“The funny thing is, a lot of patients are like, ‘This is where I first started getting prescribed pain pills,’ ” Ìý²õ²¹¾±»å.

Now, the Tennessee native says those same patients are coming to his clinic in Chatsworth, Georgia, a small city about a half hour south of the Tennessee border, to fight their addiction to those very pills.

Outpatient clinics like the one Talbott co-owns dispense drugs like methadone and buprenorphine, which are legal synthetic opioids that block cravings and withdrawal symptoms. Federal health officials say this medication-assisted treatment, coupled with counseling, is the best way to treat an addiction to prescription painkillers or heroin. Patients are required to show up a set number of times a week — the number of visits determined by how long they’ve been receiving treatment — to take their medicine in front of a nurse.

“We’re in the middle of an opioid addiction and overdose epidemic,” Talbott said. “You just think about that for a minute.”

Too Many Clinics?

The reason for the moratorium, according to state , a Republican, is the state needs to figure out why so many opioid treatment programs have opened in Georgia. Mullis sponsored the legislation — which has since been signed into law — that created the freeze on new clinics. The law also required that a committee be established to look into Mullis’ question.

“If you go to the parking lot of any of these clinics in northwest Georgia,” Mullis said, “you’ll see as many Tennessee, Alabama, North Carolina, Kentucky tags as you do Georgia tags.” People are driving in from all over the South, he says, to get treatment there.

Georgia has , more than any other Southeastern state. Tennessee has only 12, in contrast; Alabama has 24, and Mississippi has one. Only Florida comes close numbers-wise, with 65 clinics. But its population is nearly double that of Georgia’s.

While individuals who want to open a clinic in Georgia still have to fulfill multiple licensing requirements and approvals from both the state and federal governments, Mullis says it’s too easy; unlike other surrounding states, Georgia doesn’t have a  program for narcotic treatment centers. Those programs limit entry or expansion of some health care facilities by requiring operators to show there’s a need for it. For opioid treatment programs in Georgia, open competition has been the only real constraint on the number of clinics.

“I don’t want to take these facilities away from people who need it, but we need to manage, and govern, and regulate the ones that are here, and the ones that are coming here,” Mullis said.

More Enforcement

There’s also stigma around the addiction drugs used at opioid treatment centers because the drugs dispensed are opioids themselves. Critics say drugs like methadone are .

Tapering off these treatment drugs is optional, and some patients can stay on them all their lives.

, who heads the Opioid Treatment Providers of Georgia, an advocacy group for state providers, says pushing people off medication-assisted treatment shouldn’t be the focus of lawmakers’ efforts.

“If someone stays on a medication, that’s not really the issue,” he said. “People can still be dependent on something, but not live an active addiction.”

Connell, who operates three opioid treatment programs in southwest Georgia, rejects Mullis’ claim that Georgia clinics lack regulations. However, he does support the moratorium.

He says the problem is that regulations are not enforced properly by the Georgia Department of Community Health, which oversees the clinics.

“We have had some clinics open up — some people with limited knowledge of the field,” Connell said. “They have not received surveys. How do we know they’re functioning correctly?”

The Department of Community Health has only a small staff to keep track of the 67 clinics — three workers, with another person now in training. An agency spokesman says its rules and regulations also do not specify how frequently treatment centers should be inspected but that re-licensure surveys are conducted every two years.

A Treatment Shortage

A shortage of clinics in other states means Georgia’s are filling a need other Southern states aren’t meeting, Talbott argues.

He has some personal experience to bring to bear on this issue — he is in long-term recovery for an opiate addiction.

While getting his master’s degree in social work eight years ago, Talbott was prescribed painkillers for some lower back pain. He says things spiraled from there.

“I still recall to this day, learning how to help people with behavioral conditions in class, and then going to the bathroom to shoot pills and/or heroin,” Talbott said.

He says there were long wait-lists at the three Tennessee clinics closest to him that were authorized to treat his opioid dependency. Rather than wait, he drove four hours back and forth between Knoxville and a clinic in Rossville, Georgia, nearly every day for six months to get treatment.

He says he’s grateful for that Georgia clinic.

“The old Zac — that Zac that was in that graduate program for clinical social work — quickly came back,” he said, once he was able to stop the opioid use.

Georgia’s moratorium went into effect June 1. It will last a year, to give the state Legislature time to look at new ways to regulate the clinics.

This story is part of a partnership that includes , and Kaiser Health News.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

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This story can be republished for free (details).

Dan Mallory says in the middle of his trip, news hit that the Zika wasn’t only transmitted by mosquitoes, but could also be sexually transmitted. So when he returned, the Decatur couple decided to follow the CDC’s recommendation: use condoms during sex.

“It was a little bit weird to think about needing to use protection having been together for 10 years and not having had that conversation in a really, really, really long time,” Katy Mallory said.

so far, all of them in people who have traveled to one of the 55 countries where the WHO says Zika is active. None of the cases were in pregnant women.

While the virus hasn’t been seen in mosquitoes in Georgia yet, the potential for transmission, while small, exists.

The disease is spread primarily through one species of mosquito, the Aedes aegypti, though experts say the tiger mosquito could also carry it. Both species of mosquito are found in Georgia and about 30 other U.S. states. Health officials say their presence means the U.S. could eventually see small, local clusters of the Zika virus.

“One bite can do it,” said Sarah Grzywacz, an Atlanta resident who canceled a trip to Mexico after consulting with her doctor. “One bite and you can be infected, and this child we so deeply planned for and deeply wanted could be forever changed and forever injured by our desire to have a vacation.”

Grzywacz, who’s seven months pregnant, says because the mosquitoes that carry Zika are also in Georgia, she tries to stay inside as much as possible and wears pants and long-sleeved shirts when she goes outside. She knows the risk of getting Zika is very, very small, but she wants to be cautious.

“We feel mostly powerless to control what happens because it’s mosquito bites,” Grzywacz said. “How can you go outside in the summer and not get bitten by a mosquito?”

Family Planning

Some Georgia women told WABE they’re holding off on planning a pregnancy this year altogether because of Zika.

“This summer, do I need a full-body net? That is everyone’s question,” said Emory Healthcare gynecologist Dr. John Horton.

Of course there’s no need for body nets, Horton says, but he understands why women are so worried.

His office hands out a Zika form that asks patients about recent travel and any symptoms they may have. At this point, however, Horton would not recommend women delay pregnancy because of Zika.

“I recognize it’s on our Caribbean door, but we haven’t seen it yet, and it may not come,” Horton said.

Horton points out the mosquitoes that carry Zika also carry viruses like dengue, yellow fever and chikungunya. Those haven’t been widely spread in the U.S., in part because people here are better shielded from mosquitoes by screens and air conditioning.

“If it gets here, we will figure this out,” Horton says.

Stopping Zika’s Spread

That “if,” though, has state health officials on alert.

More KHN Zika Coverage

“It’s very important that people are very aware of cleaning up around their house,” said Georgia Department of Public Health Commissioner Brenda Fitzgerald.

The DPH commissioner says the state is taking the risk of Zika seriously. She says the department has set up mosquito traps to figure out where Zika risks might exist. There’s also a public service campaign underway to educate residents on preventing mosquito breeding grounds.

“Toss any container around your home that you’re not using,” Fitzgerald said. “Make sure you empty your gutters. Make sure you get rid of any standing water.”

Fitzgerald says right now the biggest risk to pregnant women is travel-related, but it’s not a minimal one, given that Atlanta’s Hartsfield-Jackson airport hit a record 100 million passengers last year.

The CDC recommends women wait eight weeks after traveling to a Zika-infected country to conceive. If a women’s male partner shows symptoms of Zika, which include rash, joint pain and eye inflammation, the couple should wait six months because the virus can linger in semen.

This story is part of a partnership that includes , and Kaiser Health News.

ºÚÁϳԹÏÍø News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about .

USE OUR CONTENT

This story can be republished for free (details).