The Built Environment and Community Rates of Non-Fatal Drug Overdoses Among Peer Recovery Program Participants

Background/Purpose

Opioid-related overdose deaths continue to rise in the United States. One strategy for reversing the trend of overdose deaths is the wide distribution of the overdose reversal agent, naloxone, among people who use drugs, service professionals, and laypeople who could intervene if they observe an overdose. Certain features of the built environment may support the goal of reducing overdose deaths by making naloxone more widely available. States that have enacted blanket standing orders for pharmacies have seen overall reductions in overdose mortality and several states have increased access at substance misuse treatment and prevention facilities as a low-cost measure to save lives. Other community-level factors associated with rates of overdose deaths include area deprivation, alcohol outlet density, and workforce participation.

The purpose of this proposal is to identify features of the built environment associated with increased rates of non-fatal opioid overdoses among participants in a post-overdose peer recovery program. We include features of the built environment that are either established in the literature as predictors of naloxone availability or overdoses, theorized to be an optimal space for naloxone distribution, or facilities already dispensing naloxone.

Methods

This proposal presents data from New Jersey (NJ) in 2019 where opioid overdose death rates were in the top 10 nationally at 37.1 individuals per 100,000. Data were combined from several sources to test the relationship between features of the built environment and rates of reversed overdoses. OORP administrative data was used to aggregate the number of reversed overdoses at the municipal level and create the main outcome variable: number of reversed overdoses per 100,000 residents. Predictor variables were created using data from the US Census, NJ Division of Alcoholic Beverage Control, NJ Division of Consumer Affairs, NJ Department of Environmental Protection, SAMHSA Treatment Locator, and public facing directories of recovery-focused meeting locations to construct measures of area deprivation, alcohol outlet density, pharmacy access, commercial land use, SUD treatment access, and opioid-specific self-help location density (i.e., Narcotics Anonymous location). A spatial error regression model was fitted to the data using GeoDa that accounts for spatial dependence in residual error and models spatial dependence in the outcome variable.

Results

OORP participants experienced reversed overdoses in 389 of NJ’s 564 municipalities in 2019. Findings indicated municipalities with greater SUD treatment density (β=75.2, p<.01); pharmacy density ((standing order (β=37.0, p<.001), no-standing order (β=36.82, p<.05)); on-premises alcohol outlet density (β=25.1, p<.001); and area deprivation (β=25.2, p<.001) had higher rates of naloxone-reversed overdoses. Population density (β=-.003, p<.001) was shown to have an inverse relationship with reversed overdoses.

Conclusions and Implications

Implications include the expansion of standing orders to all NJ pharmacies. Currently, NJ operates on an opt-in basis and our findings show that a blanket naloxone standing order could be effective in increasing community access to naloxone. A significant relationship was also found for on-premises alcohol outlets (i.e., bars and restaurants) which are promising spaces for OEND training and naloxone availability considering existing server training programs on identifying acute alcohol intoxication and the dangerous relationship between alcohol and opioids.