Jon Hager


By Jon HagerFaculty Member, Criminal Justice at American Military University

Understanding the scope of the opioid crisis is critical to determining the best ways to reduce related deaths that are plaguing cities and towns around the nation. In an effort to reach a better understanding of the problem, I decided to conduct a research project that looked at the opioid epidemic in my local area. As a death investigator who witnessed the epidemic from street level, there seemed to be a disconnect between the problem and the initiatives set up to suppress the number of opioid-related deaths.

I focused my research on Fulton County, Georgia, which is located in the northern area of the state. According to the 2016 U.S. Census Bureau, this county constitutes approximately one million people of the 10.3 million people in the State of Georgia.

In my research, I examine the specific causes for opioid-related deaths, and thus determine if initiatives to address the opioid problem are addressing these causes. This information can be used to inform further state-wide research and the development of potential solutions.

Causes of Opioid-Related Deaths in Fulton County

From 2014 to 2016, there were 3,902 deaths related to opioids in Georgia, according to the Centers for Disease Control and Prevention (CDC). I made an open records request to the Fulton County Medical Examiner’s Office to obtain the specific number of deaths where the primary cause was opioids during this same time frame.

Results showed that between 2014 and 2016, 287 deaths in Fulton County were attributed to opioids. However, after reviewing the records, 34 cases were withdrawn because the primary cause of death was not specific enough, was not relevant to the research, or was incomplete for some unknown reason.

Of the 253 viable results, the deaths were sorted based on the primary cause of death. The table shows the number of deaths attributed to each category:

Primary Cause of Opioid-Related Deaths Number of Deaths in Fulton County, GA (2014-16) Percentage of Total Opioid-Related Deaths
Prescription opioid-related deaths 105 41.5%
Heroin-related deaths 4 .02%
Prescription opioid plus heroin-related deaths 73 28.9%
Prescription opioid plus another drug-related death (i.e., ethanol, marijuana, methadone, cocaine).*Note: Does not include heroin 71 28.1%

The abuse of more than one drug at a time is known as polysubstance abuse. Polysubstance abuse plays a significant role in the number of opioid-related deaths. While there were 105 prescription opioid-related deaths, 144 of the total deaths were related to polysubstance abuse, which suggests that users of other drugs were also abusing prescription opioids. Based on this information, the question must be raised whether the problem is prescription opioids, or if users are abusing another drug and then taking prescription opioids.

What Are Georgia’s Current Solutions to the Opioid Epidemic?

Georgia, like many states across the country, has sought ways to stem the opioid epidemic. According to the Substance Abuse Research Alliance, Georgia established the following initiatives:

  • Increase access to Naloxone, which reverses an overdose
  • Improve access to opioid treatment, such as recovery centers and the expansion of Medicaid
  • Address neonatal abstinence so fewer babies are born addicted to opioids
  • Strengthen prescription drug monitoring programs
  • Increase oversight of pain clinics, to better educate patients
  • Create standards for physician education
  • Create a commission on substance use recovery

Fulton County is also taking a proactive approach to tackling the opioid epidemic. The Substance Abuse Research Alliance estimated that the opioid epidemic cost the county $450 million in 2007 and a more recent study in 2013 estimated the cost to be $78.5 billion.

The county is now taking legal action against prescription distributors, prescription manufacturers, and physicians in an effort to recover some of the costs associated with addressing this epidemic. However, restricting access to prescription medication is only one part of the solution.

Fulton County Must Do More

What could Fulton County be doing better? First, too much emphasis has been placed on restricting the availability of prescription medications and not enough on stemming the heroin problem. Approximately 29 percent of the total deaths in Fulton County from 2014 to 2016 were from a combination of prescription opioids and heroin. Additionally, heroin is more readily accessible, inexpensive, and available in increasing levels of purity, which is a possible reason why it’s contributing to so many deaths.

Another significant oversight in the county’s initiatives is the number of polysubstance abuse deaths. The statistics show that 28 percent of the opioid related-deaths from 2014 to 2016 involved prescription opioids plus another drug other than heroin, including ethanol, marijuana, methadone, and cocaine. Combined with the rate of overdoses involving heroin, 57 percent of the total opioid related-deaths from 2014 to 2016 consisted of prescription opioids plus another drug.

Taking action against prescription distributors, manufacturers, and physicians is not the full answer. Instead, more needs to be done to address polysubstance drug abuse. For example, if more measures are put in place to address addictions to other drugs, it may reduce the number of opioid-related deaths overall. Patients identifying as drug abusers should not be prescribed prescription opioids. Also, action should be taken by healthcare professionals to seek help for known drug abusers such as conducting an intervention. Cognitive behavioral therapy is also a way to help change the thought process of drug abusers and help them avoid continuing their destructive behavior.

Future Research

Fulton County’s initiatives to stem the opioid crisis must be followed up with more in-depth research about whether or not focusing on prescription opioids is an effective way to reduce opioid-related deaths. This future research must include a review of all opioid-related deaths to determine if polysubstance deaths warrant more attention and, if so, what initiatives can be put in place to address those issues.

The opioid epidemic does not discriminate, so it’s imperative to evaluate all data at the local and state level to better understand the impact of polysubstance abuse and its continued role in opioid-related death rates. There should also be increasing collaboration of local and state agencies to ensure proper collection of data related to the primary cause of the death.

About the Author: Jon Hager has worked in the criminal justice field since 2000 in the capacity of private fire investigations, autopsy technician, and as a medical examiner investigator and a forensic science professor. Jon obtained a B.S. in anthropology from Hamline University, a M.S. in forensic science from the University of New Haven and a doctorate in psychology with a concentration in criminal justice from the University of the Rockies. Jon is currently an adjunct professor of criminal justice at American Military University. To contact the author, email For more articles featuring insight from industry experts, subscribe to In Public Safety’s bi-monthly newsletter.