Heroin overdose patterns in Georgia emergency departments have shifted sharply since fentanyl entered the drug supply.
In 2025, suspected heroin-involved ED visits represent a relatively small and likely stable-to-declining share of total opioid overdoses, concentrated in large metropolitan counties and disproportionately affecting adult males aged 25 to 44 according to Georgia Department of Public Health surveillance.
This article breaks down what the latest state and federal data reveal about volume, demographics, and recurrence, helping families, clinicians, and policymakers understand where the real burden lies and how to target help.
Georgia’s Heroin Overdose ER Volume in 2025
Georgia tracks suspected overdose ED visits through its Drug Overdose Syndromic Surveillance system, which publishes monthly reports updated through August 2025. These reports display overdose indicators as a percentage of all ED visits and include substance-specific categories since 2021. The state’s monthly syndromic surveillance provides near real time visibility into trends, though the data reflect suspected cases identified by chief complaint text and diagnosis codes rather than toxicology confirmation.
Heroin-coded ED visits appear to be a smaller and potentially declining subset when compared to fentanyl and other synthetic opioids. Nationally, heroin-involved overdose deaths have dropped substantially since 2016, and by 2022 roughly 80% of heroin deaths involved illicitly manufactured fentanyl, according to the National Institute on Drug Abuse. This shift means many users who intend to use heroin are actually exposed to fentanyl, which complicates both coding and clinical presentation.
Georgia’s overdose landscape has been fentanyl dominated since 2020, reflecting the same supply contamination seen across the United States. The state experienced a rapid surge in overdoses when fentanyl infiltrated not only heroin but also cocaine and methamphetamine. This backdrop means interpreting heroin-specific ED visit counts requires caution. Some presentations coded as heroin may involve fentanyl, and vice versa, depending on what the patient reports, what clinicians document, and whether toxicology testing occurs.
How Volume is Measured?
The CDC DOSE-SYS dashboard tracks nonfatal overdose ED visits across 46 states and the District of Columbia using standardized syndrome definitions. Georgia participates in this system, which presents rates per 10,000 ED visits to account for fluctuating total ED volume. This normalization is important because ED utilization can vary with seasons, respiratory virus surges, and other factors unrelated to drug trends.
Measuring heroin specifically relies on ICD-10-CM code T40.1 for heroin poisoning and text queries in chief complaint fields. A key technical point is that the synthetic opioid category underwent a major coding change on October 1, 2020, splitting into fentanyl, tramadol, and other synthetic narcotics. Heroin coding remained stable, which improves comparability over time but also means analysts must explicitly check for fentanyl co-mentions to avoid undercounting heroin-intent cases that received fentanyl codes due to contamination. This is documented in a peer-reviewed analysis of ICD-10-CM coding trends.
Month to month variability in syndromic data is common and reflects real fluctuations, coding shifts, and facility onboarding changes. Georgia’s reports include a limitations document to guide interpretation, emphasizing that small percentage changes should not be over interpreted without multi-month context.
Demographic Patterns in Heroin-Related ER Data
Age and Sex
Adult males aged 25 to 44 constitute the core demographic for suspected heroin-involved ED visits in Georgia, consistent with national opioid overdose patterns. While fentanyl has increased ED visits across most age groups and both sexes post 2020, heroin-specific presentations remain concentrated in this age range. Women also present with heroin overdoses, but the male predominance is notable and aligns with historical patterns documented before the fentanyl surge.
Older adults aged 65 and above show lower rates of heroin-coded ED visits compared to fentanyl or prescription opioids, likely reflecting different exposure pathways and generational use patterns. Younger adults under 25 do appear in the data, but many stimulant-involved overdoses in this age group now involve fentanyl contamination rather than heroin.
Race and Ethnicity
Georgia’s State Unintentional Drug Overdose Reporting System and annual district reports assess racial and ethnic differences in overdose deaths, which can inform ED visit patterns even though the two data streams are not identical. Nationally, a ten-site ED study covering 2020 to 2023 found that Black patients had significantly lower adjusted odds of receiving outpatient treatment referrals after an overdose compared to White patients, with only 5.7% of Black patients referred versus 9.6% of White patients. This disparity raises concern that post-overdose care gaps may contribute to repeat ED visits and worse outcomes for communities of color.
Although Georgia’s 2025 heroin-specific ED demographic breakdowns by race and ethnicity are not reproduced in public dashboards at granular levels, the statewide data collection infrastructure supports these analyses. Local health districts can stratify their annual reports to identify disparities and target outreach accordingly.
Geography
Heroin-coded ED visits concentrate in large central and large fringe metropolitan counties, reflecting historical heroin market distribution and access to emergency services. The NCHS Urban-Rural Classification Scheme provides a six-level system for categorizing counties by urbanization, which Georgia can apply to ED data for more precise targeting.
Rural and micropolitan counties show fewer heroin-coded ED visits in absolute numbers, but per capita rates can be meaningful and service gaps are often greater. Fentanyl’s diffusion across Georgia means even rural areas face synthetic opioid risk, though the heroin-specific burden remains more urban focused.
The table below summarizes key surveillance systems Georgia uses to track heroin overdose ER trends in 2025:
| System | Scope | Update Frequency | Heroin-Specific Capability | Key Limitation |
| Georgia DPH Monthly Syndromic Reports | Statewide ED | Monthly (through Aug 2025) | Substance-specific indicators since 2021 | Encounter-based; public reports do not link patients over time |
| CDC DOSE-SYS | Multi-state ED | Monthly | Nested heroin syndrome definitions | Demographics only for all jurisdictions combined |
| Georgia DPH District Annual Reports | Public Health Districts | Annual (2020-2023 available) | Opioid and stimulant categories | Not monthly; 2020-2021 confounded by pandemic care-seeking |
Understanding Recurrence and Repeat Visits
Recurrence in the context of heroin overdose has two meanings. The first is recurrent respiratory depression during the same ED visit after naloxone reversal. The second is a repeat ED visit within days or weeks, sometimes called recidivism.
Within-Visit Recurrence
For uncomplicated heroin overdoses, recurrent respiratory depression after naloxone is rare beyond two to three hours. Naloxone typically lasts 30 to 90 minutes, and heroin has a relatively short half-life. Clinical guidance recommends observing patients until naloxone activity has ceased and opioid symptoms have resolved, roughly two to three hours for straightforward cases.
Fentanyl complicates this picture because it is more potent and can outlast naloxone, requiring multiple doses and longer observation. A study of presumed fentanyl overdoses in the ED found that nearly all recurrences occurred within two hours, and brief observation protocols allowed safe discharge for most patients. Long-acting opioids like methadone or buprenorphine, or polysubstance cases involving sedatives, may warrant observation of six to twelve hours or even admission.
Repeat ED Visits After Discharge
The more pressing recurrence concern in 2025 is the repeat ED visit within 30 days. This metric reflects whether post-overdose care succeeds in reducing risk. National data show large gaps in evidence-based discharge practices. In a ten-site cohort from 2020 to 2023, only 42.4% of overdose patients received naloxone at discharge, 8.4% received a buprenorphine prescription, and just 17.8% received a referral for outpatient treatment.
These gaps are modifiable. Co-prescribing naloxone with opioids has been shown to reduce opioid-related ED visits and deaths. Same-day buprenorphine initiation in the ED improves treatment retention and reduces mortality. Warm handoffs to outpatient care increase the likelihood that patients will follow through with appointments.
Georgia does not yet publish patient-linked repeat-visit rates for heroin-specific ED overdoses in its public dashboards. Calculating these rates requires linking encounters over time using patient identifiers, which is feasible within the state’s surveillance infrastructure but not displayed in the monthly reports. Until these metrics are available, clinicians and policymakers can act on the strong national evidence that standardized ED discharge bundles reduce repeat overdoses.
Why Fentanyl Complicates the Picture?
Fentanyl’s infiltration of the heroin supply is the single largest factor shaping Georgia’s 2025 heroin overdose ED trends. Since 2020, illicitly manufactured fentanyl has been found in heroin, cocaine, methamphetamine, and counterfeit pills. By 2022, fentanyl was involved in about 80% of heroin-involved deaths nationally, meaning most people who die after using heroin also had fentanyl in their system.
This co-involvement has several implications. First, patients who report using heroin may be exposed to fentanyl without knowing it, leading to more severe overdoses and higher risk of death. Second, clinicians and coders may document fentanyl rather than heroin even when the patient’s intent was to use heroin, potentially under-representing heroin in the statistics. Third, the pharmacology of fentanyl increases the risk of recurrent respiratory depression after naloxone wears off, affecting both within-visit observation protocols and post-discharge risk.
Georgia’s March 2022 statewide alert highlighted increased overdoses involving drugs mixed with fentanyl, including stimulants. Toxicology surveillance programs like the CDC-supported Fentalog Study and state policies mandating fentanyl in ED tox screens help clarify exposure patterns. Maryland and Pennsylvania implemented such mandates in 2023, and similar approaches could strengthen Georgia’s ability to accurately track and respond to fentanyl-adulterated heroin.
Text mining of chief complaint fields and explicit co-mention flags in syndromic definitions can improve capture of heroin-intent cases that involve fentanyl. Without these adjustments, heroin’s share of the ED burden appears artificially low, and targeted prevention messages miss the people who need them most.
What Georgia Can Do Now?
Even without published repeat-visit rates, Georgia has the tools to reduce heroin and opioid overdose recurrence. Standardizing ED discharge practices is the most immediate and evidence-based step. Every suspected overdose patient should leave the ED with naloxone, overdose education, and a warm handoff to outpatient treatment when appropriate.
Same-day buprenorphine initiation is feasible in the ED and has been endorsed by the American Society of Addiction Medicine. Addressing racial disparities in referral and treatment access requires explicit equity protocols and monitoring, ensuring that Black patients and other underserved groups receive the same standard of post-overdose care as White patients.
Georgia’s Public Health District reports can guide resource allocation, targeting districts with the highest suspected heroin and opioid ED visit rates. Pairing ED interventions with community-based harm reduction, such as syringe services programs and peer support, creates a continuum of care that reduces repeat overdoses and improves long-term recovery outcomes.
Building the measurement infrastructure to compute and publish patient-linked repeat-visit rates is also urgent. Georgia participates in CDC’s DOSE-SYS and has health system partners capable of near real-time analytics, as demonstrated by Emory University Medical Center’s participation in the IVY Network. Adapting similar methods for nonfatal overdose surveillance would allow quarterly reporting of three, seven, and 30 day repeat ED visit rates, stratified by substance, demographics, and geography.
Why Does This Matter?
Heroin overdose ED trends in Georgia tell a story of a shrinking but persistent problem embedded within a larger fentanyl crisis. The demographic concentration in adult males aged 25 to 44 and large metro counties reflects historical market patterns, but the fentanyl overlay means no community is immune. Repeat visits within 30 days are driven more by failures in post-discharge care than by pharmacology alone, and those failures are inequitably distributed.
Understanding these patterns helps clinicians know when to extend observation, when to initiate buprenorphine, and when to deploy naloxone kits. It helps public health officials target harm reduction resources and track whether interventions reduce repeat overdoses. For families, it offers clarity about the risks their loved ones face and the supports that work.
Georgia’s surveillance system is strong. The monthly reports provide timely signals, and the district-level annual data enable local action. What remains is to close the care gaps at the moment when help can make the biggest difference: the ED visit itself.
If you or someone you care about has experienced an overdose, connecting to Summit Wellness Group’s evidence-based treatment can break the cycle and support lasting recovery.
