The opioid effect
Overdose deaths in Georgia
• 2015: 1,302
• 2014: 1,206
• 2013: 1,098
Overdoses at Northeast Georgia Medical Center’s Gainesville ER
• 2016: Almost 700
• 2015: 275
Cost of opioid abuse in the U.S.
• $78.5 billion, with 25 percent shouldered by public sources like Medicaid, Medicare and government-funded treatment programs
Effect on babies
• Average length of hospital stay for newborn: 2 days
• Average length of hospital stay for drug-positive newborn: 23-24
Sources: Centers for Disease Control, Northeast Georgia Medical Center
In Northeast Georgia Medical Center’s Gainesville emergency room, the doctors saw roughly 400 more drug overdoses between 2015 and 2016.
For Angela Gary, executive director of emergency services, there’s no rhyme or reason to explain the jump in the number of patients.
“In all three of the emergency departments that I’m in contact with, it’s kind of all over the place on who it is, the age of them and what they’re overdosing from,” she said.
The Gainesville emergency room handled 275 overdoses in 2015 and almost 700 in 2016.
Civic leaders around Gainesville and Hall County have recently formed the Partnership for a Drug Free Hall to combat the opioid drug epidemic.
“The demographic trends parallel those in the U.S., with historically more cases in men than women, but the number of overdoses in women being on the rise,” said Deborah Bailey, executive director of governmental affairs at Northeast Georgia Health System. “When it comes to other demographics, opioid overdoses cross all geographic and economic lines.”
To combat the high percentage of opioid prescriptions coming from emergency room visits, Gary said the hospital changed its policy in 2012 and created a pamphlet of what is and isn’t accessible at the hospital. The policy is “putting some pain management guidelines down in a format that a patient can really understand,” Gary said.
“It says we can offer short-term, non-narcotic pain relief. We can provide you a list of alternative treatment options, like physical therapy, acupuncture and reputable pain management facilities. We can facilitate treatment if they disclose if they are addicted,” she said.
What can’t be done includes prescribing narcotics for chronic conditions, delivering injections for chronic pain or replacing lost or stolen prescriptions without a proper assessment.
Gainesville City Council signed off on a deal in January 2016 to acquire 82 naloxone kits, which can counter the effects in opioid overdoses. Gainesville police officers carry the kits, which are given nasally.
“If we go to a scene and suspect it’s a drug overdose and they’re given it, it’s not going to cause any harm to them,” Sgt. Kevin Holbrook said.
Gov. Nathan Deal signed the Jeffrey Dallas Gay Jr. Act in May, which removed naloxone from the dangerous drug list and made the antidote accessible over the counter. Hall County is home to the family of the law’s namesake who overdosed in 2012: Dallas Gay, the victim’s grandfather, who has been a vocal advocate and head of the Partnership for a Drug Free Hall.
“Hall County needs that. They really need a lot more awareness than what we’ve had, a lot more prevention,” said Scott Hinchman, program director at The Agora House for Men residential drug treatment.
Hinchman said the issue with intravenous heroin has been a steady problem, while prescription drug use has gone down.
“People you pass on the street and you would never think that it was someone that was using IV (heroin). Captains of the football teams and stuff like that are escalating and getting worse,” Hinchman said.
It takes longer to stabilize someone getting clean from heroin, Hinchman said. Because of the various versions of opiates, it also makes it more difficult for Hinchman to drug-test participants.
“Now the scare is that what they think normal drugs that they’re buying is laced with fentanyl and how deadly it’s becoming,” he said.
Hall County Sheriff’s Office Lt. Don Scalia said most of the heroin and other opioids are coming from the Atlanta area after traveling over the border and through the harbors. Of particular concern are the analogs of heroin and synthetic heroin, which can be laced with fentanyl, which is 100 times stronger than morphine.
“Some of those synthetic analogs of fentanyl and heroin, sometimes it takes multiple doses to counteract those particular ones,” Scalia said of administering naloxone.
Around the July 4 holiday, Scalia and his team seized what he strongly believes is “gray death,” a form of heroin that is extremely potent.
A lethal dose of heroin is about 30 milligrams, Scalia said, but a lethal dose of fentanyl and its various versions would be around 3 milligrams.
“It’s just too dangerous to field test,” Scalia said, as fentanyl analogs can be absorbed through the skin or by airborne contact.
The other major concern, Scalia said, is the manufacturing of illicit prescription drugs. The Georgia Bureau of Investigation issued a warning earlier this year about counterfeit pills.
“By a significant margin, the top counterfeited logos represent alprazolam and oxycodone,” GBI spokeswoman Nelly Miles wrote in a news release. “The two most common substances found within the counterfeit tablets were depressants and opiates.”
According to the Centers for Disease Control, the abuse of opioids costs the U.S. economy $78.5 billion per year.
Medicaid, Medicare and other government-funded treatment programs often pay for more nearly 25 percent of this cost.
The hospital was unable to provide statistics on the costs for those coming in to the hospital for overdoses.
“However, we do know the costs are significant, and one example can be seen in newborn babies born with neonatal abstinence syndrome because their mothers are addicted to drugs,” Bailey said.
The average hospital stay for a newborn is two days, Bailey said.
“The average length of stay for a newborn baby who is born addicted to drugs is 23 to 24 days at a cost of hundreds of thousands of dollars,” she said.