Geography of Heroin Overdose Deaths in Georgia, 2025

Heroin overdose deaths in Georgia remain concentrated in urban counties, but tracking county-level changes in 2025 requires navigating provisional data, suppression rules, and the reality that fentanyl now drives most opioid mortality. 

Final 2024 county data from Georgia OASIS show heroin-involved deaths are a small, declining subset of overdose fatalities, with many rural counties reporting suppressed counts below 10. 

For 2025, provisional county heroin-involved statistics are available through CDC WONDER Multiple Cause of Death, though these figures update weekly and carry uncertainty. 

This article explains how to obtain reliable county heroin data, interpret trends amid fentanyl’s dominance, and understand which Georgia counties are most affected.

Understanding Heroin-Involved Overdose Deaths in Georgia

Heroin-involved overdose deaths are identified using ICD-10 code T40.1 as a multiple cause of death among drug poisoning deaths with underlying causes X40–X44, X60–X64, X85, or Y10–Y14. 

This definition, used by both Georgia OASIS and CDC WONDER, captures deaths where heroin was listed anywhere on the death certificate, regardless of other substances present. 

Because a single overdose can involve multiple drugs, heroin-involved counts overlap with other opioid categories and do not sum to total overdose deaths.

Georgia’s heroin mortality landscape has shifted dramatically since 2015. While heroin drove opioid deaths in the mid-2010s, non-methadone synthetic opioids, primarily illicitly manufactured fentanyl, now account for the majority of opioid-involved fatalities. 

By 2024, DeKalb County officials reported that 65 to 70 percent of drug overdose deaths involved fentanyl, illustrating the substance’s dominance even in counties where heroin historically appeared.

This structural shift means heroin-only county statistics for 2025 will be low, often suppressed, and concentrated in metropolitan areas. 

For county planning, heroin-involved deaths serve as a subset indicator within a broader synthetic opioid surveillance framework.

Data Sources for County Heroin Mortality in 2024 and 2025

Three complementary systems provide county-level heroin overdose data for Georgia:

Georgia OASIS Drug Overdose, Mortality offers final, county-level heroin-involved death counts, crude rates, and age-adjusted rates for Georgia residents through 2024. 

This state system uses residence-based assignment, meaning deaths are counted in the county where the decedent lived, not where the death occurred. OASIS adheres to NCHS definitions and provides the authoritative baseline for 2024 county comparisons.

CDC WONDER Multiple Cause of Death (Provisional) updates weekly with county-level heroin-involved deaths for 2025. 

Users can query underlying overdose causes and multiple cause code T40.1 to extract provisional counts by county. 

These data are subject to revision and suppression for counts between 1 and 9, but represent the only national system offering county heroin-involved provisional statistics by residence.

NCHS Vital Statistics Rapid Release (VSRR) provides monthly state-level heroin indicators and county-level all-drug overdose counts. 

While VSRR does not break down county deaths by specific drug, it offers predicted counts that adjust for reporting delays and contextualizes Georgia’s heroin trend within broader overdose patterns.

Which Georgia Counties Report the Most Heroin Overdose Deaths?

Final 2024 data from Georgia OASIS reveal that heroin-involved deaths cluster in large metropolitan counties. 

Fulton, DeKalb, Cobb, Gwinnett, Chatham, Richmond, Muscogee, and Bibb counties historically report counts above suppression thresholds, enabling calculation of age-adjusted rates. Even in these urban centers, heroin accounts for a minority of opioid-involved deaths.

In contrast, most rural Georgia counties show suppressed heroin counts, between 1 and 9 deaths, making rate calculation impossible and trend interpretation unreliable. 

This suppression reflects both low population and heroin’s diminished role in the current overdose crisis. Where heroin counts are suppressed, NCHS confidentiality standards prevent publication to protect privacy.

For 2025, provisional data from CDC WONDER show similar geographic concentration. Counties with historically higher heroin involvement may exceed suppression thresholds, but small-number instability and wide confidence intervals limit the reliability of year-over-year comparisons. 

Analysts should pool multiple years or aggregate to public health districts when heroin counts remain below 20 to improve statistical stability.

How to Obtain County-Level Heroin Overdose Data for 2025?

To extract 2024 final county heroin-involved deaths, navigate to the Georgia OASIS Drug Overdose, Mortality query tool. 

Select 2024 as the time period, choose all counties or specific counties of interest, and select the heroin-involved subset under “All Opioids.” Request deaths, death rate, and age-adjusted death rate. Export the table and note suppressed cells, which indicate counts between 1 and 9.

For provisional 2025 county heroin-involved deaths, use CDC WONDER Provisional Multiple Cause of Death. Set the location to Georgia and group results by county. 

Select underlying cause codes X40–X44, X60–X64, X85, and Y10–Y14 for drug overdose, then add multiple cause code T40.1 for heroin. Request counts, crude rates, and age-adjusted rates with confidence intervals. 

Export the data and record the query date, as provisional figures update weekly and are subject to revision.

To contextualize county heroin trends, review VSRR’s state-level heroin indicator for Georgia. The 12-month ending heroin counts show whether heroin-involved deaths are rising, falling, or stable statewide. 

Combine this with VSRR’s county-level all-drug overdose counts to assess whether changes in overall overdose burden align with or diverge from heroin-specific patterns.

Interpreting Increases and Decreases Amid Data Limitations

When comparing 2024 and 2025 county heroin-involved deaths, use 12-month ending periods on the same month year-over-year to avoid overlap bias. 

For example, compare the 12 months ending June 2024 with the 12 months ending June 2025. Avoid month-to-month comparisons of rolling 12-month sums, which share 11 months of data and artificially inflate apparent stability or change.

Age-adjusted rates control for differences in county age structure and are the preferred measure for cross-county comparisons. 

However, when heroin counts fall below 20, rates become unstable and confidence intervals widen. In these cases, report counts without rates and note the limitation. 

Consider aggregating to multi-county public health districts or pooling 2023 through 2024 to improve reliability.

Suppression complicates trend interpretation. A county shifting from suppressed to reportable counts may reflect a true increase, improved toxicology documentation, or random variation in small numbers. 

Conversely, a county moving from reportable to suppressed may indicate a decline or simply a return to baseline low counts. Always flag suppressed cells and avoid ranking counties by small differences in heroin-involved deaths.

The Fentanyl Context: Why Heroin-Only Monitoring Underestimates Risk

Heroin-involved deaths are not mutually exclusive from other opioid categories. A single overdose can involve heroin and synthetic opioids, appearing in both T40.1 and T40.4 tallies. 

National surveillance shows that polysubstance involvement has increased since 2015, with fentanyl frequently mixed with stimulants, cocaine, and other substances.

In Georgia, this polysubstance reality means that heroin-only county statistics miss the main driver of overdose mortality. 

Statewide reporting indicates opioid overdose deaths declined modestly from 2023 to 2024, but experts caution that sustainability depends on continued investment in treatment and harm reduction. 

Counties experiencing rising all-drug overdose counts but stable or suppressed heroin counts are likely facing fentanyl-driven increases, not heroin resurgence.

For county decision makers, this context argues for prioritizing synthetic opioid surveillance and interventions. 

Naloxone distribution, fentanyl test strips, low-barrier medications for opioid use disorder, and stimulant co-involvement risk communication should anchor local strategies, with heroin-specific services targeted to subpopulations and geographic pockets where heroin remains prevalent.

Provisional Data Quality and Predicted Counts

Provisional overdose data lag longer than other causes of death due to toxicology and investigative processes. VSRR addresses this by providing predicted counts that adjust for reporting delays, offering a more accurate approximation of final totals during recent months. 

These predicted counts are available at the state level and help interpret whether apparent declines in provisional data reflect true trends or incomplete reporting.

At the county level, provisional data from CDC WONDER do not include predicted counts. Users should expect underestimation in the most recent months and recognize that counts will be revised upward as additional death certificates are processed. 

VSRR technical notes recommend waiting at least six months for overdose data to reach inclusion thresholds, though weekly updates allow earlier situational awareness with appropriate caveats.

Data quality metrics such as percent pending investigation and completeness are available in VSRR state-level products. These indicators help assess confidence in drug-specific attribution. 

Lower completeness can bias heroin-involved indicators downward if toxicology results are pending or if specific drugs are not documented on death certificates.

County-Level Heroin Trends in Context: Metro Atlanta and Beyond

Metro Atlanta counties, Fulton, DeKalb, Cobb, and Gwinnett, account for a substantial share of Georgia’s heroin-involved deaths. 

These counties have larger populations, more active drug markets, and medical examiner systems with robust toxicology capacity. 

Even so, heroin represents a minority of overdose deaths in these jurisdictions, with fentanyl predominating.

In DeKalb County, local officials reported 217 drug overdose deaths in 2023 and 203 in 2024, with fentanyl involved in 65 to 70 percent. 

While heroin-specific counts were not disclosed, the fentanyl dominance suggests heroin-involved deaths are a small subset. This pattern likely holds across other large Georgia counties.

Outside metro Atlanta, counties such as Chatham (Savannah), Richmond (Augusta), Muscogee (Columbus), and Bibb (Macon) may report heroin-involved deaths above suppression thresholds. 

However, rural counties across North Georgia, South Georgia, and the Central Savannah River Area will frequently show suppressed heroin counts, limiting the feasibility of county-specific trend analysis.

For these rural counties, aggregating to public health districts or comparing all-drug overdose counts provides a more stable and actionable risk picture. 

Heroin-specific interventions can be reserved for counties with documented heroin involvement, while fentanyl-focused strategies apply statewide.

Recommendations for County Surveillance and Response

County health departments and coalitions should adopt a multi-indicator approach to overdose surveillance in 2025. Use Georgia OASIS to establish a 2024 baseline for heroin-involved deaths by county, noting suppression and rate stability. 

Update this baseline with CDC WONDER Provisional MCD queries for 2025, comparing 12-month ending periods year-over-year and documenting suppression, revisions, and query dates.

Supplement heroin-specific data with VSRR county all-drug overdose counts to assess overall mortality pressure. 

Where all-drug counts rise but heroin remains suppressed, interpret the increase as likely fentanyl-driven and prioritize synthetic opioid interventions. 

Where heroin counts exceed suppression thresholds and show increases, consider targeted outreach to persons with heroin use histories while maintaining fentanyl-first harm reduction strategies.

Report age-adjusted rates with 95 percent confidence intervals for counties with at least 20 heroin-involved deaths. For counties with fewer deaths, present counts without rates and avoid ranking or league-table comparisons. 

Communicate non-mutual exclusivity clearly: heroin-involved counts overlap with other opioid categories and do not sum to total overdoses.

Invest in data quality by supporting medical examiners and coroners to improve toxicology documentation and specific drug reporting. 

Higher “percent with drugs specified” increases the reliability of heroin and synthetic opioid indicators, enabling more precise county-level planning.

Why Heroin-Only Monitoring Is Insufficient in 2025?

Based on the weight and quality of evidence from Georgia OASIS, CDC WONDER, and NCHS VSRR, heroin-involved overdose deaths in Georgia in 2025 remain a relatively small, urban-concentrated subset of opioid mortality, dwarfed by fentanyl and polysubstance co-involvement. 

For county decision-making, heroin-only dashboards risk underinforming strategy due to low counts, suppression, and documentation variability.

Priority should be on synthetic opioid indicators and all-opioid mortality, while still reporting heroin where feasible and statistically reliable. 

Investments should target fentanyl-focused interventions, polysubstance risk communication, and rapid nonfatal overdose surveillance, supplemented by targeted heroin services in select metropolitan counties.

Heroin-specific monitoring retains value for clinical and forensic context, subpopulation risk assessment, and documenting the residual heroin market footprint. 

However, resource allocation and rapid response decisions should be anchored in broader opioid and synthetic opioid indicators, combined with provisional county all-drug mortality and emergency department overdose signals to capture acute risk and service needs.

If you or someone you know is struggling with opioid use, help is available. Reach out to explore Thoroughbred’s addiction treatment options that address the full spectrum of substance use challenges.