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Prevalence of Nonfatal Opioid Overdoses and Interactions With the Health Care System Prior to Death Among Opioid Overdose Decedents, Rhode Island, 2023

Year: 2026
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: Most people who experience a fatal opioid overdose have never received medical care for a prior nonfatal overdose. Because minimal health care interaction could limit the effect of postoverdose interventions on preventing overdose fatalities, we evaluated the percentage of opioid overdose decedents who experienced a nonfatal opioid overdose prior to death. METHODS: We identified accidental fatal opioid overdoses that occurred in Rhode Island in 2023. To identify prior nonfatal opioid overdoses and prior health care use, we used emergency medical services (EMS) run data from 2016-2023 and emergency department (ED) discharge data from October 1, 2020, through December 31, 2023. Each date range represents the earliest date for which identifiable data were available. We excluded from analysis health care interactions that occurred within 1 day of the date of death. RESULTS: In 2023, a total of 318 Rhode Island residents who met inclusion criteria died of an opioid overdose. In the 6 months, 1 year, 2 years, 3 years, and 5 years before death, 12.3%, 16.4%, 22.6%, 26.7%, and 29.2% of decedents, respectively, had a prior nonfatal opioid overdose. The likelihood of having a prior nonfatal opioid overdose did not vary by age group, sex, race and ethnicity, or county of residence. The proportion of decedents who had at least 1 interaction with EMS or ED services increased from 45.9% at 6 months to 58.5% at 1 year, 67.0% at 2 years, 72.3% at 3 years, and 75.8% at 5 years before death. CONCLUSION: Our findings have important implications for overdose prevention efforts focused on connecting people experiencing nonfatal opioid overdoses to care, as these efforts would miss up to 71% of overdose decedents.
DOI: 10.1177/00333549261418591
Language: English
Field: Medicine
Open Access status: green
Award: RHODE ISLAND OVERDOSE DATA TO ACTION - THE RHODE ISLAND OVERDOSE DATA TO ACTION PROJECT WILL UTILIZE A MULTISECTOR, INTERDISCIPLINARY, AND COMPREHENSIVE PUBLIC HEALTH APPROACH TO RESPOND TO THE OVERDOSE (OD) EPIDEMIC IN RHODE ISLAND. THE INTEGRATED PREVENTION AND SURVEILLANCE TEAM WILL ENSURE THAT STRATEGIES REMAIN RESPONSIVE TO EMERGING TRENDS AND ELIMINATE HEALTH DISPARITIES FOR GROUPS DISPROPORTIONALLY IMPACTED BY THE OVERDOSE EPIDEMIC. BUILDING ON PREVIOUS WORK AND PARTNERSHIPS, THE RHODE ISLAND DEPARTMENT OF HEALTH (RIDOH) WILL IMPLEMENT NINE EVIDENCE-BASED STRATEGIES: 1) INCREASE ACCESS TO TIMELY DATA ON NONFATAL AND FATAL OVERDOSES; 2) REPORT TIMELY EMERGENCY DEPARTMENT (ED) AND HOSPITAL ADMISSION DATA FOR SUSPECTED OVERDOSES; 3) COLLECT AND DISSEMINATE ALL UNDETERMINED AND UNINTENTIONAL DRUG OVERDOSE DEATHS USING DEATH CERTIFICATES, MEDICAL EXAMINER, AND TOXICOLOGY DATA; 4) TRACK SUBSTANCES PRESENT AT THE TIME OF OVERDOSE; 5) LINK STATEWIDE DATASETS TO IDENTIFY RISK AND PROTECTIVE FACTORS FOR OVERDOSE; 6) EDUCATE CLINICIANS ON BEST PRACTICES FOR PRESCRIBING AND SCREENING FOR SUBSTANCE USE DISORDER, BUILD SYSTEM-WIDE CLINICAL CAPACITY TO SUPPORT TRAUMA-INFORMED CARE, AND ENHANCE THE PDMP’S DATA SHARING CAPACITY; 7) LEVERAGE PARTNERSHIPS WITH PUBLIC SAFETY AND DEVELOP AND IMPLEMENT THE LEVELS OF RESPONSE INITIATIVE; 8) EXPAND HARM REDUCTION SERVICES USING PEER NAVIGATORS; AND 9) IMPROVE LINKAGE TO CARE SERVICES IN RHODE ISLAND. RIDOH WILL USE ROBUST DATA AND SURVEILLANCE SYSTEMS TO RAPIDLY RESPOND TO THE INCREASINGLY COMPLEX NATURE OF THE EPIDEMIC AND WILL EVALUATE THE EFFECTIVENESS OF STRATEGIES TO IMPROVE THE EVIDENCE BASE FOR OVERDOSE PREVENTION. RIDOH EXPECTS TO ACHIEVE THE FOLLOWING SHORT-TERM AND INTERMEDIATE OUTCOMES: INCREASED 1) TIMELY AND ACTIONABLE SURVEILLANCE DATA TO IMPROVE PREVENTION AND RESPONSE EFFORTS, 2) DATA DISSEMINATION AND DATA SHARING, 3) CLINICIAN AWARENESS OF BEST PRACTICES AROUND PAIN MANAGEMENT, CAPACITY TO PROVIDE OUD AND STUD CARE, AND AWARENESS OF THEIR OWN PRESCRIBING PRACTICES, 4) COLLABORATION, COMMUNICATION, AND COORDINATION AMONG PARTNERS, 5) USE OF NAVIGATORS TO AID INDIVIDUALS IN LINKAGE TO CARE AND SERVICES, 6) EQUITABLE ACCESS TO HARM REDUCTION EDUCATION AND SERVICES, DECREASED 7) HIGH RISK PRESCRIBING PRACTICES, AND 8) HEALTH DISPARITIES SURROUNDING OUD AND STUD TREATMENT AND PAIN MANAGEMENT (FOR ADDITIONAL DETAIL, PLEASE SEE ATTACHED EVALUATION AND PERFORMANCE MEASUREMENT PLAN). LONG TERM OUTCOMES INCLUDE DECREASED 1) FATAL DRUG OVERDOSES, 2) NON-FATAL DRUG OVERDOSES, 3) ILLICIT OPIOID AND STIMULANT USE INCLUDING POLYSUBSTANCE USE, 4) STIGMA AROUND SUBSTANCE USE AND OVERDOSE; AS WELL AS INCREASED 5) UPTAKE OF EVIDENCED BASED TREATMENT AND LONG-TERM RECOVERY SUPPORTS, AND 6) HEALTH EQUITY AMONG POPULATIONS DISPROPORTIONALLY AFFECTED BY THE OVERDOSE EPIDEMIC.
OpenAlex ID: W7130974117
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