The changing epidemiology of opioid overdose in Baltimore, Maryland, 2012–2017: insights from emergency medical services

Abstract

Introduction An estimated 100,306 people died from an overdose from May 2020 to April 2021. Emergency Medical Services (EMS) are often the first responder to opioid overdose, and EMS encounter records can provide granular epidemiologic data on opioid overdose. This study describes the demographic, temporal, and geographic epidemiology of suspected opioid overdose in Baltimore City using data from Baltimore City Fire Department EMS encounters with the administration of the opioid antagonist naloxone. Method The present analyses used patient encounter data from 2012 to 2017 from the Baltimore City Fire Department, the city’s primary provider of EMS services. The analytic sample included patient encounters within the city that involved naloxone administration to patients 15 years of age or older ( n = 20,592). Negative binomial regression was used to calculate the incidence rates based on demographic characteristics, year, and census tract. Choropleth maps were used to show the geographic distribution of overdose incidence across census tracts in 2013, 2015, and 2017. Results From 2012 to 2017, the annual number of EMS encounters with naloxone administrations approximately doubled every 2 years, and the temporal pattern of naloxone administration was similar to the pattern of fatal opioid-related overdoses. For most census tracts, incidence rates significantly increased over time. Population-based incidence of naloxone administration varied significantly by socio-demographic characteristics. Males, non-whites, and those 25–69 years of age had the highest incidence rates. Conclusion The incidence of naloxone administration increased dramatically over the study period. Despite significant cross-sectional variation in incidence across demographically and geographically defined groups, there were significant proportional increases in incidence rates, consistent with fatal overdose rates over the period. This study demonstrated the value of EMS data for understanding the local epidemiology of opioid-related overdose. Key Messages Patterns of EMS encounters with naloxone administration appear to be an excellent proxy for patterns of opioid-related overdoses based on the consistency of fatal overdose rates over time. EMS plays a central role in preventing fatal opioid-related overdoses through the administration of naloxone, provision of other emergency services, and transportation to medical facilities. EMS encounters with naloxone administration could also be used to evaluate the impact of overdose prevention interventions and public health services.

Naloxone use by Aotearoa New Zealand emergency medical services, 2017–2021

“…Most attendances with naloxone administrations in our study were in homes and in high deprivation areas, and where the presenting complaint was unknown poisoning. With an even female/male split and a median age of 47 years, this patient cohort differed from younger and more male‐dominant cohorts described in Australia, 15 Norway, 19 Canada, 20 and the USA 18,21 . In our study, the proportion of patients who were administered naloxone and who were Māori was greater than their proportion of the general Aotearoa New Zealand population (23% vs .…”

“…6 patients/day in their state of 8 million people 17 . City of Baltimore EMS in the United States of America (USA) administered naloxone at a rate of 1100 per 100 000 person‐years in 2017, 18 or 115‐fold compared to the 2017 rate in our study.…”

Enhancing drug checking services for supply monitoring: perspectives on implementation in syringe service programs in the USA

“…For example, results can feed into “bad batch alerts” systems. The SOAR (Safety, Outreach, Autonomy, Respect) Initiative in Ohio has developed a mobile application, modeled after a text messaging service in Baltimore [ 44 , 45 ], that alerts PWUD when overdoses have surged and when fentanyl has been detected and reported in multiple batches in a particular geographic area. Feeding results into a data stream that is trusted and used by PWUD maximizes the utility of data.…”

Medical Opioid Disposal in Fukuoka and Kumamoto Cities

“…In the United States, various research reported opioid overuse and related accidents. [3][4][5] The rules on opioid disposal are different in across countries. The frequency of opioid related accidents may depend on the degree of strictness of the rules.…”