Utilizing the National Pollutant Discharge Elimination System Permit Program to Address the United States Opioid Epidemic: A Focus on Metro Atlanta, Georgia

The opioid epidemic has continued to be an ongoing public health crisis within Metro Atlanta for the last three decades. Opioid related deaths and prescription opioid related deaths have also increased significantly throughout Metro Atlanta more rapidly than any other area throughout Georgia. Public health officials and policymakers within the Metro Atlanta region have continued to increase awareness and provide resources to address the ongoing opioid epidemic; but with the opioid overdose related deaths increasing each year, these local officials have had no success with providing long-term solutions to address this public health crisis. Moreover, estimating opioid use and exposure in a large population is almost impossible, and alternative methods are being explored, including wastewater-based epidemiology. Opioid metabolites travel through the sanitary sewer through urine, fecal matter, and improper disposal of opioids to local wastewater treatment plants (WWTP). WWTPs have the ability to monitor the opioid metabolites that enter and that are discharged from their facility. Wastewater-based epidemiology has been an approach that has been utilized globally by researchers and public health officials to combat the opioid epidemic. Requiring municipalities within Metro Atlanta to monitor and report opioid contaminants that are discharged within their WWTPS via the National Pollutant Discharge Elimination System (NPDES) permit, can assist with the efforts on fighting the opioid epidemic within this area. We are proposing a new innovative approach for monitoring opioid use and analyzing trends by utilizing wastewater-based epidemiologic methods, which may help public health officials manage the opioid epidemic throughout Metro Atlanta.