Prevalence and Correlates of Individuals Who Died during Their First Overdose Emergency in New Jersey, 2017-2021

Introduction. People who use drugs (PWUD) are at risk of overdose death during their first use and may die following their first overdose. Marginalized communities are at increased risk of death due to systemic barriers resulting in limited access to education on safe use and harm reduction interventions. Understanding the prevalence and proportion of mortality during an individual’s first overdose emergency can inform more inclusive harm reduction outreach strategies. The current study presents finding that illustrate the prevalence and correlates of those who have died during their first overdose from 2017-2021 in New Jersey (NJ).

Methods. Emergency Medical Services (EMS) and mortality data from the NJ Department of Health were used to determine who died as the result of their first overdose emergency during the study period (2017-2021). Individuals were included in the sample if they were recorded in the mortality dataset as being deceased on the same day as their first naloxone administration in the EMS dataset. Those who were included were recorded with the ICD-10 codes X40-X44. Variables used included race and ethnicity, age, sex, educational attainment, marital status, and place of injury. Z-tests were conducted to assess significant year-to-year changes in mortality during an individual’s first overdose emergency encounter.

Results. During the study period, 513 people died during their first overdose. Decedents were 91.6% white (n = 470), 25.9% Black (n = 133), 87.9% male, a median age of 38.0 years, and 88.9% overdosed in their home (n = 456). Year-to-year trends indicated that in 2017 ~6.2% died on their first OD (1.8 deaths per 100,000 people), in 2018, ~5.7% died on their first OD (1.8 deaths per 100,000 people), in 2019, ~3.7% died on their first OD (1.2 deaths per 100,000 people), in 2020 ~3.8% died on their first OD (1.2 deaths per 100,000 people), and in 2021 ~8.6% died on their first OD (0.8 deaths per 100,000 people). A series of two-proportion Z-tests indicated that the decreased rate of first-time OD deaths from 2018 to 2019 was significant (p=0.0001) as was the decrease from 2019 to 2020 (p=0.0004).

Discussion. Identifying those who may be at-risk to die on their first overdose emergency may aid in the detection of emerging at-risk populations and incisively dedicate scarce harm reduction community resources. While Black residents only make up 15.5% of the population in NJ, they account for approximately 26% of deaths after an individual’s first overdose, and aside from White residents, other racial groups are underrepresented in these findings. Further, most who died overdosed in their home potentially away from bystanders who could have provided an intervention. Our results indicate that the expansion of harm reduction interventions (i.e., increasing naloxone saturation in the state; drug checking technologies) and broadly dispersed public health overdose prevention interventions may influence the tapering of first-time overdose deaths. However, the results highlight that Black decedents may be at an increased risk for death during their first overdose indicating a need to better target education and safe use materials.