Opioid addiction has plagued the Atlanta Metropolitan area for decades. According to the Centers for Disease Control and Prevention, since the beginning of the opioid epidemic in 1999, deaths related to opioids have continued to increase. Substance use disorders have become a major problem nationally, leading to a shift in social and policy-related opinions of these illnesses. In 2017, the White House declared a public health emergency about the rise of opioid misuse; as of June 2024, the public health emergency remains. According to the Georgia Department of Health, overdoses due to opioid misuse have risen since 2010, aligning with the increase in opioid misuse that comes with exposure to new substances. To tackle this, a better understanding of the brain’s role in addiction, the role of community safe havens, and public policy may help mitigate the damage that opioid misuse reflects on society.
The CDC has recognized a cyclic trend in the rise of opioids since 1999. Described as three distinct “waves,” the misuse of opioids has resulted in spikes in overdose deaths. Between 1999-2022, over 700,000 people have lost their lives due to prescribed or illegal opioids. The first wave of deaths related to opioid misuse began in the 90s when physicians prescribed opioids more easily. The beginning of the 2010s showed a swift increase in heroin-related overdoses. Finally, the third wave in 2013 resulted in a significant increase in overdoses, including the rise of fentanyl and other synthetic opioids, leading to the declaration of a national public health emergency.
The Science Behind Addiction
Providing a deeper understanding of the biological mechanisms of addiction may best combat this public health emergency. Reward, pleasure, and motivation require activation of the mesolimbic dopamine pathway, also known as the reward pathway. Drugs of abuse, like opioids, can cause dependency because they activate this pathway when binding to opioid receptors. Activation increases dopamine in the ventral tegmental area and the rewarding sensation which results in positive reinforcement.
This differs from negative reinforcement, where the person takes the drug to stave off uncomfortable withdrawal symptoms. “There’s actually some professional argument in the field about whether addiction truly comes from positive reinforcement or negative reinforcement,” according to Dr. Katharine McCann, a neuroscience professor at Georgia Tech who teaches a class on substance abuse. “All drugs of abuse are going to activate the reward centers of the brain,” she stated, highlighting the importance of clinical and scientific agreement on how these drugs affect behavior.
This contention exists within the scientific field; however, the conflation of terms like “dependence” and “addiction” in non-clinical settings has aided in the misunderstanding of the general public’s knowledge of substance use disorders. McCann states that “physical dependence is not the same thing as addiction because you’re missing that behavioral component that addiction comes with.” Addictive behavior results in some form of drug-seeking behavior: to get the reward from taking the drug or to alleviate withdrawal symptoms. She also states that physical dependence “is not always a bad thing … there are lots of substances out there and drugs out there that people are dependent on every day that help them function,” like blood pressure medications, antidepressants, or other neuropsychiatric medications. However, these medications do not contain an addictive quality and, therefore, do not pose the same risk of abuse as opioids.
Overall, breaking the stigma surrounding drug use and substance use disorders may rely on using more precise language. Physical dependence does not mean addiction, and addiction does not necessarily imply a substance use disorder. “Most people who study addiction think of addiction in this three-stage cycle that repeats itself,” says McCann. Stage 1, the binge intoxication stage, occurs when the reward of dopamine happens from the intake of the substance. This results in positive reinforcement. Next, the withdrawal stage occurs when physical withdrawals as well as negative emotions transpire. Finally, the third stage of cravings and preoccupation results in the seeking behavior. Whereas the first two stages represent physical dependence, the inclusion of the third stage differentiates physical dependence from addiction.
The Diagnostic and Statistical Manual of Mental Disorders lists multiple criteria that can qualify for a diagnosis of substance use disorder. Eleven criteria determine the severity of the disorder, with more symptoms indicating more severity of substance misuse. Most treatments include a mixture of different approaches, such as support groups and medications, depending on the severity.
Treatments for Substance Use Disorder
Perhaps one of the biggest challenges with this epidemic is the difficulty in treating these disorders. McCann suggests that “one of the reasons that it’s so hard to treat, and probably the main reason, is because of the stigma surrounding it.” Using the correct terminology when referring to specific aspects of these diseases may present a simple way to help decrease the current stigma. For example, reducing a person to their struggle by using the term “addict” removes the human aspect of these diseases by removing their agency. Shifting to first-person language shows humanity, as well as giving dignity to those struggling by suggesting that recovery can happen. The National Institute of Drug Abuse recommends replacing words like “clean” with “abstinence from drugs” to avoid negative connotations. Using medical terminology emphasizes the fact that substance use disorders are an illness, which helps to reduce stigma.
McCann also suggested another barrier to treatment is the “individual variability of how people react to drugs.” Not every treatment will work for everybody, which may discourage those seeking help. Many factors, like genes and the environment, can influence this, so future research in these areas may provide better care options. Dr. Ashley Bradford, an applied public policy researcher at Georgia Tech, agreed that “We need to make sure that treatment options are scientifically based,” such as pharmacotherapy, a treatment that uses medication to help reduce the use of opioids.
“There’s not only stigma on the outside, but there’s stigma on the inside.”
While the general public may think the stigma around substance misuse ends when the person seeks treatment, it seems that harsher criticisms may arise depending on the method of treatment chosen. For example, McCann says that “there’s a stigma around using methadone,” a medication mainly used for opioid-use disorders to help rewire the brain’s response to opioids. Methadone helps to lessen the physical symptoms of opioid withdrawal, as well as blocks the rewarding sensation associated with dopamine release after taking opioids. Prescribers may also recommend methadone for specific chronic pain conditions since it does not carry the same risk of abuse as opioids.
Bradford also supports the use of methadone to help with the reduction of opioid misuse: “When it comes to patient outcomes, we know that medication-assisted treatment works.” This form of treatment has a greater effect when combined with behavioral therapy, since using methadone mainly helps to lessen physical withdrawal symptoms, like nausea, increased blood pressure, and muscle pain.
Missy Owen, co-founder of the recovery community center The Zone with her husband, Michael Owen, said infighting exists between those in recovery with the use of pharmacotherapy, like methadone, and those in recovery through other avenues. “They fight back and forth among themselves about who’s really [in recovery] and who’s not. There’s not only stigma on the outside, but there’s stigma on the inside,” she said, which can make it harder to find communities of support for long-term recovery.
“People who are on methadone treatment are still physically dependent on an opioid,” McCann stated, alluding to the main reason for the controversy surrounding this treatment. The precision of language used to talk about this subject may help to clear up any misunderstanding about pharmacotherapy. “I think most clinicians would not necessarily say they’re addicted to methadone while they might be still physically dependent because they’re not meeting all those other criteria — disrupting their lives,” McCann stated. Pharmacotherapy aims to eventually wean off the medication, so judgment based on the method of treatment chosen can lead to even greater stigma.
Unfortunately, the analgesic properties of opioids in pain relief add to the challenge of treating opioid misuse; however, current research has made progress in designing new medications that provide the pain-relieving effects that opioids do while eliminating activation of the reward pathway. Along with this, McCann explained that these medications are better at targeting specific areas in the brain without triggering the rewarding sensation while acting over a longer period of time. New pharmaceuticals with less risk of abuse may close this gap; medications that are slower to onset and slower to offset help to lower abuse potential while still providing pain relief.
As of January 2025, the FDA approved suzetrigine (Journavx) for acute pain, which may help eliminate hydrocodone or oxycodone, some of the most commonly prescribed opioids. Suzetrigine does not act by binding to opioid receptors; instead, it helps to reduce pain transmission between nerve cells by preventing the neuron from firing, thus lowering the number of signals sent. In doing this, the reward pathway does not activate, which provides an option for long-term pain relief without the risk of abuse.
Community centers also offer significant potential for those in recovery and seeking help. One such independent non-profit is The Zone in Marietta, GA, a Recovery Community Organization. Led by those in recovery, The Zone “provides a major, major, big reset button,” Michael Owen stated, emphasizing the need for non-profit organizations tailored to those struggling with addiction.
“The Zone helps people stay in recovery because it gives them the opportunity to build a network of like-minded people,” Missy Owen said since it “gives them all the resources and the support that they need to be able to maintain their recovery.” Community centers such as these provide hope to overcome substance use disorder. “It builds them up — they gain their confidence back,” she stated.
The thrift store, one of the most successful programs at The Zone, operates fully through those in recovery. Michael Owen said employees learn transferable skills such as “customer service skills, work orders, phone calls, inventory, pricing, and advertising,” which translate to many different jobs. “They know that we couldn’t do all this without them, and that gives them a sense of value,” Missy Owen said, highlighting the importance of belonging and acceptance in the recovery journey.
Because The Zone provides many different branches of support, funding poses a challenge to the services they can provide. Some of their revenue comes through the thrift store, but most comes from external funding. Missy Owen explained that “funding is always a problem because there are so many causes out there, and we’re all fighting for the same dollars.” She elaborated that the challenge also lies in providing services for free to a large community. “Last year alone, we had 55,289 visits to The Zone. We served over 41,000 meals,” she said.
Current Drug Policies
While access to treatment and community support present a major area of improvement for recovery, federal and state drug policies can also cause barriers to gaining support and access to treatments. McCann suggests that future drug policy should come from the success of previous policies, especially in terms of remission, relapse, and interventions. “I certainly think that policy should be based on data, and I think that data can come from multiple places,” she stated. Both experimental and real-world data provide the necessary evidence for useful changes in policy.
Some current policies focus on the prevention of new substance use disorders. For example, reforming access to opioids through physicians for pain management. Bradford mentioned the use of opioid prescription limits, which lessen the amount prescribed at a time: “This is important because longer term and higher dosage opioid prescriptions are associated strongly with long term opioid use.” Limiting this access requires more routine monitoring from prescribers, as well as more appropriate doses for pain management. In November of 2022, the CDC published guidelines for prescribing opioids, recommending only necessary dosages to manage acute pain; managing chronic pain should involve other analgesics, like ibuprofen, to lower the risk of abuse. This was last updated in May of 2024.
“We try to rebuild people and help them get back to their pre-addiction lives.”
Along with this, physicians also now have better access to patient history. “There are state-level databases that physicians can access… to look at the history of medical care for these patients and see what other prescriptions these patients are being prescribed,” Bradford stated. Programs such as this can reduce overprescribing, which can lead to illicit distribution and misuse.
Finally, continued physician education programs help to keep prescribers updated on healthcare data and best practices. Specific seminars for pain management and opioid prescriptions aim to certify that prescribers read and implement the latest research and suggested prescribing practices for these medications.
More controversial policies, like “harm-reduction policies,” may also help reduce substance use disorders. Bradford said, “these tend to be needle or syringe exchange programs and Narcan programs.” These centers differ from recovery centers: harm reduction aims to help lessen the likelihood of overdose, whereas recovery centers encourage abstinence from substance use. In Atlanta, places like the Atlanta Harm Reduction Coalition provide syringe exchange locations throughout the city. According to the Rules and Regulations of the State of Georgia, these centers must meet specific criteria to provide these services, such as registration with the Georgia Department of Public Health. Other criteria include free disposal and replacement of needles to consumers, provision of referrals for substance use disorder treatment, as well as screening and care services for HIV. Harm Reduction Centers must also provide naloxone, also known as Narcan, which helps to reverse an opioid overdose.
“With needle exchange programs, the idea is we want to stop the spread of communicable disease. With Narcan, we want to keep people alive.” Bradford stated. As Georgia continues to incorporate these harm reduction policies, the number of substance use disorders and their associated deaths should decrease.
The Future of Opioids
Overall, more research, better access to treatments, and drug policy reform may provide the most effective change to overcome the current opioid epidemic, both in Atlanta and nationally. “I think the only way we can make effective policy is by taking a more holistic look at how the policies we have are affecting people… and how they’re based in science,” McCann stated. Bradford agreed, stating, “We need to be, as a field, very flexible with the types of interventions that we study … and the research needs to follow what’s happening in the real world.”
“Everyone has been touched by the opioid epidemic in some way.”
Moreover, clearer expert communication about substance use disorders and the surrounding public policy will aid in breaking the stigma surrounding these disorders. “We’re having a real crisis when it comes to translating our academic research to lay people in all aspects of academia. This is a major challenge … the people who are producing this research need to be better at translating our research,” Bradford stated. “That is one of the most important aspects of our jobs.”
As far as community centers go, better funding for access to care may lessen societal costs, Michael Owen said. “There is a cost to your community that maybe you’ve never thought of — it’s the overdose responses through EMTs, fire department, police department; it’s the hospital stays from an overdose emergency room. It’s the autopsy reports that somebody has to pay for,” cementing the value of community centers in providing relief for those struggling with a substance use disorder. “We try to rebuild people and help them get back to their pre-addiction lives,” Missy Owen said, highlighting that providing hope for recovery helps to prevent relapse and support the community.
Ultimately, “everyone has been touched by the opioid epidemic in some way,” Bradford stated. A multi-faceted approach, focusing on policy that supports the research, scientifically based treatments, and better community support, may help to lower the rate of substance use disorders in the Atlanta area.
