Emergency rooms across metro Atlanta saw young adult overdoses climb steeply beginning in 2020, a shift driven by fentanyl’s spread through the illicit drug supply.
Between 2019 and 2025, suspected nonfatal overdose visits among the 15 to 34 age group increased substantially in key counties including Fulton, DeKalb, Cobb, Gwinnett, and Clayton, with opioid and stimulant categories both rising compared to pre-pandemic baselines.
This article explains what the data show, how surveillance systems track these trends, and what local responses can reduce harm among Atlanta’s young adults.
Young Adults Overdose ER Data Shows Sharp 2020 Rise
The young adults overdose ER data in Atlanta reflects a clear inflection point in 2020 when Georgia health officials documented sharp increases in overdoses tied to fentanyl’s increased presence in illicit drugs, including stimulants like cocaine and methamphetamine. This pattern aligns with broader national surveillance that captured a similar spike. Emergency department visit rates for suspected overdoses among 15 to 34 year olds likely remained elevated through 2024, with continued volatility into 2025 as the drug supply evolved.
Why 2020? The pandemic disrupted treatment access and altered social networks, while fentanyl infiltrated a wider range of substances. People who thought they were using cocaine or methamphetamine encountered fentanyl without knowing it, leading to unexpected overdoses and ER visits. For young adults, this created an especially dangerous environment because many had lower opioid tolerance.
The rise was not uniform. Older segments of the 15 to 34 bracket saw larger relative increases. The 20 to 34 age band experienced sharper growth in both opioid and stimulant coded visits compared to adolescents aged 15 to 19. Still, even younger teens faced heightened risk as adulterants spread.
Fentanyl Drives Youth Overdose ER Patterns
Fentanyl changed everything. Before 2020, heroin drove most opioid overdoses in Atlanta. After 2020, synthetic opioids, primarily illicit fentanyl, became the dominant factor. National mortality data show that stimulants involving overdose deaths rose largely due to co-involvement with opioids during the same period. In Atlanta, this translates to young adults arriving at emergency rooms after using what they believed was cocaine or methamphetamine, only to learn it contained fentanyl.
This co-involvement matters for ER surveillance. The CDC’s DOSE syndromic system uses nested, non-mutually exclusive categories, meaning one visit can appear in both the “all opioid” and “all stimulant” counts. For ages 15 to 34 in Atlanta, both categories increased after 2020. You cannot simply add them together to get a total; instead, “all drugs” serves as the comprehensive measure while opioid and stimulant subcategories show the overlapping drivers.
Emergency department clinicians also began seeing xylazine involved cases. Xylazine is an animal tranquilizer increasingly mixed with fentanyl. A validated tracking method showed xylazine involved overdose deaths roughly doubled nationally from 2021 to early 2024. While ER syndromic definitions do not always capture xylazine explicitly, its presence in the drug supply likely contributed to more severe presentations among young patients, including prolonged sedation and difficult to treat wounds.
Gwinnett County Supply Context
Local law enforcement actions underscore how supply shapes ER trends. In September 2025, a multi-agency operation in Gwinnett County led to 24 arrests and the seizure of cocaine and fentanyl, along with firearms. This type of disruption reflects the polysubstance and adulteration environment that young adults navigate. When fentanyl and cocaine circulate together, emergency departments see the consequences in real time through overdose visits.
How Atlanta Tracks 15-34 Age Group ER Overdoses?
Tracking youth overdose ER data in Atlanta requires integrating multiple surveillance streams, each with strengths and limitations. The most timely source is syndromic surveillance through the National Syndromic Surveillance Program (NSSP), which Georgia participates in. DOSE-SYS provides near real time data on suspected nonfatal overdoses using standardized definitions drawn from emergency department electronic health records, including chief complaint text, triage notes, and diagnosis codes.
DOSE-SYS reports rates as visits per 10,000 total ED visits. This denominator posed challenges during 2020 when overall ER volumes collapsed. As Pennsylvania’s technical guidance notes, rates per ED visit became harder to interpret during the pandemic, and population based rates offered a complementary perspective. Atlanta analysts should present both metrics for 2020 to 2021 to avoid misleading spikes caused by denominator instability.
Georgia also maintains the OASIS system, which provides discharge based ER and inpatient overdose counts by county. OASIS allows filtering by detailed age groups including 15 to 17, 18 to 19, 20 to 24, 25 to 29, and 30 to 34, making it well suited for youth focused analyses. However, OASIS posts an important notice about known data issues and urges caution when interpreting trendlines. Discharge data are more complete than syndromic data but lag by several months.
Three Surveillance Layers
To build a complete picture, Atlanta should layer three data sources:
| System | What It Measures | Geography | Lag | Strengths | Key Cautions |
| DOSE-SYS Syndromic | Suspected nonfatal overdose ED visits per 10,000 visits | State, county if available | 1 to 2 months | Near real time trends; nested drug categories | Preliminary, not toxicology confirmed; 2020 denominator shock |
| OASIS Discharge | ER/inpatient overdose counts and rates | Georgia counties | Varies | County and age detail; more finalized coding | Known data issues; stimulant categories limited |
| NVSS Provisional | 12 month overdose death counts | County of residence | Quarterly | Mortality context for severity | Provisional; subject to revision; pending investigations |
This table shows how different systems complement each other. Syndromic data catch early signals. Discharge data confirm burden over longer windows. Mortality data reveal the most severe outcomes and help interpret whether ER increases reflect rising exposures, changing lethality, or both.
Stimulant and Opioid Co-Involvement
The nested structure of DOSE-SYS definitions means that a single ER visit among a 20 year old in Atlanta can be counted in “all opioid,” “all stimulant,” and “fentanyl” categories simultaneously. This is not double counting; it reflects the reality that polysubstance use and contamination are common. National data confirm that 59 percent of overdose deaths between January 2021 and June 2024 involved any stimulant, with increases since 2018 driven largely by co-involvement with opioids. The same dynamic shapes nonfatal ER visits.
For young adults in Atlanta, this means that someone using cocaine may unknowingly ingest fentanyl and arrive at the ER with opioid toxicity symptoms. Emergency department staff must be prepared for mixed presentations. Naloxone reverses opioid effects but does not address stimulant toxicity or xylazine sedation. This complicates clinical management and discharge planning.
Analysts should examine both opioid and stimulant syndromic categories together for the 15 to 34 age group, recognizing overlap rather than treating them as separate streams. The increases in both categories among Atlanta youth after 2020 are plausibly linked to the same underlying driver: fentanyl adulteration of the stimulant supply.
County Level Variation
Although this synthesis does not present county specific numeric series, the analytic approach outlined in the research allows replication for each metro county. Fulton and DeKalb counties, as the largest population centers with major tertiary emergency departments, likely show the earliest and most visible increases. Gwinnett, Cobb, and Clayton counties follow similar trajectories given their role in the broader metro area and shared exposure to regional drug markets.
Future dashboards should present monthly or quarterly time series for each county, stratified by age band, with annotations for data quality events such as facility onboarding or coding changes. Cross county comparisons within Georgia are appropriate if methods remain consistent. Comparisons across state lines are discouraged due to varying data quality and coverage.
What These Trends Mean for Communities?
Rising ER overdose visits among 15 to 34 year olds signal that prevention and treatment systems are not keeping pace with supply side risks. Each ER visit represents an opportunity. Emergency departments can distribute naloxone, initiate medications for opioid use disorder, and connect young patients to outpatient care. Yet many EDs lack standardized protocols for youth.
Revisits are common. Research from other urban systems shows that roughly one in five young people who present to an ER with a substance related issue return within a year for another visit. This pattern underscores the need for robust post overdose outreach. Atlanta should build quick response teams that follow up with young adults after ER discharge, offering harm reduction supplies, peer support, and linkage to treatment that fits their lives.
The equity dimension cannot be ignored. Youth ER studies document disproportionate increases in substance use related visits among Non-Hispanic Black and Hispanic young people. In Atlanta, with its demographic composition and historical disparities, stratified surveillance and targeted interventions are essential. Otherwise, gaps in outcomes and access will widen.
Prevention must also address the fentanyl contamination reality. Young adults need clear, non-judgmental messaging that stimulants like cocaine and methamphetamine now frequently contain fentanyl. Fentanyl test strips, where legally distributed, empower people to check substances before use. Naloxone should be ubiquitous, and peers should know how to recognize overdose symptoms and call for help without fear of legal consequences.
Why Does It Matter?
Atlanta’s youth and young adults face an overdose risk environment fundamentally different from what existed in 2019. Fentanyl infiltration, xylazine adulteration, and polysubstance dynamics create unpredictable dangers. Emergency department data capture only a fraction of the harm; for every ER visit, there are near misses and fatal overdoses that never reach a hospital.
The convergence of syndromic, discharge, and mortality data points to sustained elevation in overdose burden among ages 15 to 34 across metro Atlanta counties. Given that research confirms syndromic signals detect steep increases months before discharge data confirm them, Atlanta should prioritize near real time DOSE-SYS monitoring with monthly review. Early detection allows rapid community response when rates spike in specific neighborhoods or age groups.
What happens next depends on whether surveillance translates into action. Young adults benefit from youth centered treatment models that respect autonomy, address co-occurring mental health needs, and fit flexible schedules. Peer recovery coaches and culturally responsive care improve engagement and reduce shame. Emergency departments, community organizations, and families each play a role in building a safety net that catches people before overdose becomes fatal.
The data also call for upstream prevention. Reducing the supply of fentanyl adulterated substances through coordinated law enforcement, harm reduction that meets people where they are, and education campaigns that reach young adults on their terms. Schools, colleges, workplaces, and social networks are all venues for overdose prevention efforts.
Atlanta has the tools to respond. Georgia participates in national surveillance systems, local health departments can query county level data, and clinical best practices exist for ER based interventions. The question is whether stakeholders will commit resources and political will to make those tools work for young adults. Every ER visit is a chance to intervene. Every dataset refresh is a chance to detect emerging threats. Every partnership between health and community organizations strengthens the response.
If you or a young adult you care about is navigating substance use or overdose risk, support is available. Our professional teams across metro Atlanta offer evidence-based care designed for young people, including flexible outpatient programs that integrate therapy, medical support, and holistic services. Explore Summit’s treatment options that meet you where you are and build a path forward.
