 to 54 were the second highest, but the deaths decreased in that bracket by 8 percent compared to the previous year. Unfortunately, the third highest bracket – aged 35 to 44 – increased by 3 percent, which was the highest increase of all age groups.
In Anderson County, more deaths occurred at a younger age than Knox County. Those 25 years old to 54 years old made up more than half of the county’s deaths in 2025. But, more people died in the 35 to 44 year old age bracket – which represented a 30 percent jump – than any other group. However, the death total for individuals age 45 to 54 dropped by 38 percent.
You can read more about all the data points in the full report. The Knox County RFC on Monday also released its annual report which provides an extensive overview of the RFC facilities, staff, and cases. That report can be found here https://knoxcounty.org/rfc/pdfs/KCRFC_Annual_Report_2025.pdf.
