Georgia’s nonfatal overdose landscape varies dramatically by county, with some areas experiencing steep increases while others remain relatively stable.
Recent surveillance data from Georgia’s integrated drug overdose monitoring systems reveal that rural and micropolitan counties often show higher population-adjusted rates and steeper trend slopes than urban cores, even as statewide numbers climbed sharply after 2020.
This article walks you through which Georgia counties are defying or amplifying state trends, what the data actually measures, and why these geographic differences matter for targeting prevention and treatment resources.
Georgia Overdose Data Shows County Variation
Georgia monitors nonfatal overdoses through a robust, multi-layered surveillance infrastructure that few states can match. The state feeds data into CDC’s national DOSE system, both the syndromic ED component and the discharge-based component, while also maintaining its own OASIS analytics portal for county-level hospital utilization. Together, these systems capture emergency department visits, inpatient hospitalizations, and near real-time signals when overdose clusters emerge.
What makes Georgia’s situation complex is the nested relationship between surveillance streams. Syndromic data, drawn from electronic health records and updated monthly, flag suspected overdoses quickly but use ED visit volume as the denominator. That means rates reflect overdoses per 10,000 total ED visits, not per 100,000 population. During early COVID months in 2020, when overall ED traffic dropped but overdose visits stayed elevated, this denominator shift created apparent rate spikes that required careful interpretation. The discharge-based DOSE system, validated against national hospitalization data, offers more stable population-based rates but arrives with a lag.
Georgia’s public health analysts reconcile these streams by cross-checking monthly syndromic trends with annual discharge summaries and layering in pre-hospital EMS naloxone data. When Macon saw a cluster of suspected counterfeit Percocet overdoses in 2017, this integrated approach allowed rapid detection and community alerts within days. That same capacity now operates statewide, with county-level monthly reports published by Georgia’s Department of Public Health to help local districts spot emerging threats.
Understanding Nonfatal Overdose Surveillance Systems
Georgia participates in CDC’s Overdose Data to Action initiative, which requires jurisdictions to build comprehensive overdose surveillance infrastructure linking morbidity and mortality data. The backbone of nonfatal surveillance rests on two complementary platforms: DOSE-SYS for timeliness and DOSE-DIS for completeness.
DOSE-SYS aggregates suspected overdose ED visits using standardized syndrome definitions applied to free-text chief complaints and preliminary diagnosis codes. Eight nested categories, all drugs, all opioids, fentanyl, heroin, all stimulants, methamphetamine, cocaine, and benzodiazepines, allow analysts to track polysubstance patterns. These categories overlap by design. A single ED encounter involving both fentanyl and cocaine appears in the opioid, fentanyl, stimulant, and cocaine counts, reflecting the reality that polysubstance involvement now drives most severe overdoses.
DOSE-DIS uses finalized hospital discharge records coded with ICD-10-CM poisoning codes T36 through T50, limited to unintentional or undetermined intent and initial encounters. Recent validation studies comparing DOSE-DIS rates with the Healthcare Cost and Utilization Project found 82 to 93 percent of quarterly differences stayed within plus or minus 0.5 per 100,000 people, affirming that discharge data provide accurate state-level burden estimates.
Georgia augments these national systems with its OASIS web query tool, which gives county-level access to ER and inpatient drug overdose visits. OASIS data capture all acute drug poisonings excluding alcohol, using the same ICD-10-CM T-code framework as DOSE-DIS. Analysts can pull age-adjusted rates per 100,000 population, stratified by opioid involvement, demographics, and county of residence. Roughly 61 percent of these encounters occur in emergency departments and 39 percent require inpatient admission, though about 1 percent result in death at discharge.
Table 1. Georgia’s Nonfatal Overdose Surveillance Systems
| System | Update Frequency | Metric | Primary Strength | Key Limitation |
| DOSE-SYS | Monthly | Suspected OD per 10,000 ED visits | Near real-time cluster detection | Preliminary; ED volume denominator |
| DOSE-DIS | Annual | Age-adjusted rates per 100,000 | Validated burden estimates | 8-month data lag |
| OASIS | Periodic | County rates per 100,000 | Customizable geography | Coding practice variation |
| EMS/NEMSIS | Near real-time | Naloxone administrations | Earliest signal; spatial hotspots | Case confirmation varies |
This layered approach trades off timeliness against certainty. When a county shows a sudden spike in syndromic data, public health teams can deploy harm reduction resources immediately while waiting for discharge data to confirm whether the signal represents a true incidence increase or a reporting artifact.
Fentanyl’s Role in Georgia Overdose Trends
Illicitly manufactured fentanyl reshaped Georgia’s overdose landscape starting around 2013, but the inflection point arrived in 2020. National overdose death rates jumped 31 percent that year, with synthetic opioid-involved deaths climbing 56 percent, according to CDC mortality data. Georgia mirrored that acceleration. Opioid-involved overdose deaths, which had been rising gradually for a decade, suddenly spiked as fentanyl infiltrated not just heroin supplies but also counterfeit prescription pills and stimulants like cocaine and methamphetamine.
Georgia’s nonfatal indicators tracked this shift in tandem. Suspected opioid overdose ED visit rates, measured through DOSE-SYS, elevated notably from 2020 forward. More striking was the concurrent rise in stimulant-involved ED visits, suggesting fentanyl contamination in non-opioid drug supplies. State toxicology reports from the fatal overdose surveillance system confirmed fentanyl’s presence in an increasing share of cocaine and methamphetamine deaths, turning what users thought were stimulant-only episodes into life-threatening opioid overdoses.
The ICD-10-CM coding system was adopted on October 1, 2020, introducing specific codes for fentanyl (T40.41), tramadol (T40.42), and other synthetic narcotics (T40.49). Before that date, all synthetic opioids except methadone fell under a single T40.4X code. This coding change improved granularity for tracking fentanyl specifically but created a structural break in time series that analysts must bridge when estimating multi-year trends. Georgia’s OASIS documentation explicitly notes this transition, cautioning users to segment analyses before and after the change or apply proportional redistribution methods.
Despite measurement challenges, the signal remains clear. Fentanyl now dominates Georgia’s overdose crisis. ED syndromic surveillance captures this through rising fentanyl-specific syndrome rates. Discharge data, once the coding transition stabilized in 2021, show fentanyl codes appearing in a growing fraction of opioid-involved hospitalizations. EMS reports document increased naloxone administration, often requiring multiple doses to reverse fentanyl’s potent respiratory depression.
Counties Bucking the Trend
Statewide trends obscure profound county-level variation. While Georgia’s overall nonfatal overdose rates climbed steeply after 2020, some counties experienced relatively flat trajectories or even slight declines, while others saw rates double or triple within just a few years. Understanding which counties buck the trend requires separating level from slope, high current rates versus accelerating change, and accounting for population size, urbanization, and baseline prescribing patterns.
Rural and micropolitan counties often show both higher population-adjusted overdose rates and steeper post-2020 trend slopes than large urban cores. Counties with historically high opioid prescribing rates, documented in prescription drug monitoring program analyses, tend to sustain elevated nonfatal overdose burdens even as prescribing itself has declined statewide. The Pew Charitable Trusts found Georgia counties varied by a factor of roughly 300 in per capita prescribing, with Ware and Haralson at the high end and Crawford, Dooly, and Twiggs near the bottom.
This prescribing variation provides a hypothesis for which counties likely occupy the extremes of nonfatal overdose rankings. High-prescribing rural counties may face dual pressures: legacy prescription opioid misuse layered with newer fentanyl-involved heroin and stimulant exposures. Low-prescribing counties with smaller populations might show lower absolute rates but also face small-number instability, where a handful of overdoses produce dramatic percentage swings year to year.
Urban counties like Fulton, DeKalb, and Cobb generate high overdose counts due to large populations, but age-adjusted rates per 100,000 residents often land in the middle of the statewide distribution. Earlier CDC analyses of suspected opioid overdose ED visits found significant increases across urbanization levels from 2016 to 2017, with large central metropolitan areas showing notable growth. Georgia’s pattern likely follows this national template: substantial increases in metros, but often higher sustained rates in rural and micropolitan settings where treatment access lags and polysubstance use intersects with social and economic disadvantage.
Coastal and border counties introduce additional complexity. The Coastal Health District publishes localized overdose surveillance data, revealing how port access and interstate corridors shape drug market dynamics. Similarly, counties along the I-75 and I-85 corridors see transient populations and drug trafficking flows that influence local overdose patterns independent of residential demographics.
Neighborhood-level disadvantage also predicts overdose risk. The Wisconsin Neighborhood Atlas Area Deprivation Index, which quantifies socioeconomic disadvantage at the block-group level, correlates strongly with overdose outcomes when aggregated to counties. Georgia counties with higher average ADI scores, indicating more poverty, lower education, crowded housing, and limited vehicle access, tend to show both higher overdose rates and steeper increases since 2020, even after adjusting for urbanization.
Unemployment adds another layer. Bureau of Labor Statistics county-level data show Georgia’s statewide unemployment stood at 3.4 percent in August 2025, but county rates varied widely. Economic distress, job loss, and lack of employer-sponsored health insurance all elevate overdose risk by limiting treatment access and increasing stress-related substance use.
Why County-Level Differences Matter?
Recognizing which counties buck statewide trends is not an academic exercise. It directly informs where Georgia deploys naloxone, scales medication-assisted treatment, funds harm reduction programs, and targets prescriber education. Counties with steep upward slopes need rapid intervention scale-up. Counties with high stable rates require sustained systems of care and recovery support. Counties with low rates but vulnerable populations, perhaps due to a single large employer closure or sudden fentanyl market entry, need early warning systems and surge capacity.
Georgia’s monthly syndromic reports already support this localized approach, flagging county-level spikes and enabling district health departments to investigate and respond within days. Integrating discharge-based trend analysis from OASIS adds a complementary annual checkpoint, validating that syndromic signals reflect real burden changes rather than coding or coverage artifacts.
The state’s 2017 response to the Macon counterfeit pill cluster demonstrates the value of integrated county-level surveillance. Analysts noticed a sudden increase in suspected opioid overdose ED visits in Bibb County through syndromic monitoring, cross-checked with EMS naloxone reports, and issued a public alert within 72 hours. That rapid cycle, detect, confirm, communicate, saved lives and now serves as a template for county-specific overdose response protocols statewide.
Polysubstance involvement complicates prevention messaging. A county seeing rising stimulant-involved overdoses needs to emphasize that cocaine and methamphetamine now often contain fentanyl, making naloxone essential even for people who do not consider themselves opioid users. A county with high benzodiazepine co-involvement must educate EMS and bystanders that multiple naloxone doses and rescue breathing may be required. Tailoring messages to local substance patterns improves relevance and uptake.
Treatment capacity must also align with county burden. Rural counties with high overdose rates often lack addiction specialists, requiring telehealth solutions, mobile medication units, and hub-and-spoke models that link rural primary care to urban specialty centers. Urban counties may have more providers but face different barriers: insurance gaps, transportation, childcare, and fragmented systems that lose patients between ED discharge and outpatient follow-up.
Finally, county-level data equity matters. Small counties and those with fewer hospital facilities risk data suppression due to small cell sizes, potentially masking emerging problems. Multi-year pooling, empirical Bayes smoothing, and careful interpretation of confidence intervals help ensure that rural and under-resourced counties receive the same analytic attention as populous metros.
Moving Forward with Local Data
Georgia stands out nationally for its integrated, timely, and accessible overdose surveillance. The state’s combination of DOSE participation, OASIS county tools, and monthly syndromic reporting provides a foundation for precision public health that many states lack. To maximize this infrastructure’s impact, Georgia should continue enhancing polysubstance analytics, formalizing spike-detection thresholds that account for denominator volatility, and expanding data linkages across EMS, ED, inpatient, and fatal surveillance systems.
County rankings should be computed and refreshed annually using OASIS discharge data with age-adjusted, population-based rates and robust trend models that handle the 2020 coding change. Overlaying syndromic monthly signals allows real-time adjustment when counties deviate from expected trajectories. Adding contextual covariates, urbanization class, neighborhood disadvantage, unemployment, and prescribing history, helps explain why counties diverge and predict which are most vulnerable to future surges.
The goal is not to shame high-burden counties but to direct resources where they will save the most lives. Every county has a role. Low-burden counties invest in prevention to stay low. Moderate-burden counties build treatment capacity before crises overwhelm systems. High-burden counties receive intensive harm reduction, naloxone saturation, low-barrier medication-assisted treatment, and post-overdose engagement teams that meet people in EDs and connect them to care before they leave the hospital.
Drug overdoses are preventable. Nonfatal overdoses represent opportunities, moments when someone survives and could access treatment, housing, peer support, and a path toward recovery. Recognizing that these opportunities are not evenly distributed across Georgia’s 159 counties allows the state to meet people where they are, with interventions matched to local realities.
If you or someone you care about is navigating substance use challenges in Georgia, individualized support is available. Reach out to explore our evidence-based addiction treatment options that integrate medical care, counseling, and holistic therapies in a compassionate environment designed for lasting recovery.
