Opioid Overdose Surveillance Georgia, 2017 Drug Surveillance Unit Epidemiology Section Division of Health Protection Georgia Department of Public Health https://dph.georgia.gov/drug-surveillance-unit 1 Opioid Overdose Surveillance, Georgia, 2017 The purpose of this report is to describe fatal (mortality) and nonfatal (morbidity) opioid-involved overdoses in Georgia during 2017, including prescription opioids, and illicit opioids such as heroin, fentanyl, and fentanyl analogs. Opioid overdose data were analyzed by the Georgia Department of Public Health (DPH) Epidemiology Program, Drug Surveillance Unit, using Georgia hospital discharge inpatient and emergency department (ED) visit data, and DPH Vital Records death data. Key Findings Opioid-involved overdose deaths have been rapidly increasing in Georgia since 2010, driven initially by increased use and misuse of prescription opioids (e.g., Oxycodone and Hydrocodone). Beginning in 2013, illicit opioids, such as heroin and fentanyl, drove the sharp increase in opioid-involved overdose deaths. o From 2010 to 2017, the total number of opioid-involved overdose deaths increased by 104%, from 514 to 1051 deaths. In 2017, among Georgia residents: o Any opioid-involved overdoses accounted for 5,656 ED visits, 2,622 hospitalizations, and 996 deaths. o Heroin-involved overdoses accounted for 1,521 ED visits, 335 hospitalizations, and 261 deaths. o Fentanyl-involved overdoses accounted for 363 deaths. o Persons aged 25-34 years more frequently died from an opioid-, synthetic opioids-, heroin- or fentanyl-involved overdose, and visited an ED for an opioid-involved overdose than persons of other age categories, yet older persons were more frequently hospitalized because of an opioid-involved overdose. o Males aged 25-34 years died from an opioid-involved overdose more frequently than any other age category, and were 2.9 times more likely to die from an overdose than females of the same age. o Males were 1.8 times more likely to die from any opioid-involved overdose, and 3.7 times more likely to die from a heroin-involved overdose than females. However, females, particularly those aged 45 years and older, were more frequently hospitalized for an opioid-involved overdose than males. o Whites were 4.2 times more likely to die from an opioid-involved overdose, 2.4 times more like to visit an ED for any opioid-involved overdose, and 4.2 times more likely to visit an ED for a heroininvolved overdose than Blacks. o The highest numbers of heroin- and opioid-involved overdose deaths, ED visits, and hospitalizations occurred predominantly in urban areas (Atlanta Metropolitan Area, Augusta, Macon, Columbus, and Savannah). However, high rates of opioid overdose-involved ED visits and hospitalizations occurred in both urban and rural areas, particularly in North, South Central, and Southeast Georgia. For more information: County level data and other Georgia drug surveillance reports: https://dph.georgia.gov/drug-surveillance-unit Georgia Department of Public Health (DPH) Main Opioid Page: https://dph.georgia.gov/stopopioidaddiction Georgia overdose mortality interactive maps and statistics: https://oasis.state.ga.us/PageDirect.aspx?referer=MortalityDrugOverdoses Prescription Drug Monitoring Program (PDMP) information: GA PDMP Overview and FAQs https://dph.georgia.gov/pdmp 2 Fatal Drug Overdoses (Mortality), Georgia, 2017 Data Source Overdose-involved deaths were derived from DPH Vital Records death certificates. The following data include all deaths that occurred in Georgia among Georgia residents and deaths that occurred outside of Georgia among Georgia residents, unless otherwise specified. Case Definitions (Note: categories are not mutually exclusive, includes only drug overdose deaths caused by acute poisoning) Any drug overdose death May involve any over-the-counter, prescription, or illicit drug Deaths with any of the following ICD-10 codes as any underlying cause of death: X40-44, X60-64, X85, Y10-14 Drug overdose death involving any opioid Involves both prescription opioid pain relievers (e.g., hydrocodone, oxycodone, and morphine), opioids used to treat addiction (e.g., methadone), as well as heroin, opium, and synthetic opioids (e.g., tramadol and fentanyl that may be prescription or illicitly manufactured) Deaths with any of the following ICD-10 codes as any underlying cause of death: X40-44, X60-64, X85, Y10-14 AND one of the following: Any of the following ICD-10 codes as any other listed cause of death: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 Any cause of death text field contains one of the following terms (or common misspelling): heroin, fentanyl (and fentanyl analogs), methadone, buprenorphine, butalbital, codeine, eddp, hydrocodone, hydromorphone, levorphanol, meperidine, norbuprenorphine, oxycodone, oxymorphone, tapentadol, tramadol OR (for cases without an X or Y code in the underlying cause of death): Any cause of death text field contains the word "TOXIC" AND at least one of the following terms (or common misspelling): heroin, fentanyl (and fentanyl analogs), methadone, buprenorphine, butalbital, codeine, eddp, hydrocodone, hydromorphone, levorphanol, meperidine, norbuprenorphine, oxycodone, oxymorphone, tapentadol, tramadol Drug overdose death involving synthetic opioids other than methadone Involves synthetic opioids other than methadone (e.g., tramadol and fentanyl that may be prescription or illicitly manufactured). Note: polysubstance abuse deaths may also involve methadone or other opioids Deaths with any of the following ICD-10 codes as any underlying cause of death: X40-44, X60-64, X85, Y10-14 AND one of the following: The following ICD-10 code as any other listed cause of death: T40.4 Any cause of death text field contains the following keywords and common misspellings: fentanyl (and fentanyl analogs), tramadol OR (for cases without an X or Y code in the underlying cause of death): Any cause of death text field contains the word "TOXIC" AND at least one of the following terms (or common misspelling): fentanyl (and fentanyl analogs), tramadol Drug overdose death involving heroin Involves heroin. Note: polysubstance abuse deaths may also involve other opioids Deaths with any of the following ICD-10 codes as any underlying cause of death: X40-44, X60-64, X85, Y10-14 AND one of the following: The following ICD-10 code as any other listed cause of death: T40.1 Any cause of death text field contains the following keywords and common misspellings: heroin, morphine OR (for cases without an X or Y code in the underlying cause of death): 3 Any cause of death text field contains the word "TOXIC" AND at least one of the following terms (or common misspelling): heroin, morphine Drug overdose death involving fentanyl Note: polysubstance abuse deaths may also involve other opioids Any cause of death text field contains the word "TOXIC" AND at least one of the following terms (or common misspelling): fentanyl (and fentanyl analogs) Other Definitions or Limitations Deaths represent individual people who died in Georgia and deaths among Georgia residents outside of Georgia. Overdose death county represents the county of residence, or the place of injury (where the overdose occurred) as specified, when the place of injury field or the county of residence field was blank the county of the death certifier was used. Rate indicates the number of deaths among Georgia residents per 100,000 population using 2017 Census data as the denominator, and all rates are age-adjusted unless age category is presented. Rates for categories with fewer than 5 deaths may not be accurate and are not presented in this report. ICD-10 Code Description X40-X44 (accidental poisonings by drugs), X60-X64 (intentional self-poisoning by drugs), X85 (assault by drug poisoning), Y10-Y14 (drug poisoning of undetermined intent), T40.0 (opium), T40.1 (heroin), T40.2 (natural and semisynthetic opioids), T40.3 (methadone), T40.4 (synthetic opioids, other than methadone, T40.6 (other and unspecified narcotics) Nonfatal Overdoses (Morbidity), Georgia, 2017 Data Source Nonfatal overdose counts were derived from Georgia hospitalization and emergency department (ED) visit discharge data, and included all ED visits or hospitalizations occurring in a non-Federal acute care hospital in Georgia, among Georgia residents, with a discharge diagnosis indicating acute drug overdose during 2017. Case Definitions (categories are not mutually exclusive) ED visit or hospitalization involving any drug overdose May include any over-the-counter, prescription, or illicit drug Any mention of ICD-10CM codes: T36-T50 AND 6th character: 1-4, and a 7th character of A or missing ED visit or hospitalization involving any opioid overdose Includes prescription opioid pain relievers (e.g., hydrocodone, oxycodone, and morphine), opioids used to treat addiction (e.g., methadone), as well as heroin, opium, and synthetic opioids (e.g., tramadol and fentanyl that may be prescription or illicitly manufactured) Any mention of ICD-10CM codes: T40.0X, T40.1X, T40.2X, T40.3X, T40.4X, T40.60, T40.69 AND 6th character: 1-4, and a 7th character of A or missing ED visit or hospitalization involving a heroin overdose Any mention of ICD-10CM code: T40.1X AND 6th character: 1-4, and a 7th character of A or missing 4 Other Definitions or Limitations Please Note: The case definition has changed and cannot be compared to previous reports. Any opioid may include prescription or illicit opioids. ED Visits and Hospitalization categories are not mutually exclusive. Hospitalizations may also appear in the ED Visits category if they were admitted to the hospital through the ED. ED visits and hospitalizations may represent multiple visits by individuals in Georgia. County indicates the patient's county of residence. Only Black and White are indicated for race because of incomplete or sparse data on other races and ethnicities. Rate indicates the number of ED visits or hospitalizations among Georgia residents per 100,000 population using 2017 Census data as the denominator, and all rates are age-adjusted unless age category is presented. Rates for categories with fewer than 5 ED visits or hospitalizations may not be accurate and are not presented in this report. ICD-10 CM Code Description Poisoning by: T36-T50 (range includes all drugs), T40.0X (opium), T40.1X (heroin), T40.2X (other opioids), T40.3X (methadone), T40.4X (synthetic narcotics), T40.60 (unspecified narcotics), T40.69 (other narcotics) 6th Character: 1 (accidental, unintentional), 2 (intentional self-harm), 3 (assault), 4 (undetermined intent) 7th Character: A (initial encounter) or missing 5 Drug Overdose Deaths (Mortality) Note: Any opioid may include prescription or illicit opioids. Categories are not mutually exclusive. Overdoseinvolved deaths were derived from DPH Vital Records death certificates. The following data include deaths that occurred in Georgia regardless of the patient's residence state. No. deaths Drug-Involved Overdose Deaths Occurring in Georgia, by Drug Type, 2010-2017 1200 1000 800 600 Any Opioid Synthetic Opioids Heroin Fentanyl 400 200 0 2010 2011 2012 2013 2014 2015 2016 2017 From 2010 to 2017, the number of opioid-involved overdose deaths increased by 104% in Georgia, from 514 to 1051 deaths. Beginning in 2013, illicit opioids, such as heroin and fentanyl, drove the sharp increase in opioidinvolved overdose deaths in GA. Note: fentanyl is included in the synthetic opioid category. Note: The following data include all deaths that occurred in Georgia among Georgia residents and deaths that occurred outside of Georgia among Georgia residents, unless otherwise specified. No. deaths Drug-Involved Overdose Deaths, by Drug Type, Georgia Residents, 2016-2017 2016 2017 2000 1500 1000 500 1617 1459 904 996 378 478 214 261 363 227 0 All Drugs Any Opioid Synthetic Opioids Heroin Fentanyl In 2017 in Georgia, overdose deaths involving fentanyl (363) were higher than deaths involving heroin (261). Note: fentanyl is included in the synthetic opioid category. 6 Drug-Involved Overdose Death Rates, by Age and Drug Type, 25.0 Georgia Residents, 2017 Deaths/ 100,000 pop. 20.0 Any Opioid 15.0 Heroin 10.0 Fentanyl 5.0 0.0 Overall <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Age Category (years) Persons aged 25-34 years died from an opioid-, synthetic opioids-, heroin- or fentanyl-involved overdose more frequently than persons of other age categories. Deaths/ 100,000 pop. Drug-Involved Overdose Death Rates, by Race and Drug Type, Georgia Residents, 2017 18.0 15.7 16.0 White Black 14.0 12.0 10.0 8.0 6.0 4.5 3.7 4.0 2.0 1.0 0.0 Any Opioid Heroin Race Whites were 4.2 times more likely to die from an opioid-involved overdose than Blacks. 7 Deaths/ 100,000 pop. Drug-Involved Overdose Death Rates, by Sex and Drug Type, Georgia Residents, 2017 14.0 12.3 12.0 10.0 Male Female 8.0 6.9 6.0 4.1 4.0 2.0 1.1 0.0 Any Opioid Heroin Sex Males were 1.8 times more likely to die from any opioid-involved overdose, and 3.7 times more likely to die from a heroin-involved overdose, than females. Opioid-Involved Overdose Death Rates, by Age and Sex, Georgia Residents, 2017 35.0 30.0 Male Female 25.0 20.0 15.0 10.0 5.0 0.0 Overall <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Age Category (years) Deaths/ 100,000 pop. Males aged 25-34 years died from an opioid-involved overdose more frequently than persons of any other age category, and were 2.9 times more likely to die from an overdose than females of the same age. 8 Opioid-Involved Overdose Emergency Department Visits and Hospitalizations (Morbidity) Note: The case definition has changed and cannot be compared to previously published reports. Any opioid may include prescription or illicit opioids. ED visits and hospitalization categories are not mutually exclusive. Hospitalizations may also appear in the ED visits category if they were admitted to the hospital through the ED (95% of opioid hospitalizations were admitted from the ED in 2017). Opioid-Involved Overdose Involved Emergency Department Visits and Hospitalizations, by Drug Type, Georgia, 2017 Any opioid may include prescription and/or and illicit opioids; categories are not mutually exclusive Number represents events that occurred in Georgia regardless of the patient's residence state Number represents events that occurred in Georgia among Georgia residents Drug Category No. No. Any Opioid ED Visits Any Opioid Hospitalizations 6058 2784 5656 2622 Heroin ED Visits 1699 1521 Heroin Hospitalizations 366 335 Note: The following data include all ED visits and hospitalizations that occurred in Georgia among Georgia residents. No. of visits or hospitalizations Opioid-Involved Overdose Emergency Department (ED) Visits and Hospitalizations, by Drug Type, Georgia Residents, 2016-2017 6000 5000 5195 5656 Any Opioid Heroin 4000 3000 2639 2622 2000 1000 0 1204 ED Visits 2016 1521 ED Visits 2017 306 Hospitalizations 2016 335 Hospitalizations 2017 From 2016 to 2017 in Georgia, hospitalizations for opioid-involved overdoses decreased by 1%. Hospitalizations for heroin-involved overdoses increased by 9%. ED visits for opioid- and heroininvolved overdoses increased by 9% and 26% respectively. 9 ED visits/ 100,000 pop. Total <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Hospitalizations/ 100,000 pop. Total <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Opioid-Involved Overdose ED Visit Rates, by Age and Drug Type, Georgia Residents, 2017 120.0 100.0 80.0 60.0 40.0 20.0 0.0 Any Opioid Heroin Opioid-Involved Overdose Hospitalization Rates by Age and Drug, Georgia Residents, 2017 60.0 50.0 Any Opioid Heroin 40.0 30.0 20.0 10.0 0.0 Age Category (years) Age Category (years) Persons aged 25-34 years were more likely to visit an ED because of an opioid-involved overdose than persons of other age categories, yet older persons were more frequently hospitalized because of an opioid-involved overdose. Heroin-involved overdoses occurred most frequently among persons aged 25-34 years, and were less common among younger and older persons. Opioid-Invovled Overdose Emergency Department Visit and Hospitalization Rates, by Race and Drug Type, Georgia Residents, 2017 80.0 74.2 White Black 60.0 40.0 31.4 20.0 0.0 Any Opioid ED Visit 24.2 5.8 Heroin ED Visit 32.3 13.9 5.5 1.3 Any Opioid Hospitalization Heroin Hospitalization Whites were 2.4 times more likely to visit an ED for any opioid-involved overdose, and 4.2 times more likely to visit an ED for a heroin-involved overdose than Blacks. Visits or hospitalizations / 100,000 pop. 10 ED visits/ 100,000 pop. Total <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Hospitalizations/ 100,000 pop. Total <1 1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Opioid-Involved Overdose ED Visit Rates, by Age and Sex, Georgia Residents, 2017 150.0 Male Female 100.0 50.0 0.0 Opioid-Involved Overdose Hospitalization Rates by Age and Sex, Georgia Residents, 2017 Male Female 80.0 60.0 40.0 20.0 0.0 Age Category (years) Age Category (years) Males aged 25-34 years visited an ED and/or died from an opioid-involved overdose more frequently than females of the same age category. Females, particularly those aged 45 years and older, more frequently visited an ED, were more frequently hospitalized for an opioid-involved overdose than males. 11 HEROIN-INVOLVED OVERDOSES NOTE: Rates could not be calculated for most counties due to the low number of heroin-involved overdose deaths, ED visits and hospitalizations. Therefore, the number (not rate) of overdoses are presented in this map. 12 NOTE: Rates could not be calculated for some counties due to the low number of heroin-involved overdose deaths, ED visits and hospitalizations. Therefore, the number (not rate) of overdoses are presented in this map. 13 ANY OPIOID-INVOLVED OVERDOSES 14 15 16 Georgia Bureau of Investigations (GBI) Crime Laboratory Submissions Crime laboratory submissions are evidence items (pills, powders, etc.) seized by law enforcement and submitted to the GBI Crime Laboratory (https://dofs-gbi.georgia.gov/) for forensic chemical identification. A case may contain one submission or several. For example, a case may consist of a single plastic bag with powder material inside, or a case may have been a result of a massive search warrant and contain many bags of powder, plus pills and liquids. Each submission that is tested is recorded and tracked. These data represent only items tested during each calendar year; these numbers may change slightly as untested items are completed. No. of Lab Submissions GBI Crime Lab Submissions: Heroin and Fentanyl, 2014-2017 1600 1400 1200 1000 800 600 400 200 0 1174 44 2014 Heroin Fentanyl (including analogs) 1412 1426 66 2015 117 2016 1320 209 2017 Submissions to the GBI Crime Laboratory for Heroin and Fentanyl increased by 12.4% and 375% respectively from 2014 to 2017. No. of Lab Submissions GBI Crime Laboratory Submissions, Top 5 Opioids, 2014-2017 2000 1800 1600 1400 1200 1000 800 600 400 200 0 176158351829 1493 Oxycodone 2014 2015 2016 2017 1458 1501 1257 1128 1412 1426 1320 1174 Hydrocodone Heroin 321 312 257 151 Morphine 327 277 237 139 Methadone 17 No. of Lab Submissions GBI Crime Laboratory Submissions, Major Drugs, 2017 16000 14000 12000 10000 8000 6000 4000 2000 0 14639 6302 1966 1493 1320 1128 Oxycodone, hydrocodone, and heroin were the opioids most frequently submitted to the GBI Crime Laboratory for identification, and in the top six drugs most commonly submitted. Oxycodone and hydrocodone were also the two most frequently prescribed opioids in Georgia in 2018. (see the Georgia PDMP 2016-2017 Report available at https://dph.georgia.gov/drug-overdose-surveillanceunit). 18 Counties with the Highest Number or Rate of Any Opioid-Involved Overdose Deaths, Emergency Depart (ED) Visits and Inpatient Hospitalizations -- Georgia, 2017 Number, and age-adjusted rate per 100,000 population. Note: rates could not be calculated for some counties due to the low number of any opioid-involved overdose ED visits, hospitalizations, and deaths, only counties with >15 were included in the top 10 rate ranking Rank 1 No. deaths County of residence Cobb (118) No. deaths County of injury Cobb (126) Death rate County of residence Banks (29.7) No. ED visits and hospitalizations County of residence Fulton (691) ED visit and hospitalization rate County of residence Atkinson (232.2) 2 Fulton (103) Fulton (125) Gilmer (28.4) Cobb (643) Bartow (167.1) 3 Gwinnett (71) Gwinnett (64) Lumpkin (27.4) Gwinnett (511) Echols (161.7) 4 DeKalb (48) DeKalb (61) Pickens (21.3) DeKalb (393) Talbot (159.1) 5 Cherokee (33) Cherokee (34) Bartow (20.6) Hall (290) Polk (157.1) 6 Richmond (28) Carroll (22) Tattnall (20.5) Richmond (287) Lumpkin (152.5) 7 Chatham (26) Chatham (20) Carroll (19.1) Paulding (241) Paulding (150.7) 8 Forsyth (24) Hall (16) Bryan (15.8) Cherokee (240) Dawson (149.9) 9 Hall (24) Richmond (15) Cobb (15.1) Chatham (199) Banks (148.4) 10 Henry (23) Bibb (14) Glynn (14.5) Bartow (193) White (144.3) 19 Note: The following data include deaths that occurred in Georgia regardless of the patient's residence state. Drug Overdose Deaths (Mortality) -- Georgia, 20102017 Any opioid may include prescription and/or illicit opioids; categories are not mutually exclusive Number represents events that occurred in Georgia regardless of the patient's residence state Year Any Drug No. Any Opioid No. Synthetic Opioids No. Heroin No. Fentanyl No. 2017 1591 1051 506 284 381 2016 1436 954 399 228 245 2015 1364 901 411 252 255 2014 1041 637 164 236 138 2013 1113 556 82 131 52 2012 1066 554 65 106 48 2011 1042 519 84 29 N/A 2010 1059 514 102 4 N/A Drug Overdose Emergency Department (ED) Visits and Hospitalizations (Morbidity) -- Georgia Residents, 2016-2017 Number, and age-adjusted rate per 100,000 population Any opioid may include prescription and/or illicit opioids; categories are not mutually exclusive Year Any Opioid ED Visits Hospitalizations No. Rate No. Rate Heroin ED Visits Hospitalizations No. Rate No. Rate 2017 5656 52.6 2622 23.5 1521 14.9 335 3.3 2016 5195 48.9 2639 24.3 1204 11.8 306 3.0 20 Opioid Related Overdose Morbidity and Mortality -- Georgia Residents, 2017 (for emergency department (ED) visits, inpatient hospitalizations, and deaths) Number and rate per 100,000 population (rate is age-adjusted except when age categories are presented) Any opioid may include prescription and/or illicit opioids; categories are not mutually exclusive Any Opioid ED Visits Hospitalizations Deaths No. Rate No. Rate No. Rate Total 5656 52.6 2622 23.5 996 9.5 Age group <1 year 8 6.3 1 N/A 0 N/A 1-4 years 55 10.4 12 2.3 0 N/A 5 -14 years 23 1.6 9 0.6 1 N/A 15-24 years 497 34.4 123 8.5 64 4.4 25-34 years 1202 81.6 335 22.7 220 14.9 35-44 years 763 55.6 286 20.8 225 16.4 45-54 years 733 51.9 394 27.9 171 12.1 55-64 years 902 70.2 594 46.2 135 10.5 65-74 years 559 62.4 407 45.5 49 5.5 75-84 years 203 48.5 146 34.9 3 N/A 85+ years 69 47.1 38 25.9 5 3.4 Sex (age group) Male 2465 47.3 985 18.5 559 11.0 <1 year 5 7.7 1 N/A 0 N/A 1-4 years 28 10.4 9 3.3 0 N/A 5-14 years 6 0.8 3 N/A 0 N/A 15-24 years 278 37.8 74 10.1 49 6.7 25-34 years 775 106.1 206 28.2 168 23.0 35-44 years 404 61.0 145 21.9 139 21.0 45-54 years 297 43.3 135 19.7 99 14.4 55-64 years 375 61.4 215 35.2 74 12.1 65-74 years 206 50.5 141 34.6 26 6.4 75-84 years 66 36.8 44 24.5 1 N/A 85+ years 25 50.6 12 24.3 3 N/A Female 2546 44.2 1359 22.4 314 5.7 <1 year 3 N/A 0 N/A 0 N/A 1-4 years 27 10.4 3 N/A 0 N/A 5-14 years 17 2.5 6 0.9 1 N/A 15-24 years 219 30.8 49 6.9 15 2.1 25-34 years 427 57.5 129 17.4 52 7.0 35-44 years 359 50.5 141 19.8 86 12.1 45-54 years 436 60.1 259 35.7 72 9.9 55-64 years 527 78.1 379 56.2 61 9.0 21 65-74 years 353 72.4 266 54.5 23 4.7 75-84 years 137 57.3 102 42.7 2 N/A 85+ years 41 42.2 25 25.7 2 N/A Race White 3842 65.5 1837 28.4 729 13.5 Black 906 26.6 339 11.7 130 3.9 22 Opioid Overdose Surveillance and Response Information/Resources To report an increase in overdoses, a potential overdose cluster, or any other unusual drug-related event, call the Georgia Poison Center at 1-800-222-1222. Please see https://dph.georgia.gov/stopopioidaddiction for more information on how the Georgia Department of Public Health (DPH) is working to combat the opioid epidemic, including: Opioid and substance misuse response: https://dph.georgia.gov/georgias-opioid-response Prescription Drug Monitoring Program (PDMP): https://dph.georgia.gov/pdmp Drug Surveillance Unit: https://dph.georgia.gov/drug-surveillance-unit Please see https://dph.georgia.gov/opioid-epidemic-individuals-and-families for information on the opioid epidemic for individuals and families, including: Addiction prevention Drug take-back Signs of an overdose and steps to take Naloxone information Georgia's Prescription Drug Monitoring Program (PDMP) Georgia's Medical Amnesty Law Harm reduction Neo-natal abstinence syndrome Treatment resources Please see https://dph.georgia.gov/opioid-epidemic-medical-providers-and-pharmacists for information on the opioid epidemic for medical providers and pharmacists, including: Steps providers can take to help prevent opioid misuse and addiction in their patients Prescribing guidelines Georgia's Prescription Drug Monitoring Program (PDMP) Georgia's Naloxone Standing Order Georgia's Medical Amnesty Law Please see https://dph.georgia.gov/opioid-epidemic-first-responders-and-ems for information on the opioid epidemic for Law Enforcement and EMS, including: Georgia's Prescription Drug Monitoring Program (PDMP) Responder safety Georgia's Medical Amnesty Law Georgia's Naloxone Standing Order Naloxone administration Case documentation guidelines Georgia Department of Public Health (DPH), Epidemiology Section, Drug Surveillance Unit https://dph.georgia.gov/drug-surveillance-unit 23