ATLANTA — As dollars from national opioid settlements continue making their way to states, Georgia leaders are still deciding what to do with about $700 million the state is expected to receive over the next few years.

The various settlements are from opioid manufacturers, their affiliated firms, and pharmacies for their role in the ongoing opioid epidemic, which attributed to 71% of the nearly 2,400 drug overdose deaths in Georgia in 2021.

According to the Centers for Disease Control and Prevention, opioids were involved in 80,411 overdose deaths nationwide in 2021.

In February 2022, Gov. Brian Kemp announced receipt of $13 million from a multi-state opioid settlement case against McKinsey & Company, a management consulting firm that represents major opioid companies.

Kemp said the funds would be used be used to expand Medication Assisted Treatment availability, increase detoxification service capacity, promote stigma reduction, increase access to naloxone for emergency service providers and expand training on naloxone to community providers.

A spokesperson for the Georgia Department of Behavioral Health and Developmental Disabilities, which has received the majority of the funding thus far, said no update was available as to the status of their affiliated projects and initiatives.

DBHDD received nearly $5 million for MAT, which is the use of FDA-approved medications, in combination with counseling, behavioral therapies and social support to treat substance use and opioid use disorders. More than $3.2 million was received by DBHDD to expand detoxification bed space to provide medically monitored residential withdrawal management services.

A study commissioned by DBHDD gives insight into how much behavioral bed space may be needed in Georgia to accommodate current and future needs.

Georgia DBHDD Bed Study

and Strategic Plan

The study conducted by Alvarez & Marsal and released this year assessed the use of the state’s behavioral health crisis and forensic system and future bed space needs for the next 10 years.

The behavioral health crisis system of Georgia comprises community-based services to assist individuals in crisis, facility-based treatment to stabilize individuals in crisis, and outpatient services to help individuals return to the community.

Facility-based treatments include crisis stabilization sites, behavioral crisis centers, state hospitals and state-contracted private hospitals.

The study notes that inflation, COVID-19’s increased prevalence of behavioral health diagnoses and limited workforce shortages, and the expected increase for demand due to the national rollout of the 988 Suicide and Crisis Lifeline have affected the state’s behavioral health system.

Staffing challenges have led to low occupancy rates, limiting the availability of current capacity,” the study suggests. “Investing in workforce should be a priority for DBHDD as it seeks to meet future demand for its crisis services; this future demand can and should be met first by existing beds.”

According to the study, Georgia will need five new facilities, such as behavioral health crisis centers, by 2025 to meet near-term demand; an additional facility by 2027 and two more by 2032, for a total of eight new facilities over a 10-year period.

Each facility is preferred to have with 24 crisis stabilization unit beds and 16 temporary observation chairs.

Adult behavioral health bed need is greatest in the northwest corner of Georgia, and regions surrounding Athens and parts of metro Atlanta, according to the study, which notes that a new facility is assumed to be needed when a region’s projected bed need is 50% or more of the bed capacity of a behavioral health crisis center.

The projected need also assumes that Georgia is able to meet optimal occupancy of 85% for all of its existing facilities, the study states.

Georgia also has a great near and long-term need for additional forensic state hospital beds, with a gap of 119 beds projected by 2025, according to the study. Forensic hospitals service patients who are in custody or who were referred via courts.

This projected need is supported by the state’s growing forensic waitlist,” the study states. “While this need can be met by building new facilities, it may also be mitigated by increasing resources to reevaluate individuals on the forensic admissions waitlist, expanding jail-based competency restoration programs, and/or increasing utilization of forensic step-down facilities, such as Community Integration Homes and Forensic Apartments.”

Impact of opioids on Georgians and settlement funds allocations

According to the Georgia Department of Public Health, from 2019-2021, the total number of opioid-related overdose deaths increased from 853 to 1,718, an increase of 101%.

DPH states that the increases were driven largely by fentanyl, a synthetic opioid often found laced in other drugs such as cocaine, heroin and counterfeit pills.

From 2019 to 2021, fentanyl-related drug overdose deaths increased 124% in Georgia, and overall, 57% of drug overdose deaths were attributed to fentanyl.

Non-fatal drug overdoses have also increased in Georgia.

DPH data shows that from 2019 to 2021, emergency department visits and hospitalizations for drug overdoses increased 10%, from 24,886 to 27,388.

Part of Georgia’s $13 million of opioid settlement funds from the McKinsey & Company settlement has been used to launch a statewide stigma reduction and opioid awareness campaign, and another nearly $3 million is expected to be used to purchase and distribute naloxone kits — used to reverse overdoses — to Emergency Medical Service providers and law enforcement officers throughout the state.

In May, Kemp established the Georgia Opioid Settlement Advisory Committee via executive order to provide recommendations regarding the allocation of a majority of the opioid settlement funds the state is expected to receive. The GOSAC will consist of eight members and one non-voting chairperson.

According to the Governor’s Office of Planning and Budget, Georgia will receive a combined $636 million from the national settlement with pharmaceutical distributors McKesson, Cardinal Health, and AmerisourceBergen — and manufacturer Janssen Pharmaceuticals Inc. and its parent company Johnson & Johnson.{

The national distributor settlement funds will be disbursed on an 18-year plan, while the Janssen/J&J Settlement funds will be disbursed on a nine-year plan.