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Rehabilitation is the Resolution

Writer's picture: Arch Policy InstituteArch Policy Institute

Hi everyone! My name is Ruhee Merchant, and I am the co-lead for the Healthcare Policy Center and Policy Center co-Coordinator.  


The strength and vibrance of Athens-Clarke County (ACC) is in peril due to the escalating crisis of the opioid epidemic in Georgia. The state has seen a 124% increase in fentanyl-related overdose deaths from 2019 to 2021 with 29 counties outpacing the national average for overdose. In 2022, ACCPD administered Narcan 127 times and saw 60 suspected fatal overdoses, primarily due to fentanyl. Around 6% of households in ACC have at least one family member with an alcohol or substance use disorder, and this combined with a lack of access to care has resulted in preventable fatalities. 


The upshot in overdoses can be attributed to drugs being laced with fentanyl, an opioid around 50 times stronger than heroin. It has been difficult to assess where the fentanyl is coming from, but Athens Clarke County Police Department (ACCPD) reports that they have been working to disrupt the supply chains of high-level fentanyl traffickers and spread opioid education. 


In response to the national uptick in drug overdoses, the Federal Drug Administration (FDA) has increased access to harm reduction programs, ensuring access to life-saving medications such as Naloxone, Buprenorphine, and syringe services programs. 


Georgia has taken actions in response to the increasing issue. Through the 2014 Georgia’s 9-1-1 Medical Amnesty Law, the state legalized the prescription of Naloxone. The drug reverses opioid overdoses by binding to opioid receptor sites, blocking opioids from attaching. The legalization has resulted in larger-scale manufacturing and sale, with the drug retailing at around $30-$50 at pharmacies. Furthermore, the state does not require prior authorization from a physician for Naloxone anymore, loosening the restrictions around its purchase. The Georgia Overdose Prevention (GOP) group has also developed a Google Maps indicating sites to locate free Naloxone distribution kits across Georgia; Athens Clinic is one of the 13 host sites. The group additionally conducts regular street outreach focused on harm reduction around Athens. 


The state also allows for prescribed use of Methadone. The drug is an alternative harm reduction medication that quenches opioid cravings and withdrawals. While the drug is promising, approximately half of the counties in Georgia don’t have access to a methadone clinic. The lack of accessibility disproportionately hits rural counties. Additionally, while Athens-Clarke and surrounding counties have access to the Alliance Recovery Center, DM&ADR, and The Genesis Center of Winder, which can provide this drug, barriers still persist. The primary issues consist of cost and transportation, as methadone costs $12 a day, and only selective insurances cover it. While Medicare and Medicaid cover the cost, not all work-sponsored insurance does.

 

Buprenorphine is similar to methadone, and it also can be self-administered. The downside is that it is not effective for people with high opioid tolerances. Most buprenorphine providers are clustered in urban areas again creating an issue of accessibility for Georgia’s 85 rural counties. Because of this 64% of individuals seeking buprenorphine cannot access providers. This being said, UGA Cooperative Extension has received a $350,000 grant from the USDA to expand previous efforts to address opioid abuse in rural communities and centers. One recommendation is to enable methadone delivery at Federally Qualified Health Centers (FQHCs) - which has existing infrastructure. The decision would just require more personnel and training. 


The Athens Wellbeing Project recommends tackling this problem in Athens-Clarke County through a three-tiered plan. The first part consists of expansion to naloxone distribution, a feasible, small-reach solution. The second recommendation is high reach with moderate feasibility, involving improving surveillance systems to track the incidence and prevalence of opioid abuse. The last suggestion has medium reach and high feasibility. It entails deploying Quick Response Teams (QRT) composed of law enforcement, a medic, a mental health professional, and a peer recovery specialist from Advantage’s PROUD Program to respond to cases of drug overdose. It is critical to build teams that are equipped to responsibly interact with survivors and effectively promote de-escalation strategies. 


Historically, Georgia has employed abstinence-only withdrawal programs in their detention facilities, with a mandatory minimum sentence of 2-15 years of jail for drug possession felonies. This rigid framework has resulted in Athens-Clarke County Jails’ delay in implementing a Medication Assisted Treatment (MAT) program, a data-driven program that combines medications and behavioral therapy to support those with substance abuse issues. This program effectively weans patients off of dangerous opioids at a slow pace. 


Our current infrastructure still criminalizes addiction and risky activity, promoting recidivism. In-house rehabilitation programs have documented a 16% decrease in recidivism among inmates with opioid use disorders, encouraging sustainable detoxification for a more positive experience upon re-entry. In previous years, API, which was formerly known as Roosevelt, had urged the Athens-Clarke County Jail to work with Armor Correctional Health Services to implement an in-house MAT, standardize access to naloxone, methadone, buprenorphine, and counseling into operational procedure. Additionally, they had a partnership with Alliance Recovery Center to support long term rehabilitation and post-re-entry.


Lack of access to drug treatment is a problem that has continuously been ignored and treated with band-aid solutions. Now is the time to acknowledge the wounds that scar our communities and begin to heal.


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