Locational and Contextual Attributes of Opioid Overdoses in New Jersey

Background and Purpose: The U.S. is currently experiencing an opioid epidemic, resulting in unprecedented rates of opioid use disorder and a 4-fold increase in rates of fatal opioid overdose between 1999 and 2017. In New Jersey, where fatal overdose rates exceed the national average, more than 3,100 overdose fatalities are estimated to have occurred in 2018. Statewide efforts to reduce opioid overdoses include distribution of naloxone and education on its use, as well as expanded access to treatment following a non-fatal overdose. However, much remains unknown about the characteristics of opioid overdose events, including where they are most likely to occur, information which could have critical implications for efforts to prevent future overdoses. Accordingly, the current study uses data on a large number of overdose events across New Jersey to identify locations where overdoses occur and the contextual attributes that predict these locational variations.

Methods: Data for this study are from an evaluation of a program that utilizes peer support professionals and case managers to engage individuals within emergency departments immediately following an overdose reversal. The program is delivered in more than 50 hospitals across New Jersey’s 21 counties. Data were collected using a form completed for all participants who consented to services. The sample for the current study includes 3,970 overdose survivors who averaged 37 years old, were 70% male, and of whom 67% were White, 19% were Black, 11% were Hispanic, and 3% were of another race. Open-ended responses to an item indicating where the overdose occurred was recoded into distinct categories to identify the relative frequency of overdose locations. Data were then merged with publicly-available U.S. census data to assess attributes of communities in which overdoses took place. Multinomial logistic regression analyses were conducted to identify predictors of where overdoses occurred, including patient demographic characteristics and attributes of the municipalities of overdose.

Results: Results show that overdoses occur in a large variety of places, including homes, vehicles, medical settings, outdoors, stores and restaurants, and many others. The most common locations included private residences (65%), outdoor public places (15%) indoor public places (9%), and in vehicles (8%). Location of overdose was associated with demographic characteristics of overdose victims and attributes of the municipalities of overdose. For instance, higher population density and lower median income in the municipality of overdose were associated with greater odds of an overdose occurring outdoors compared to a private residence. Individuals who overdosed outdoors were older and more likely to be male than those who overdosed elsewhere. Among all racial/ethnic groups, overdoses were most likely to occur at home, but Black victims overdosed in outdoor locations at higher rates than other groups and Whites were more likely than other groups to overdose in a private residence.  

Conclusions: This study illuminated the need for a comprehensive approach to addressing opioid overdoses. Findings are useful for state and local planning to address this alarming public health issue. Overdose prevention strategies can be tailored using these locational and contextual factors in order to increase impact.