Opioid overdose surveillance, Georgia 2018 : Drug Surveillance Unit, Epidemiology Section, Division of Health Protection, Georgia Department of Public Health

Opioid Overdose Surveillance Georgia, 2018
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, 2018
The purpose of this report is to describe fatal (mortality) and nonfatal (morbidity) opioid-involved overdoses, which occurred in Georgia during 2018, 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 rapidly increased in Georgia from 2010-2017, driven largely 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 through 2017.
o From 2010 to 2018, the total number of opioid-involved overdose deaths occurring in Georgia increased by 87%, from 514 to 962 deaths.
From 2017-2018 all drug overdose death categories decreased except for heroin. In 2018, among Georgia residents:
o Any opioid-involved overdoses accounted for 4,985 ED visits, 2,353 hospitalizations, and 910 deaths.
o Heroin-involved overdoses accounted for 1,353 ED visits, 325 hospitalizations, and 314 deaths. o Fentanyl-involved overdoses accounted for 327 deaths. o Quarterly opioid-involved overdose ED visit rates trended slightly downward in 2018. o Quarterly heroin-involved overdose ED visit rates trended slightly downward during 2018, with the
exception of Quarter 3 (Q3). o Opioid-involved ED visit rates among males remained steady from 2018 Q1 (12.1) to 2018 Q3
(12.2) then trended downwards in 2018 Q4 (10.7). o Opioid-involved ED visit rates among females slightly trended downwards during 2018, with the
exception of Q4. o Persons aged 35-44 years died from an opioid-involved overdose more frequently than persons of
other age categories. o Persons aged 25-34 years more frequently died from a heroin- or fentanyl-involved overdose, and
visited an ED for an opioid-involved overdose than persons of other age categories, yet older persons aged 45 and older 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 3.0 times more likely to die from an overdose than females of the same age. o Males were 1.9 times more likely to die from any opioid-involved overdose, and 3.1 times more likely to die from a heroin-involved overdose than females. However, females, particularly those aged 55 years and older, were more frequently hospitalized for an opioid-involved overdose than males. o Quarterly opioid-involved overdose death rates among males trended downward from 2018 Q1 (2.9) to 2018 Q2 (2.7) then increased from 2018 Q3 (2.7) to 2018 Q4 (3.1). o Opioid-involved overdose deaths rates among females trended downward from 2018 Q1 (1.7) to 2018 Q2 (1.4), upwards in 2018 Q3 (1.6), then down in 2018 Q4 (1.4). o Quarterly opioid-involved ED visit rates among Whites trended downwards in 2018.
2

o Quarterly opioid-involved ED visit rates among Blacks remained steady during 2018. o Whites were 3.4 times more likely to die from an opioid-involved overdose, 2.5 times more like to
visit an ED for any opioid-involved overdose, and 4.7 times more likely to visit an ED for a heroininvolved overdose than Blacks. o Quarterly opioid-involved overdose death rates among Whites trended downward slightly in 2018. o Quarterly opioid-involved overdose death rates among Blacks remained steady in 2018. o The highest numbers of heroin- and opioid-involved overdose deaths, ED visits, and hospitalizations occurred predominantly among residents in urban areas (Atlanta Metropolitan Area, Augusta, Macon, Columbus, and Savannah). However, high rates of opioid overdose-involved ED visits and hospitalizations occurred among residents 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 drug 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
3

Fatal Drug Overdoses (Mortality), Georgia, 2018
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):
4

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 2018 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, 2018
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 2018.
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
5

Other Definitions or Limitations 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 2018 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
6

Drug-Involved 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, 2010-2018

1200 1000

Any Opioid

800

Synthetic Opioids

600

Heroin

400

Fentanyl

200

0 2010 2011 2012 2013 2014 2015 2016 2017 2018

From 2010 to 2018, the number of opioid-involved overdose deaths increased by 87%, from 514 to 962 deaths.
Beginning in 2013, illicit opioids, such as heroin and fentanyl, drove the sharp increase in opioidinvolved overdose deaths through 2017. Note: fentanyl is included in the synthetic opioid category.
From 2017 to 2018 drug-involved overdose death categories decreased except for heroin.

Quarterly Drug-Involved Overdose Deaths Occurring in Georgia, by

350

Drug Type, 2015-2018

300

Any Opioid

250

Heroin

200

Fentanyl

150

100

50

0 2015 2015 2015 2015 2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

No. deaths

Opioid-involved overdose deaths trended downward during 2018 Q1 to 2018 Q2, then leveled off. Fentanyl-involved overdose deaths remained steady during 2018.
7

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.

Drug-Involved Overdose Deaths, by Drug Type, Georgia Residents, 2016-2018

No. deaths

2016 2017 2018

1800 1600 1400 1200 1000
800 600 400 200
0

1617 1459 1507
All Drugs

996

904

910

378 478 449

214 261 314

Any Opioid

Synthetic Opioids

Heroin

363 327 227
Fentanyl

In 2018, overdose deaths involving fentanyl (327) were similar in number to deaths involving heroin (314). Note: fentanyl is included in the synthetic opioid category.
From 2017 to 2018, drug overdose death categories decreased except for heroin.

Deaths/ 100,000 pop.

Drug-Involved Overdose Death Rates, by Age and Drug Type, Georgia Residents, 2018

20.0 18.0 16.0 14.0 12.0 10.0
8.0 6.0 4.0 2.0 0.0
Overall <1

Any Opioid Heroin Fentanyl
1-4 5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+ Age Category (years)

Persons aged 35-44 years died from an opioid-involved overdose more frequently than persons of other age categories.
Persons aged 25-34 years died from a heroin- or fentanyl-involved overdose more frequently than persons of other age categories.
8

Deaths/ 100,000 pop.

Drug-Involved Overdose Death Rates, by Race and Drug Type,
Georgia Residents, 2018
16.0 14.0
14.0 White Black
12.0

10.0

8.0

6.0

5.1

4.1

4.0

2.0

1.5

0.0 Any Opioid

Heroin

Race

Whites were 3.4 times more likely to die from an opioid-involved overdose than Blacks.

Quarterly Opioid-Involved Overdose Death Rates, by Race, Georgia Residents, 2016-2018

4.5

4.2

4.2

4.0

4.3

4.0 3.5

3.2

3.4

3.1

3.7

3.4

3.4

3.5

3.1

3.0

2.5

2.0

1.5 1.0

0.7

0.7

0.9

1.0

1.0

1.0

0.7

1.1

1.0

0.9

0.9

1.2

0.5

0.0

2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018

Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

White Black

Opioid-involved overdose death rates among Whites trended downward slightly in 2018. Opioid-involved overdose death rates among Blacks remained steady in 2018.

Deaths/ 100,000 pop

9

Deaths/ 100,000 pop.

Drug-Involved Overdose Death Rates, by Sex and Drug Type,

Georgia Residents, 2018

12.0

11.4

10.0

Male Female

8.0

6.0

6.0

4.7

4.0

2.0

1.5

0.0

Any Opioid

Heroin

Sex

Males were 1.9 times more likely to die from any opioid-involved overdose, and 3.1 times more likely to die from a heroin-involved overdose than females.

Opioid-Involved Overdose Death Rates, by Age and Sex, Georgia Residents, 2018
25.0

20.0

Male

Female

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 3.0 times more likely to die from an overdose than females of the same age.

10

Deaths/ 100,000 pop

Quarterly Opioid-Involved Overdose Death Rates, by Sex,

Georgia Residents, 2016-2018

4.0

3.5

3.2 3.3 3.4

3.2

3.1

3.0

2.8

2.9 2.7 2.7

2.3

2.3

2.4

2.5 2.0

1.7

1.4

1.7

1.9

1.9

1.5

1.4

2.0

1.7

1.4

1.6

1.4

1.5

1.0

0.5

0.0 2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Males Females

Opioid-involved overdose death rates among males trended downward from 2018 Q1 to 2018 Q2 then increased from 2018 Q3 to 2018 Q4.
Opioid-involved overdose deaths rates among females trended downward from 2018 Q1 to 2018 Q2, upwards in 2018 Q3, then down in 2018 Q4.

11

Opioid-Involved Overdose Emergency Department Visits and Hospitalizations (Morbidity)
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 2018).

Opioid-Involved Overdose Emergency Department Visits and Hospitalizations, by Drug

Type, Georgia, 2018

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

Number represents events that occurred in Georgia among Georgia residents

Drug Category

No.

No.

Any Opioid ED Visits

5386

4985

Any Opioid Hospitalizations

2523

2353

Heroin ED Visits

1509

1353

Heroin Hospitalizations

349

325

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, 2016-2018

6000 5000

5195

5656

4985

Any Opioid Heroin

4000 3000 2000 1000
0

1204 ED Visits 2016

1521 ED Visits 2017

1353

2639 306

2622 335

2353 325

ED Visits 2018

Hospitalizations 2016

Hospitalizations 2017

Hospitalizations 2018

From 2017 to 2018, ED visits for opioid- and heroin-involved overdoses decreased by 12% and 11% respectively.
Hospitalizations for opioid- and heroin-involved overdoses decreased by 10% and 3% respectively.
12

ED visits/ 100,000 pop

Quarterly Opioid-Involved Overdose Emergency Department (ED) Visit Rates, by Drug Type, Georgia Residents, 2016-2018

16.0 14.0 12.0

11.0

12.4

12.3

13.1

14.7 13.8

12.0 12.1

11.9

11.7

11.3

10.7

10.0

8.0

6.0 4.0

2.1

3.0

2.7

4.1

3.9

4.4

2.8

3.8

3.5

3.3

3.5

2.8

2.0

0.0

2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Any Opioid Heroin

Opioid-involved overdose ED visit rates trended slightly downward in 2018. Heroin-involved overdose ED visit rates trended slightly downward during 2018, with the exception
of Q3.

Opioid-Involved Overdose ED Visit Rates, by Age and Drug Type, Georgia
Residents, 2018

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, 2018
50.0

40.0

Any Opioid Heroin

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 persons aged 45 and older 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.

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+

13

Visits or hospitalizations / 100,000 pop.

Opioid-Invovled Overdose Emergency Department Visit and Hospitalization Rates, by Race and Drug Type, Georgia Residents,
2018

80.0 65.1
60.0

White Black

40.0

26.4

20.0

0.0 Any Opioid ED Visit

21.8 4.6
Heroin ED Visit

28.5 11.8

5.1

1.3

Any Opioid Hospitalization Heroin Hospitalization

Whites were 2.5 times more likely to visit an ED for any opioid-involved overdose, 4.7 times more likely to visit an ED for a heroin-involved overdose, and 2.4 times more likely to be hospitalized for an opioid-involved overdose than Blacks.

ED visits/ 100,000 pop

Quarterly Opioid-Invovled Overdose Emergency Department (ED) Visit Rates, by Race, Georgia Residents, 2016-2018

25.0

19.0 19.6 20.4

20.0 16.1 17.3 17.2

16.7 17.5 17.2 16.6 16.4 14.9

15.0

10.0

5.6

6.7

7.6

7.1

8.2

9.2

7.3

6.7

6.8

6.6

6.1

6.9

5.0

0.0 2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Note: Quarterly 2018 data is preliminary and subject to change.

Any Opioid ED Visits Among Whites
Any Opioid ED Visits Among Blacks

Opioid-involved ED visit rates among Whites trended downwards in 2018. Opioid-involved ED visit rates among Blacks remained steady during 2018.

14

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, 2018

150.0 100.0
50.0 0.0

Male Female

Opioid-Involved Overdose Hospitalization Rates by Age and Sex,
Georgia Residents, 2018
Male Female 60.0 50.0 40.0 30.0 20.0 10.0
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 55-74 years, more frequently visited an ED, and were more frequently hospitalized for an opioid-involved overdose than males.

ED visits/ 100,000 pop

Quarterly Opioid-Involved Overdose Emergency Department (ED) Visit Rates, by Sex, Georgia Residents, 2016-2018

18.0 16.0 14.0 12.0 10.0
8.0 6.0 4.0 2.0 0.0
2016 2016 2016 2016 2017 2017 2017 2017 2018 2018 2018 2018 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4
Note: Quarterly 2018 data is preliminary and subject to change.

Any Opioid ED Visits Among Males
Any Opioid ED Visits Among Females

Opioid-involved ED visit rates among males remained steady from 2018 Q1 to 2018 Q3 then trended downwards in 2018 Q4.
Opioid-involved ED visit rates among females slightly trended downwards during 2018, with the exception of Q4.

15

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.
16

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.
17

ANY OPIOID-INVOLVED OVERDOSES
18

19

20

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. Note: Data as of July 2019.

No. of Lab Submissions

GBI Crime Lab Submissions: Heroin and Fentanyl, 2014-2018

1600 1400 1200 1000
800 600 400 200
0

1174
44 2014

Heroin 1417

Fentanyl (including analogs)

1453

1338

1075

56 2015

109 2016

209 2017

197 2018

From 2014 to 2018, heroin submissions to the GBI Crime Laboratory decreased by 8.4% and Fentanyl submissions increased by 348%.

No. of Lab Submissions

GBI Crime Laboratory Submissions, Top 5 Opioids, 2014-2018

2014 2015 2016 2017 2018

2000 1800 1600 1400 1200 1000
800 600 400 200
0

1832 1861 1768

1521

1513 1457

1257 1136

1145

752

Oxycodone

Hydrocodone

1453

1417 1338

1174

1075

Heroin

310 321 254
153 111

276

327 238

100

140

Morphine

Methadone

21

No. of Lab Submissions

GBI Crime Laboratory Submissions, Major Drugs, 2018

18000 16000

16113

14000

12000

10000

8000 6000

5380

4000 2000

1104

1136

1075

752

0

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. Hydrocodone was the most frequently prescribed opioid in Georgia while oxycodone was the 2nd highest prescribed opioid in Georgia in 2018. (see the Georgia PDMP 2018 Report available at https://dph.georgia.gov/drug-overdose-surveillance-unit).

22

Counties with the Highest Number or Rate of Any Opioid-Involved Overdose Deaths, Emergency Department (ED) Visits and Inpatient Hospitalizations -- Georgia, 2018

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
Fulton (99)

No. deaths County of injury
Fulton (119)

Death rate County of residence
Richmond (20.1)

No. ED visits and hospitalizations County of residence
Fulton (612)

ED visit and hospitalization rate County of residence
Polk (181.6)

2

Cobb (85)

Cobb (88)

Bartow (17.5)

Cobb (522)

Haralson (170.4)

3

Gwinnett (76)

DeKalb (62)

Walton (16.4)

Gwinnett (430)

Bartow (170.0)

4

DeKalb (56)

Gwinnett (50)

Cherokee (14.9)

DeKalb (340)

White (150.9)

5

Cherokee (38)

Cherokee (31)

Douglas (14.1)

Richmond (261)

Chattooga (132.5)

6

Richmond (38)

Richmond (25)

Henry (11.2)

Chatham (252)

Elbert (131.0)

7

Chatham (30)

Henry (22)

Chatham (10.8)

Hall (244)

Jeff Davis (130.3)

8

Henry (28)

Hall (18)

Cobb (10.8)

Cherokee (189)

Richmond (128.7)

9

Douglas (19)

Bartow (16)

Coweta (10.8)

Bartow (184)

Lumpkin (123.6)

10

Bartow (18)

Chatham (16)

Columbia (10.7)

Columbia (176)

Jackson (123.5)

23

Note: The following data include deaths that occurred in Georgia regardless of the patient's residence state.

Drug Overdose Deaths (Mortality) -- Georgia, 20102018

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.

Year 2018 2017 2016 2015 2014 2013 2012 2011 2010

Any Drug No. 1582 1591 1436 1364 1041 1113 1066 1042 1059

Any Opioid No. 962 1051 954 901 637 556 554 519 514

Synthetic Opioids No. 476 506 399 411 164 82 65 84 102

Heroin No. 341 284 228 252 236 131 106 29 4

Fentanyl No. 348 381 245 255 138 52 48 N/A N/A

Drug Overdose Emergency Department (ED) Visits and Hospitalizations (Morbidity) -- Georgia Residents, 2016-2018

Number, and age-adjusted rate per 100,000 population Any opioid may include prescription and/or illicit opioids; categories are not mutually exclusive.

Any Opioid

Heroin

ED Visits

Hospitalizations

ED Visits

Hospitalizations

Year 2018

No.

Rate

No.

Rate

No.

Rate

No.

Rate

4985

45.6

2353

20.7

1353

13.1

325

3.2

2017 2016

5656

52.6

2622

23.5

1521

14.9

335

3.3

5195

48.9

2639

24.3

1204

11.8

306

3.0

24

Opioid Related Overdose Morbidity and Mortality -- Georgia Residents, 2018 (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 Rates for counts under 5 may be unstable and are not presented.
Any Opioid

ED Visits

Hospitalizations

Deaths

No.

Rate

No.

Rate

No.

Rate

Total

4985

45.6

2353

20.7

910

8.7

Age group (yrs)

<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

498

34.5

123

8.5

69

4.8

25-34 years

1200

81.5

335

22.7

228

15.5

35-44 years

752

54.8

287

20.9

239

17.4

45-54 years

726

51.4

395

28.0

176

12.5

55-64 years

901

70.1

596

46.4

140

10.9

65-74 years

553

61.8

409

45.7

51

5.7

75-84 years

201

48.0

147

35.1

3

N/A

85+ years

68

46.4

39

26.6

3

N/A

Sex (age group)

Male

2450

47.0

987

18.6

580

11.4

<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

277

37.7

74

10.1

53

7.2

25-34 years

769

105.3

205

28.1

171

23.4

35-44 years

401

60.6

146

22.1

146

22.1

45-54 years

299

43.6

136

19.8

104

15.2

55-64 years

373

61.1

216

35.4

78

12.8

65-74 years

203

49.8

141

34.6

26

6.4

75-84 years

65

36.3

44

24.5

1

N/A

85+ years

24

48.5

12

24.3

1

N/A

Female

2532

43.9

1365

22.4

330

6.0

<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

221

31.1

49

6.9

16

2.3

25-34 years

431

58.0

130

17.5

57

7.7

35-44 years

351

49.4

141

19.8

93

13.1

45-54 years

427

58.8

259

35.7

72

9.9

55-64 years

528

78.2

380

56.3

62

9.2

65-74 years

350

71.8

268

55.0

25

5.1

25

75-84 years

136

56.9

103

43.1

2

N/A

85+ years

41

42.2

26

26.8

2

N/A

Race

White

3819

65.1

1842

28.5

757

14.0

Black

898

26.4

402

11.8

139

4.1

26

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
27