The nation’s opioid epidemic is causing some medical examiners to skip some autopsies because of a lack of staff, The Wall Street Journal reports.

The shortage of medical examiners is greatest in areas including New England and the Rust Belt, where overdose deaths from heroin and fentanyl have dramatically increased. “It’s a problem for every area of our office, from transporting bodies to doing autopsies to toxicology testing,” said James Gill, Chief Medical Examiner in Connecticut.

The National Association of Medical Examiners recommends autopsies for all overdoses. The group advises pathologists to perform no more than 250 autopsies annually, to avoid exhaustion and mistakes. In many areas hard-hit by the opioid epidemic, pathologists perform an average of 325 autopsies a year.