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Prior to the pandemic, Georgia and the country as a whole had begun to see slight downward trends in the rates of opioid prescriptions and overdoses, though both remained alarmingly high. (Alena Bogatyrenko/Shutterstock)

A Georgia lawmaker is advancing legislation to combat the dramatic rise in opioid-related overdose deaths detected since the start of the coronavirus pandemic.

Rep. Sharon Cooper, R-Marietta, introduced a bipartisan bill that would require physicians to concurrently prescribe the anti-overdose medication naloxone when prescribing opioids in amounts greater than 50 morphine milligram equivalents. This would in effect become a near-universal requirement, as the Centers for Disease Control and Prevention estimates that the vast majority of opioid prescriptions far exceed that amount.

“These are very powerful drugs and are not to be taken lightly,” Cooper said.

According to data from the Georgia Department of Public Health, opioid-involved overdose deaths increased by 25% in the 15-week period following the onset of the pandemic in early March, and current levels of overdose-induced emergency-room visits and deaths remain elevated. This trend was seen across the entire country, prompting the CDC to distribute a health advisory recommending a variety of responses, including expanding the availability of naloxone.

Cooper believes that improving education and access to the life-saving medication is essential in reverting the troubling trends that have emerged during the pandemic. 

Jeff Breedlove, chief of communications and policy at the Georgia Council on Substance Abuse, fervently agrees, and he plans to do everything he can to help the bill pass.

“The Georgia Council on Substance Abuse considers this to be an important step, a transformational step, and a step that will save lives,” he said.

Breedlove calls the rise in overdose deaths an “epidemic within a pandemic” resulting from the isolation necessitated by COVID-19. The Georgia Council on Substance Abuse, which organizes 30 other recovery organizations across the state, places a strong emphasis on peer-led support services, which have been severely impacted by the pandemic. Without them, Breedlove said, many in recovery have fallen back into active addiction, and the number of new substance-use disorder patients is on the rise as well.

“The opposite of addiction is connection. At the end of the day, that’s what sustains recovery, is connection,” Breedlove said.  

Restrictions imposed by the pandemic have forced the peer-led recovery community to adapt at an unprecedented speed. Breedlove and his team made the shift to the virtual space by hosting more than 1500 recovery meetings online and transitioning the annual recovery month events in September to the virtual realm. While he is proud of the way they adapted, he sees a return to post-pandemic normalcy and targeted legislation as essential toward ending the ongoing opioid outbreak.

Upended progress

Prior to the pandemic, Georgia and the country as a whole had begun to see slight downward trends in the rates of opioid prescriptions and overdoses, though both remained alarmingly high. From 2018 to 2019, opioid prescriptions in Georgia fell by 8%, and opioid-related deaths and emergency room visits had begun to taper slightly from their record highs.

The Georgia Department of Behavioral Health and Developmental Disabilities, which oversees the state’s substance-use disorder response, attributes that trend to increased education and funding for peer-led recovery services, as well as an increase in access to naloxone by first responders and others. Breedlove praised the department for its leadership in responding to the opioid crisis, which resulted in a 245% increase in overdose deaths in Georgia from 2010 to 2017.

Breedlove feels that the state was generally trending in the right direction prior to the pandemic, citing a long-term increase in state funding and enhanced issue awareness among lawmakers in the General Assembly. But despite inroads made, the pandemic ravaged the lives of thousands in Georgia and resulted in hundreds more overdose deaths in 2020 than 2019, with likely many more yet to be counted due to data reporting lags. For Breedlove, this underscores the urgent need for Cooper’s bill to pass.

“It should set a record for moving through the process as fast as any other bill has,” Breedlove said. “Because the only thing this bill does is save lives.”  

Cooper, who chairs the House Health and Human Services Committee, originally hoped to move the legislation through the General Assembly this session, but said the chaotic schedule imposed by the pandemic has hindered her ability to advance the bill. She also cited concerns from physician and pharmacy groups in the state about how much naloxone would need to be kept in stock and what to do about unfilled prescriptions as reasons for the delay.

The Medical Association of Georgia issued a statement saying it had not yet determined a position on the bill and that it is considering all of its implications. The Georgia Pharmacy Association is tracking the legislation but declined to make a statement.

If the bill does not get through this year, Cooper said she would revise the bill’s language next year so it would go into effect as soon as the governor signs it.  In the meantime, she is encouraging physicians to prescribe naloxone on their own volition in an effort to get ahead of the problem, despite a potential lag in legislation.

Breedlove believes that the work cannot stop with this legislation. He says that Georgia needs to brace for a “hurricane” of addiction awaiting the conclusion of the pandemic, and that a failure to meet the moment with an aggressive slate of recovery-related bills and strongly enhanced funding will result in a devastating reality check for the state and its leaders.

“There’s going to have to be more funding, or there’s going to be more people in the criminal justice system and more people in the morgues,” Breedlove said. 

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