The opioid epidemic has impacted thousands of lives across the country. At the University of Georgia, professors across various disciplines are studying the national effects of opioid and other drug-related deaths on the state’s treatment options in local communities and health care policies.
“There really isn’t an element of the social fabric of the state of Georgia that addiction isn’t going to touch,” said Orion Mowbray, a School of Social Work associate professor.
Lack of substance abuse centers near Athens sparks controversy
Over the last few years, Mowbray has poured over questions surrounding prescription opioids and their misuse. His team began collecting data from local areas in and around Athens-Clarke County on the types and availability of substitute services to treat opioid addictions as well as the fatality rates from opioids.
Funding for this project came from Advantage Behavioral Health Systems, which is a public health provider contracted out for 10 counties in Georgia, with a focus on Athens-Clarke and its surrounding counties such as Jackson, Greene and Barrow.
After accumulating information on fatality rates, Mowbray noticed the positive correlation of deaths with the lack of proper access to treatment facilities.
“When we assess for the prevalence of substance abuse services in this region, our data suggests that there aren’t many options for substance use services,” Mowbray said. “There are in Athens-Clarke, where it’s the most populated area, but the further out you get into these rural areas, the harder it is [to find].”
The second issue Mowbray found was the shortage of locations featuring medication-assisted treatment.
According to Mowbray, the early model for treating opioid addiction was “to quit cold turkey.” Later on, medication began to be used to help patients detoxify — first to cure alcoholism and then to treat opioid problems over time.
"Our data suggests that there aren’t many options for substance use services [in the Athens-Clarke area]."
- Orion Mowbray, School of Social Work associate professor
In a 2017 study conducted by the CDC, the prescribing rates for opioids in Jackson, Madison Elbert and Clarke averaged 107.33 per 100 people. In Feb. 2018, Athens-Clarke County filed a lawsuit against opioid manufacturers and distributors.
The combination of illegally obtaining opioids, misusing them and increasing the drug’s strength is cause for immediate concern, Mowbray said.
Mowbray said he and other researchers often have a difficult time getting their findings in front of legislators and others who have the power to make changes.
While the consequences associated with opioid addiction impact families, friends and coworkers, Mowbray emphasized the importance of educating young people that a person is “more than their addiction.”
“Even for a person who's not impacted by addiction in any way, I can pretty much guarantee that in their day to day life, no matter where they go after they leave the university, they will come into contact with someone who's either actively in the throes of addiction or in recovery from it,” Mowbray said.
Georgia overdose deaths grow in urban areas
According to the Center for Disease Control, opioids are the leading cause of drug overdose deaths. From 2016-2017, the state of Georgia witnessed a 10.5 percent increase in overdose deaths.
Jayani Jayawardhana, an associate professor in the College of Pharmacy, modified her own research to study the impact of all drug overdose deaths, including opioids, on rural counties in Georgia. She found that drug overdose deaths have increased over time from 1999-2015, but deaths in rural counties were about 23% lower than deaths in non-rural counties when she factored in all social determinants.
While Jayawardhana agreed it’s difficult to overlook the opioid epidemic in the Appalachian region, urban areas also pose as a threat due to increased opportunities to access drugs. She cited The Triangle, an area of northern Atlanta suburbs in the counties of Fulton, Cobb, DeKalb and Gwinnett, that have experienced a surge of heroin deaths among their youth populations.
“If you have higher income levels you have the purchasing power, and you’re more likely to be insured so you can get access to medication faster than those who are uninsured,” Jayawardhana said.
Medicaid coverage for opioid addiction treatment plans
Amanda Abraham, an assistant professor of public health administration and policy in the School of Public and International Affairs, has co-written a legislative agenda for the state to address the opioid crisis. Part of her research looks at the impact of Medicaid expansion on the substance use disorder treatment system.
Through her findings, Abraham learned that more patients with Medicaid insurance in Medicaid expansion states benefit from increased coverage for substance use disorder treatments under the Affordable Care Act.
“This is the first time in U.S. history that any health insurance plan is required to cover SUD (substance use disorder) treatment,” Abraham said via email. “This could inform state Medicaid programs by demonstrating the benefits of offering more generous coverage of SUD treatment and removing prior authorization requirements on medications to treat opioid use disorder.”
Both Abraham and Jayawardhana collaborated with professors Matthew Perri and Henry Young to analyze the changes to Georgia’s Medicaid laws. They specifically examined laws that could affect the appropriate or inappropriate prescribing behavior of doctors on the state’s Medicaid population.
“I was also interested in how it would affect health outcomes and healthcare utilization, such as hospital inpatient visits, emergency room visits, doctor visits as well as possible overdose deaths,” Jayawardhana said.
After Jayawardhana’s work on the collaborative grant, she connected with Christina Valentini through the Center for Undergraduate Research Opportunities to help her examine the effects of social determinants like race, gender and socioeconomic status on both opioid and general drug overdose deaths.
“When we started the research, discussing opioid use and abuse was not as socialized as it is today,” Valentini, who graduated with a bachelor of science degree in health promotion in 2017, said via email. “Now, opioid use and abuse is gaining attention not only in politics but also in the media. Research on opioid use and abuse is integral to protect population health because it impacts individuals of all socioeconomic backgrounds.