Leveraging value-engineering framework and non-traditional research funding mechanisms to address the drug overdose epidemic: the CODE initiative

Timely drug overdose mortality surveillance is critical for public health response, yet death certification in the USA is frequently delayed by weeks or months due to resource constraints in medicolegal death investigation systems. While research in the field of analytical toxicology has advanced significantly, these research advancements have not translated into improved timeliness or completeness of overdose reporting at scale. This gap reflects structural misalignment between public health infrastructure needs and traditional biomedical research funding mechanisms, which prioritise hypothesis-driven discovery over translational engineering and operational deployment.

This article examines how the US National Institute on Drug Abuse (NIDA)’s Cause of Death Elucidated (CODE) initiative addressed this challenge by combining a federal prize competition with milestone-driven Small Business Innovation Research (SBIR) contracts. The initiative employed the Kano model as a framework to translate stakeholder needs into product requirements, mobilised non-traditional expertise outside conventional NIH (National Institutes of Health) applicant pools and advanced research into development of field-deployable postmortem toxicology screening solutions. The CODE experience demonstrates that funding mechanism design itself functions as a process innovation, determining who participates, what solutions emerge and whether scientific capability translates into public health capacity.