Abstract
Background
Emergency medical services (EMS) encounters for non-fatal opioid overdose in the United States increased from 2018 to 2022, and persons treated for an overdose by EMS increasingly refuse EMS transport to emergency departments after an overdose. Understanding where non-fatal overdoses occur can inform overdose prevention and response efforts.
Methods
EMS data from biospatial by ImageTrend were queried from 888 counties reporting consistently during January 2022–December 2024, representing approximately 30.6% of the US population. Frequencies and proportions of non-fatal opioid-involved overdose (hereafter, “non-fatal overdose”) EMS encounters were calculated by location, sex, race and ethnicity, age group, and U.S. Census Bureau region. Quarterly trends in proportions were also examined.
Results
Private residences (55.3%) were the most common location of non-fatal overdoses, followed by streets and highways (19.5%), across all demographic groups. Non-fatal overdose encounters were also common in schools and public administrative buildings among persons aged <19 years, and in healthcare facilities among persons ≥55 years. Minor declines (AQPC: −0.9) were observed from January 2022 through September 2024 in private residences, but not in streets and highways.
Discussion and Conclusions
Tailoring risk reduction efforts, such as training potential bystanders on opioid overdose reversal medication (OORM) administration and increasing OORM availability in public and private locations, to settings where non-fatal overdose is most common may help reduce overdose morbidity and mortality.
Keywords: opioids, drug overdose, emergency medical services
BACKGROUND
Emergency medical services (EMS) encounters for non-fatal opioid-involved overdoses in the United States increased from a rate of 98.1 per 10,000 EMS encounters in 2018 to 179.1 in 2022 [1]. EMS providers frequently serve as the first point of medical contact and may provide treatment for persons experiencing an overdose. As individuals increasingly refuse transport to emergency departments (EDs) following an overdose [2], traditional surveillance sources such as ED data may not fully capture the burden of non-fatal overdose. EMS data may find some cases not present in ED data as well as add new types of information. Identifying common locations where non-fatal overdoses occur, a data point not captured in other non-fatal overdose data sources, across demographic groups is crucial for tailoring public health interventions. For example, reports from North Carolina [3] and Rhode Island [4] indicate that more than 60% of EMS responses to non-fatal opioid-involved overdoses occurred at private residences. Similar analyses across multiple jurisdictions are limited. This study described the locations of non-fatal opioid-involved overdoses (hereafter referred to as “non-fatal overdose”) encounters across multiple US counties and examined temporal trends using EMS data.
METHODS
Data Source, Classification and Inclusion Criteria
EMS data from biospatial by ImageTrend [5], were queried from 888 counties* that consistently shared records during January 2022–December 2024. Biospatial by ImageTrend aggregates EMS encounter data from state and local EMS providers for analytic use, using the National EMS Information System (NEMSIS) data standard [6]. Unlike the national NEMSIS research dataset [7], biospatial by ImageTrend provides information at the county level, which permits partial inclusion of states and increases geographic representation in the analysis. Biospatial by ImageTrend receives EMS data from 46 states, 28 with full coverage (biospatial receives all records that the state EMS office receives) and 18 partial coverage (biospatial receives some of the data from sources other than the state office, e.g. through partnerships directly with EMS providers). Following previous methods [1], biospatial by ImageTrend’s underlying event coverage (UEC) ratio was used to select counties for inclusion; county must have met UEC of 75% for each month in the study period to qualify, to ensure consistency. Twenty-six states and the District of Columbia had at least one county that met the UEC threshold (75%) and were included in this analysis (Supplemental Table 1). Counties include county equivalents such as the District of Columbia, boroughs and census areas in Alaska, and independent cities in Virginia. The included counties collectively represent approximately 30.6% of the U.S. population.
Suspected non-fatal overdose encounters were identified using the Council of State and Territorial Epidemiologists EMS Guidance [8]. The following types of encounters were excluded: fatal, duplicate, those with no patient contact, or missing incident location information. Overdose location was determined using the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) Y92 place of occurrence code in the EMS record for the following categories, with “X” representing the variable final digit for all included subcodes: private residences (Y92.0X); healthcare facilities (Y92.12X,Y92.23X,Y92.53X); institutional residences (e.g., nursing homes, prisons) (Y92.1,Y92.10-Y92.11X, Y92.13X-Y92.169); schools and public administrative buildings (Y92.2, Y92.21, Y92.21X, Y92.22X, Y92.24X, Y92.25X, Y92.26X, Y92.29); sports and athletic areas (Y92.3X); streets, highways, paved roads, and public transportation (referred to in this analysis as “streets and highways”) (Y92.4X, Y92.81X); trade/service areas (e.g. shops, banks, restaurants) (Y92.5X-Y92.52X, Y92.54X-Y92.59X), industrial/construction areas, and farms (Y92.6X, Y92.7X, Y92.86); other outdoor areas (Y92.82X, Y92.83X-Y92.85X); and other/unspecified locations (Y92.8, Y92.89, Y92.9X).
Characteristics analysed included age group, sex, U.S. Census Bureau region, and race and ethnicity. Persons of Hispanic or Latino ethnicity were classified as Hispanic/Latino regardless of race, while non-Hispanic persons were reported by single race classification (American Indian or Alaska Native [AI/AN], Asian, Black, Native Hawaiian or Other Pacific Islander, or White).
Data Analysis
Counts and proportions of non-fatal opioid-involved overdose EMS encounters by location and demographic characteristics were calculated. An “other, unspecified” location category representing 2.2% of the overall data is not shown. Missing data were excluded from analyses when that variable was used in the analysis. A total of 3,868 (0.6%) encounters were missing data on age, 3,304 (1.0%) were missing sex, and 78,903 (12.1%) were missing race/ethnicity information. Chi-square tests were performed to examine differences in distributions of EMS encounters across characteristics and locations (SAS 9.4; SAS Institute).
For the two most common locations where overdoses occurred, Joinpoint regression was used to estimate average quarterly percent change (AQPC) and quarterly percent change (QPC) of trends in proportions (Joinpoint regression program version 5.44.0; National Cancer Institute). QPC accounted for correlation between quarters. Trends were assessed by characteristics. Significance level was set at <0.05. This analysis was reviewed by the United States Centers for Disease Control and Prevention (CDC), deemed not research, and conducted in accordance with applicable federal law and CDC policy (45 C.F.R. part 46, 21 C.F.R. part 56; 42 U.S.C. Sect. 241(d); 5 U.S.C. Sect. 552a; 44 U.S.C. Sect. 3501 et seq).
RESULTS
A total of 651,023 non-fatal opioid -involved overdose EMS encounters were identified across 888 counties in 26 states and the District of Columbia from January 2022 to December 2024 (Table 1). The highest percentage of encounters involved persons aged 35–54 years (39.0%), males (65.1%), and white persons (63.1%). Persons aged <19 years and ≥55 years accounted for 2.4% and 28.7% of encounters, respectively. Differences in distributions of EMS encounters for each characteristic – location type pair were all found to be significant (p <0.001).
Table 1.
Characteristics of non-fatal opioid-involved overdose Emergency Medical Services encounters, overall and by top 5 locations*, 888 counties†, January 2022–December 2024§
| Characteristic | All | Non-fatal Opioid-involved Overdose Emergency Medical Service Encounters by Location, n (%) |
||||
|---|---|---|---|---|---|---|
| N (%) | Private residences |
Streets and highways** |
Trade / service areas |
Healthcare facilities |
Schools / Public administrative buildings |
|
| Overall | 651,023 (100) | 359,869 (55.3) | 126,909 (19.5) | 62,394 (9.6) | 31,371 (4.8) | 23,112 (3.6) |
| Age group, years (n=647,155) | ||||||
| <19 | 15,483 (2.4) | 9,531 (61.6) | 1,922 (12.4) | 832 (5.4) | 531 (3.4) | 1,751 (11.3) |
| 19–34 | 193,743 (29.9) | 99,384 (51.3) | 42,362 (21.9) | 23,188 (12.0) | 3,829 (2.0) | 7,699 (4.0) |
| 35–54 | 252,545 (39.0) | 131,326 (52.0) | 56,917 (21.9) | 28,074 (11.1) | 6,324 (2.5) | 9,467 (3.8) |
| ≥55 | 185,384 (28.7) | 118,078 (63.7) | 24,317 (13.1) | 9,886 (5.3) | 20,622 (11.1) | 4,014 (2.2) |
| Sex (n=647,719) | ||||||
| Male | 421,920 (65.1) | 215,797 (51.1) | 95,679 (22.7) | 43,776 (10.4) | 16,127 (3.8) | 16,051 (3.8) |
| Female | 225,799 (34.9) | 142,567 (63.1) | 30,289 (13.4) | 18,308 (8.1) | 15,123 (6.7) | 6,897 (3.1) |
| Race and ethnicity (n=572,120) | ||||||
| American Indian/Alaska Native | 5,334 (0.9) | 2,936 (55.0) | 910 (17.1) | 596 (11.2) | 209 (3.9) | 279 (5.2) |
| Asian | 4,097 (0.7) | 2,213 (54.0) | 872 (21.3) | 339 (8.3) | 226 (5.5) | 149 (3.6) |
| Black or African American | 143,280 (25.0) | 72,302 (50.5) | 36,009 (25.1) | 12,584 (8.8) | 6,153 (4.3) | 5,861 (4.1) |
| Hispanic or Latino | 57,370 (10.0) | 28,772 (50.2) | 13,738 (23.9) | 5,022 (8.8) | 1,843 (3.2) | 2,255 (3.9) |
| Native Hawaiian or Other Pacific Islander | 1,155 (0.2) | 604 (52.3) | 275 (23.8) | 102 (8.8) | 35 (3.0) | 62 (5.4) |
| White | 360,884 (63.1) | 212,507 (58.9) | 56,920 (15.8) | 35,102 (9.7) | 20,005 (5.5) | 11,958 (3.3) |
| Census region (n=651,023) | ||||||
| Midwest | 104,495 (16.1) | 62,490 (59.8) | 16,135 (15.4) | 8,710 (8.3) | 5,902 (5.6) | 4,113 (3.9) |
| Northeast | 82,532 (12.7) | 41,998 (50.9) | 21,539 (26.1) | 5,389 (6.5) | 3,080 (3.7) | 3,942 (4.8) |
| South | 338,569 (52.0) | 198,887 (58.7) | 54,562 (16.1) | 35,672 (10.5) | 17,854 (5.3) | 10,555 (3.1) |
| West | 125,427 (19.3) | 56,494 (45.0) | 34,673 (27.6) | 12,623 (10.1) | 4,535 (3.6) | 4,502 (3.6) |
For all location categories analysed, please see Supplemental Table 2.
Data from biospatial by ImageTrend. Twenty-six states and the District of Columbia had at least one county or county equivalent that met the sufficient underlying event coverage threshold (75%) and were included in this analysis (see Supplemental Table 1).
Column percentages are shown in the “All” column. All other percentages in the Table under Emergency Medical Service Encounters by Location are row percentages. Chi-square tests were performed to examine differences in distributions of EMS encounters across characteristics and locations (all p <0.001).
Streets and highways also include other paved roads and modes of public transportation such as subways.
Overall, 55.3% of the encounters occurred in private residences, 19.5% on streets and highways, and 9.6% in trade or service areas (Table 1). Although these three location categories were similarly found to have the highest percentage of encounters across most demographic groups, notable deviations were observed in specific age groups: for those aged <19 years, the third most common location was schools/public administrative buildings (11.3%), and for those aged ≥55 years, the third most common location was healthcare facilities (11.1%). The remaining four categories assessed – institutional residences, other outdoor areas, industrial, construction or farm areas, and sports or athletic areas - represented only 5% of overall encounters (Supplemental Table 2).
Temporal trend analysis (Figure 1) indicated that the proportion of non-fatal overdose EMS encounters occurring in private residences statistically significantly decreased by an average of 0.9% (95% CI: −1.8, 0.0) per quarter during January 2022–December 2024 (Table 2). Significant declines in non-fatal opioid overdose EMS encounters among private residences were observed across all age groups (AQPC range: −1.4% to −1.0%), except among persons aged ≥55 years. Among males, the proportion decreased by 1.2% per quarter over the study period. Significant decreasing trends were also identified among AI/AN persons (AQPC: −1.5%, 95% CI: −2.7, −0.7), including a significant decline during Q1 2022–Q3 2023 (QPC: −3.1%, 95% CI: −8.2, −1.0 ), as well as among Black (AQPC: −1.3%, 95% CI: −2.6, −0.1 ) and Hispanic or Latino (AQPC: −1.0%, 95% CI: −2.0, −0.1) persons over the study period. Regionally, significant declines were observed in the Northeast (AQPC: −1.5%, 95% CI: −3.1, 0.0) and West (AQPC: −1.6%, 95% CI: −2.9, −0.6) Census regions (Figure 1, Table 2).
Figure 1.
Trends of proportion of non-fatal opioid-involved emergency medical service (EMS) encounters in private residences during January 2022 to December 2024 by age group (a), sex (b), race/ethnicity (c) and US Census region* (d).
* Data from biospatial by ImageTrend. Asian and Native Hawaiian or other Pacific Islander, non-Hispanic groups were combined for analysis. NH, Non-Hispanic.
Table 2.
Joinpoint regression analysis of trends in quarterly proportion of opioid-involved non-fatal overdose Emergency Medical Service (EMS) encounters occurring at private residences and streets and highways†, overall and by age group, sex, race and ethnicity, and U.S. Census Bureau region—888 counties, January 2022–December 2024.
| Characteristics | Private Residences | Streets and Highways† | ||||
|---|---|---|---|---|---|---|
| Average quarterly % change (AQPC) (95% CI) |
Trend segment, quarterly % change (QPC) (95% CI) |
Average quarterly % change (AQPC) (95% CI) |
Trend segment, quarterly % change (QPC) (95% CI) |
|||
| Segment 1 | Segment 2 |
Segment 1 | Segment 2 | |||
| Overall | −0.9 (−1.8, 0.0)* | Q1 2022–Q4 2024 −0.9 (−1.0, 0.0)* |
NA | 0.9 (−1.9, 3.6) | Q1 2022–Q4 2024 0.9 (−1.9, 3.6) |
NA |
| Age group, yrs | ||||||
| <19 | −1.0 (−1.5, −0.6)* | Q1 2022–Q4 2024 −1.0 (−1.5, −0.6)* |
NA | 2.6 (−0.8, 6.0) | Q1 2022–Q4 2024 2.6 (−0.8, 6) |
NA |
| 19–34 | −1.4 (−2.6, −0.4)* | Q1 2022–Q4 2024 −1.4 (−2.6, −0.4)* |
NA | 1.6 (−0.5, 3.7) | Q1 2022–Q4 2024 1.6 (−0.5, 3.7) |
NA |
| 35–54 | −1.2 (−2.2, −0.4)* | Q1 2022–Q4 2024 −1.2 (−2.2, −0.4)* |
NA | 1.6 (−0.6, 3.7) | Q1 2022–Q4 2024 1.6 (−0.6, 3.7) |
NA |
| ≥55 | −0.4 (−1.1, 0.3) | Q1 2022–Q4 2024 −0.4 (−1.1, 0.3) |
NA | −0.5 (−4.3, 3.4) | Q1 2022–Q4 2024 −0.5 (−4.3, 3.4) |
NA |
| Sex | ||||||
| Female | −0.5 (−1.4, 0.3) | Q1 2022–Q4 2024 −0.5 (−1.4, 0.3) |
NA | 0.8 (−2.4, 4.1) | Q1 2022–Q4 2024 0.8 (−2.4, 4.1) |
NA |
| Male | −1.2 (−2.1, −0.3)* | Q1 2022–Q4 2024 −1.2 (−2.1, −0.3)* |
NA | 1.1 (−1.5, 3.7) | Q1 2022–Q4 2024 1.1 (−1.5, 3.7) |
NA |
| Race and ethnicity | ||||||
| American Indian or Alaska Native | −1.5 (−2.7,-0.7)* | Q1 2022–Q3 2023 −3.1 (−8.2, −1.0)* |
Q3 2023–Q4 2024 0.4 (−3.0, −7.0) |
0.2 (−5.5, 5.9) | Q1 2022-Q3 2023 5.9 (0.8, 46.0)* |
Q3 2023-Q4 2024 −6.2 (−37.2, −0.2)* |
| Asian | −0.9 (−2.1, 0.1) | Q1 2022–Q4 2024 −0.9 (−2.1, 0.1) |
NA | −0.7 (−3.1, 1.6) | Q1 2022–Q4 2024 −0.7 (−3.1, 1.6) |
NA |
| Black or African American | −1.3 (−2.6, −0.1)* | Q1 2022–Q4 2024 −1.3 (−2.6, −0.1)* |
NA | 0.7 (−1.6, 3.1) | Q1 2022–Q4 2024 0.7 (−1.6, 3.1) |
NA |
| Hispanic or Latino | −1.0 (−2.0, −0.1)* | Q1 2022–Q4 2024 −1.0 (−2.0, −0.1)* |
NA | 1.3 (−1.4, 3.9) | Q1 2022–Q4 2024 1.3 (−1.4, 3.9) |
NA |
| Native Hawaiian or Other Pacific Islander | −0.9 (−2.2, 0.2) | Q1 2022–Q4 2024 −0.9 (−2.2, 0.2) |
NA | −2.2 (−9.5, 4.2) | Q1 2022–Q4 2024 −2.2 (−9.5, 4.2) |
NA |
| White | −0.5 (−1.3, 0.3) | Q1 2022–Q4 2024 −0.5 (−1.3, 0.3) |
NA | 0.2 (−2.5, 2.8) | Q1 2022–Q4 2024 0.2 (−2.5, 2.8) |
NA |
| Not Reported | −1.5 (−2.7, −0.5)* | Q1 2022–Q4 2024 −1.5 (−2.7, −0.5)* |
NA | 2.4 (−0.1, 4.9) | Q1 2022–Q4 2024 2.4 (−0.1, 4.9) |
NA |
| Census region¶ | ||||||
| Midwest | −1.2 (−2.5, 0.0) | Q1 2022–Q4 2024 −1.2 (−2.5, 0) |
NA | 1.3 (−2.8, 5.1) | Q1 2022–Q4 2024 1.3 (−2.8, 5.1) |
NA |
| Northeast | −1.5 (−3.1, 0.0)* | Q1 2022–Q4 2024 −1.5 (−3.1, 0.0)* |
NA | 1.2 (−2.6, 5.0) | Q1 2022–Q4 2024 1.2 (−2.6, 5) |
NA |
| South | −0.2 (−1.0, 0.5) | Q1 2022–Q4 2024 −0.2 (−1.0, 0.5) |
NA | −0.3 (−2.6, 1.7) | Q1 2022–Q4 2024 −0.3 (−2.6, 1.7) |
NA |
| West | −1.6 (−2.9, −0.6)* | Q1 2022–Q3 2023 −2.9 (−8.3, 3.6) |
Q3 2023–Q4 2024 −0.1 (−7.3, −6.4) |
1.6* (0.2, 3.0) | Q1 2022-Q3 2023 4.4 (2.7, 9.9)* |
Q3 2023-Q4 2024 1.6 (−8.2, 0.4) |
Abbreviations: NA = not applicable; Q1 = Quarter 1 (Jan–Mar); Q2= Quarter 2 (Apr–Jun); Q3= Quarter 3 (Jul–Sep); Q4= Quarter 4 (Oct–Dec).
Estimates of average quarterly percent change/quarterly percent change are statistically significant at p<0.05. Segment 1 and Segment 2 refer to trend periods identified by Joinpoint regression. When no joinpoints were identified, Segment 1 represents the full study period, Q1 2022–Q4 2024, and Segment 2 is shown as NA because no additional trend segment was detected.
Streets and highways also include other paved roads and modes of public transportation such as subways.
Data from biospatial by ImageTrend. Twenty-six states and the District of Columbia had at least one county or county equivalent that met the sufficient underlying event coverage threshold (75%) and were included in this analysis (see Supplemental Table 1):
For the second most common location—streets and highways—the proportion of non-fatal overdose EMS encounters did not change significantly over the study period, with an exception observed in the West region (Figure 2). The proportion in the West increased on average by 1.6% per quarter, with a significant increase noted during Q1 2022–Q3 2023 (QPC: 4.4%, 95% CI: 2.7, 9.9) (Table 2).
Figure 2.
Trends of proportion of non-fatal opioid-involved overdose emergency medical service (EMS) encounters in streets and highways* by age group (a), sex (b), race/ethnicity (c) and US Census Region (d).
* Data from biospatial by ImageTrend. Asian and Native Hawaiian or other Pacific Islander, non-Hispanic groups were combined for analysis. Streets and highways also include other paved roads and modes of public transportation such as subways. NH, Non-Hispanic.
DISCUSSION
Among 888 U.S. counties in 26 states and the District of Columbia, over half of all non-fatal opioid-involved overdose EMS encounters between 2022 and 2024 occurred at a private residence, which is consistent with patterns observed in fatal opioid and other drug overdoses in state and national analyses [3-4, 9-10]. These findings demonstrate the need to make opioid overdose reversal medications (OORM) like naloxone available in homes by offering naloxone to patients receiving opioids or medications for opioid use disorder or receiving care for an overdose, and to educate household members on overdose prevention and OORM use [11]. Additionally, findings from this study showed relatively stable trends in the proportion of non-fatal overdose EMS encounters occurring in private residences and streets and highways from January 2022 through December 2024. Private residences continued to account for the majority of non-fatal EMS overdose encounters, as seen in other national and state-based analyses [3-4, 12]. This finding is consistent with sociological data suggesting American adults spend an increasing amount of time in the home [13].
Overall, the second most common location of non-fatal overdoses was streets and highways. School/public administrative buildings also represented a notable proportion among persons <19 years of age, and healthcare facilities among persons ≥55 years of age. These findings highlight the importance of making OORMs and overdose response training widely accessible in both private and public settings. Some jurisdictions have begun expanding OORM availability in public settings, similar to automated external defibrillators (AEDs) for cardiac arrhythmias, increasing the potential for timely bystander intervention [14]. Appropriate first-aid training and increased education on Good Samaritan protections may also be needed. CDC’s Overdose Data to Action [15] funding empowers state and local communities to utilize EMS and other data sources to place these resources appropriately.
Our findings also reveal important temporal trends in non-fatal opioid overdoses that align with broader patterns observed in fatal overdose data. Notably, while non-fatal overdoses occurring in private residences have shown a decrease, those on streets and highways have remained stable. This suggests that targeted overdose prevention efforts may be necessary for populations that are less likely to have stable housing or who spend less time at home. Furthermore, data indicate that fatal overdose rates decreased between 2022 and 2023 for individuals aged 15–54, while rates increased for those aged 55 and older [16]. Our findings that non-fatal overdoses in the home did not decline among the older population, in contrast to other age groups, may provide insight into the challenges faced by this demographic. It is worth considering the impact of the COVID-19 pandemic on these trends. Work-from-home policies during the pandemic likely increased the time individuals spent at home in 2022, a pattern that may have reversed as many returned to in-person work and activities [13,17]. This shift could have influenced the risk of non-fatal overdoses in different settings, particularly for working-aged individuals compared to older adults who may have remained more homebound.
This is the first study looking at the location and trends of non-fatal opioid overdose-involved EMS encounters using multi-state data. EMS data enhances estimates of non-fatal overdose burden by capturing patients that may not present to the ED [1-2, 18]. EMS responders play a critical role in overdose response and prevention, both in reversing non-fatal overdoses and in performing screening and referral to treatment [19-22]. The use of EMS data demonstrates that they provide a timely, location-specific record of non-fatal overdoses which can help target resources.
Limitations
The findings in this report have several limitations. First, the data are a convenience sample where inclusion was limited to counties where a majority of their EMS data was captured by biospatial by ImageTrend; thus, findings may not be generalizable nationally. Second, this study included suspected opioid overdoses, as EMS records do not contain toxicological information confirming the involvement of specific substances. Next, it is not clear whether opioids were prescribed, which may be more common among some populations such as those ≥55. Lastly, EMS providers generally input encounter location information into a patient care record from a given set of options that are then mapped to ICD-10-CM place of occurrence codes by the vendor. These lists may not include all possible ICD-10-CM codes, which may lead to imprecise recording of encounter locations.
CONCLUSIONS
Distributing OORMs to individuals who may be present during an overdose in a home setting, as well as stationing OORMs in public spaces such as schools/public administrative buildings and healthcare facilities, may help mitigate overdose morbidity and mortality. Widely available training on overdose recognition and response, including OORM administration, could reduce overdose deaths. Offering linkage to care services, including during EMS encounters [22], for people at risk of overdose could further reduce the impact of future overdoses. Additional risk reduction efforts, such as increasing take-home testing and encouraging peer support, can be tailored to the settings where non-fatal opioid-involved overdoses are most common.
Supplementary Material
KEY MESSAGES.
What is already known on this topic:
Information on where non-fatal overdoses occur is limited. Emergency medical services (EMS) data are useful to monitor non-fatal opioid-involved overdose trends and provide information on location of overdose.
What this study adds:
Private residences (55.3%) were the most common location of non-fatal opioid-involved overdoses across all demographic groups, followed by streets and highways (19.5%). There were minor significant declines observed from January 2022 through September 2024 in private residences, but not in streets and highways.
How might this study affect research, practice, or policy:
Training potential bystanders on opioid overdose reversal medication (OORM) administration and increasing OORM availability in public and private locations may mitigate overdose morbidity and mortality; interventions can be tailored to the settings where non-fatal overdose is common.
Acknowledgments
The authors wish to acknowledge Snehaa D. Krishnan and Dr. R. Matthew Gladden, CDC, for their contribution to project development, and Dr. Fang Xu, CDC for helpful revisions to the manuscript draft. The authors also wish to thank jurisdictions sharing EMS data with biospatial by ImageTrend.
Funding:
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Footnotes
Competing Interests: Josh Walters reports that ImageTrend (biospatial) supports the CDC under contract #75D30124P18494, through which data, applications, and support services were provided in assistance of this manuscript. The rest of the authors have no competing interest.
Patient and Public Involvement: It was not appropriate or possible to involve patients or the public in the design, conduct, reporting, or dissemination plans of this research.
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