Georgia governor signs limits on drug treatment centers

Deal signs legislation after lawmakers, residents complain about programs

ATLANTA – Georgia is increasing regulation of addiction treatment centers, prompted by complaints from northwest Georgia lawmakers and residents that a cluster of programs there largely treat people traveling from other states.

Gov. Nathan Deal signed the legislation on Thursday.

State records obtained by The Associated Press back up residents' complaints. Last year, one in five people treated at an opioid treatment center in Georgia came from out of state, according to state Department of Behavioral Health and Developmental Disabilities records. In northwest Georgia, two out of every three patients weren't from the state.

Patients and treatment center owners say locals' concerns are unfair and stigmatize the facilities and people seeking help for addiction to opioids and other drugs. New patients receiving methadone must take their doses at a treatment center and are only allowed to take a few doses home after passing drug tests and completing other forms of treatment.

Access to treatment facilities is an issue nationwide. In 2015, fewer than 20 percent of people who needed addiction treatment received it, according to the National Survey on Drug Use and Health sponsored by the U.S. Department of Health and Human services.

Georgia leads the South in the number of treatment centers with 71. Florida, with twice the population, has 69.

"It appears that we have had abuses of the system," Deal said. "We believe just as we had to crack down on pain pill clinics, this is a crackdown in the area of the opioids themselves."

State Sen. Jeff Mullis, a Republican from Chickamauga in the northwestern part of the state, sponsored the bill and blamed Georgia's relatively lax rules for the number of treatment centers locating in his area rather than across the border in Tennessee where regulations are stricter.

Treatment centers now will have to have to demonstrate a need for their services before opening, similar to Tennessee's model. The measure also limits the number of treatment centers that can open in newly created regions around the state.

The outlines effectively stop any new centers from opening in northwest Georgia; existing facilities already meet the region's cap.

Deal also signed two bills aimed at opioid addiction on Thursday. According to the Centers for Disease Control and Prevention, about 1,300 people fatally overdosed on drugs in Georgia last year.

'Gray death' is the latest opioid street mix causing worry

A new and dangerous opioid combo, called “gray death” underscores the ever-changing nature of the U.S. addiction crisis.

Investigators who nicknamed the street mixture have detected it or recorded overdoses blamed on it in Alabama, Georgia and Ohio. The drug looks like concrete mix and varies in consistency from a hard, chunky material to a fine powder.

The substance is a combination of several opioids blamed for thousands of fatal overdoses nationally, including heroin, fentanyl, carfentanil -- sometimes used to tranquilize large animals like elephants -- and a synthetic opioid called U-47700.

"Gray death is one of the scariest combinations that I have ever seen in nearly 20 years of forensic chemistry drug analysis," Deneen Kilcrease, manager of the chemistry section at the Georgia Bureau of Investigation, said.

Gray death ingredients and their concentrations are unknown to users, making it particularly lethal, Kilcrease said. And because these strong drugs can be absorbed through the skin, simply touching the powder puts users at risk, she said.

Last year, the U.S. Drug Enforcement Administration listed U-47700 in the category of the most dangerous drugs it regulates, saying it was associated with dozens of fatalities, mostly in New York and North Carolina. Some of the pills taken from Prince's estate after the musician's overdose death last year contained U-47700.

The Georgia Bureau of Investigations issued a public safety alert about U-47700 after 17 deaths were attributed to the drug in the last four months -- equal to all of 2016.

Gray death has a much higher potency than heroin, according to a bulletin issued by the Gulf Coast High Intensity Drug Trafficking Area. Users inject, swallow, smoke or snort it.

Georgia's investigation bureau has received 50 overdose cases in the past three months involving gray death, most from the Atlanta area, said spokeswoman Nelly Miles.

In Ohio, the coroner's office serving the Cincinnati area says a similar compound has been coming in for months. The Ohio attorney general's office has analyzed eight samples matching the gray death mixture from around the state.

The combo is just the latest in the trend of heroin mixed with other opioids, such as fentanyl, that has been around for a few years.

Fentanyl-related deaths spiked so high in Ohio in 2015 that state health officials asked the federal Centers for Disease Control and Prevention to send scientists to help address the problem.

The mixing poses a deadly risk to users and also challenges investigators trying to figure out what they're dealing with this time around, said Ohio Attorney General Mike DeWine, a Republican.

"Normally, we would be able to walk by one of our scientists, and say 'What are you testing?' and they'll tell you heroin or 'We're testing fentanyl,'" DeWine said. "Now, sometimes they're looking at it, at least initially, and say, 'Well, we don't know.'"

Some communities also are seeing fentanyl mixed with non-opioids, such as cocaine. In Rhode Island, the state has recommended that individuals with a history of cocaine use receive supplies of the anti-overdose drug naloxone.

These deadly combinations are becoming a hallmark of the heroin and opioid epidemic, which the government says resulted in 33,000 fatal overdoses nationally in 2015. In Ohio, a record 3,050 people died of drug overdoses last year, most the result of opioid painkillers or their relative, heroin.

Most people with addictions buy heroin in the belief that's exactly what they're getting, overdose survivor Richie Webber said.

But that's often not the case, as he found out in 2014 when he overdosed on fentanyl-laced heroin. It took two doses of naloxone to revive him. He's now sober and runs a treatment organization, Fight for Recovery, in Clyde, about 45 miles (72 kilometers) southeast of Toledo.

A typical new combination he's seeing is heroin combined with 3-methylfentanyl, a more powerful version of fentanyl, said Webber, 25. It's one of the reasons he tells users never to take drugs alone.

"You don't know what you're getting with these things," Webber said. "Every time you shoot up you're literally playing Russian roulette with your life."