Table 2. Circumstances Surrounding and Scene Evidence Identified in Overdose Deaths by Buprenorphine and Other Opioid Involvement in 42 Jurisdictions From July 2019 to June 2021^a.

Circumstances	Overdose deaths, No. (%) [95% CI]
	Buprenorphine-involved (n = 1901)	Other opioid–involved (n = 75 882)b
Evidence of overdose circumstancesc
Overdosed at home	1259 (72.0) [69.8-74.1]	45 719 (65.2) [64.9-65.6]
Fatal drug use witnessed	134 (7.0) [5.9-8.3]	6632 (8.7) [8.5-8.9]
Potential bystander presentd	858 (45.1) [42.9-47.4]	35 301 (46.5) [46.2-46.9]
Naloxone administered	436 (23.1) [21.2-25.0]	16 139 (21.4) [21.1-21.7]
Documentation of no pulse at first responder arrival	1158 (62.2) [60.0-64.4]	42 005 (56.3) [55.9-56.7]
Seen in emergency department	338 (18.0) [16.3-19.8]	15 408 (20.5) [20.2-20.8]
Scene evidence
Route of drug usee,f
Injection	517 (27.2) [25.2-29.3]	18 511 (24.4) [24.1-24.7]
Smoking	186 (9.8) [8.5-11.2]	10 733 (14.1) [13.9-14.4]
Snorting	181 (9.5) [8.2-10.9]	11 521 (15.2) [14.9-15.4]
Ingestion	271 (14.3) [12.7-15.9]	11 304 (14.9) [14.6-15.2]
Otherg	53 (2.8) [2.1-3.6]	369 (0.5) [0.4-0.5]
No reported route of drug use	978 (51.4) [49.2-53.7]	36 198 (47.7) [47.4-48.1]
Evidence of drugs on scenef
Prescription drugs	560 (29.5) [27.4-31.6]	18 184 (24.0) [23.7-24.3]
Illicit drugs	540 (28.4) [26.4-30.5]	29 234 (38.5) [38.2-38.9]
Evidence of history of drug use and treatment
History of opioid use	882 (46.4) [44.1-48.7]	32 088 (42.3) [41.9-42.6]
Recent return to use of opioidsc	180 (9.5) [8.2-10.9]	5894 (7.8) [7.6-8.0]
Prior overdose in the past yearc	107 (5.6) [4.6-6.8]	4782 (6.3) [6.1-6.5]
Current treatment for substance use disordersc,f,h
Any	428 (22.5) [20.7-24.5]	4482 (5.9) [5.7-6.1]
Rehabilitation	32 (1.7) [1.2-2.4]	1488 (2.0) [1.9-2.1]
Medications for opioid use disorder	384 (20.2) [18.4-22.1]	2421 (3.2) [3.1-3.3]
Cognitive/behavioral therapy	24 (1.3) [0.8-1.9]	200 (0.3) [0.2-0.3]
Narcotics anonymous	3 (0.2) [0.03-0.5]	104 (0.1) [0.1-0.2]
Othere	20 (1.1) [0.6-1.6]	610 (0.8) [0.7-0.9]
Current treatment for painc,h	166 (8.7) [7.5-10.1]	6261 (8.3) [8.1-8.5]
Evidence of other circumstancesc
Recent release from institutional setting	131 (7.0) [5.9-8.3]	6795 (9.1) [8.9-9.3]
Experiencing homelessness or housing instabilityi	107 (5.7) [4.7-6.9]	5029 (6.7) [6.5-6.9]
Mental health diagnosis	584 (30.7) [28.7-32.9]	17 395 (22.9) [22.6-23.2]
Current mental health treatmentj	596 (31.4) [29.3-33.5]	10 121 (13.3) [13.1-13.6]

^a A list of jurisdictions is presented in eTable 1 in Supplement 1.

^b Includes opioid-involved overdose deaths that did not involve buprenorphine. Thus, the buprenorphine-involved and other opioid–involved categories are mutually exclusive.

^c Missing values were excluded from calculations of percentages.

^d A potential bystander is defined as a person 11 years or older who was physically nearby either during or shortly preceding a drug overdose and potentially had an opportunity to intervene or respond to the overdose. This includes persons in the same structure (eg, same room or same building but different room) as the decedent during that time. This does not include persons in different self-contained parts of larger buildings (eg, a person in a different apartment in the same apartment building).

^e Route of drug use cannot be directly linked to specific drugs if more than 1 drug was detected and more than 1 route was reported.

^f Categories are not mutually exclusive.

^g Includes transdermal, suppository, sublingual, and buccal.

^h Current treatment is defined as being treated at the time of the fatal overdose.

ⁱ Persons experiencing homelessness were those who resided in places not designed for or ordinarily used as regular sleeping accommodations or in a supervised shelter or drop-in center designated to provide temporary living arrangements. Persons experiencing housing instability were those who lack resources to obtain or retain permanent housing and includes interrelated challenges (eg, trouble paying rent, overcrowding, moving frequently, or staying with relatives).

^j Current mental health treatment includes treatment for both mental health and substance use disorders at the time of the fatal overdose.