ArticleJournal of epidemiology and community health2020
Individual and county-level variation in outcomes following non-fatal opioid-involved overdose.
Article in Journal of epidemiology and community health, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 19 papers, 1 of them a synthesis that pooled it.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
19 citing papers in PubMed, 1 synthesis or guideline pooled it, 39 citations in OpenAlex.
- Neurocognitive impairments and brain abnormalities resulting from opioid-related overdoses: A systematic review.Drug and alcohol dependence · 2021Pooled it
- Recruiting a National Sample of First Response Agencies to Participate in an Overdose Prevention Research Project: Randomized Controlled Trial and Feasibility Study.JMIR formative research · 2026Trial
- Impact of enhanced practices on opioid overdose deaths: A community-based modeling approach.Addiction (Abingdon, England) · 2026Article
- Timely Receipt of New Medication Treatment After Acute Care Encounters for Opioid Overdose in the U.S. Medicaid Population.Journal of general internal medicine · 2026Article
- Non-fatal Overdose and Associated Factors Among People Who Use Opioids: Findings From a Cross-sectional Study.Journal of community health · 2025Article
- Multilevel Factors Associated With Hospitalizations in the First-Year Postpartum Among Persons With Opioid Use Disorder.Substance use & addiction journal · 2025Article
- People entering opioid substance use treatment have low rates of naloxone knowledge and possession.Drug and alcohol dependence · 2025Article
- Early detection and prediction of non-fatal drug-related incidents and fatal overdose outbreaks using the Farrington algorithm.Addiction (Abingdon, England) · 2025Article
- Addressing data gaps in opioid overdose reporting: enhancing systems to protect vulnerable older adults.Innovation in aging · 2025Article
- How emergency departments are responding to the opioid crisis: Results from a statewide survey in Kentucky.Addiction science & clinical practice · 2024Article
- The Feasibility of Using the National PulsePoint Cardiopulmonary Resuscitation Responder Network to Facilitate Overdose Education and Naloxone Distribution: Protocol for a Randomized Controlled Trial.JMIR research protocols · 2024Article
- Hippocampal volume loss in individuals with a history of non-fatal opioid overdose.Addiction biology · 2023Article
- Buprenorphine After Nonfatal Opioid Overdose: Reduced Mortality Risk in Medicare Disability Beneficiaries.American journal of preventive medicine · 2023Article
- Antecedents of fatal overdose in an adult cohort identified through administrative record linkage in Indiana, 2015-2022.Drug and alcohol dependence · 2023Article
- A pilot study investigating cognitive impairment associated with opioid overdose.Drug and alcohol dependence · 2023Article
- Gastroenterology Specialist Supply and Early-Onset Colorectal Cancer Incidence and Mortality in the U.S., 2014-2018.Gastro hep advances · 2023Article
- Beliefs and misperceptions about naloxone and overdose among U.S. laypersons: a cross-sectional study.BMC public health · 2022Article
- Gaps in naloxone ownership among people who inject drugs during the fentanyl wave of the opioid overdose epidemic in New York City, 2018.Substance abuse · 2022Article
- Population-Based Multilevel Models to Estimate the Management Strategies for Acute Myocardial Infarction in Older Adults with Dementia.Clinical epidemiology · 2021Article
Corrections and comments
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Authors and funding
3 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundA lack of large-scale, individually linked data often has impeded efforts to disentangle individual-level variability in outcomes from area-level variability in studies of many diseases and conditions. This study investigated individual and county-level variability in outcomes following non-fatal overdose in a state-wide cohort of opioid overdose patients.
methodsParticipants were 24 031 patients treated by emergency medical services or an emergency department for opioid-involved overdose in Indiana between 2014 and 2017. Outcomes included repeat non-fatal overdose, fatal overdose and death. County-level predictors included sociodemographic, socioeconomic and treatment availability indicators. Individual-level predictors included age, race, sex and repeat non-fatal opioid-involved overdose. Multilevel models examined outcomes following non-fatal overdose as a function of patient and county characteristics.
results10.9% (n=2612) of patients had a repeat non-fatal overdose, 2.4% (n=580) died of drug overdose and 9.2% (n=2217) died overall. Patients with a repeat overdose were over three times more likely to die of drug-related causes (OR=3.68, 99.9% CI 2.62 to 5.17, p<0.001). County-level effects were limited primarily to treatment availability indicators. Higher rates of buprenorphine treatment providers were associated with lower rates of mortality (OR=0.82, 95% CI 0.68 to 0.97, p=0.024), but the opposite trend was found for naltrexone treatment providers (OR=1.20, 95% CI 1.03 to 1.39, p=0.021). Cross-level interactions showed higher rates of Black deaths relative to White deaths in counties with high rates of naltrexone providers (OR=1.73, 95% CI 1.09 to 2.73, p=0.019).
conclusionAlthough patient-level differences account for most variability in opioid-related outcomes, treatment availability may contribute to county-level differences, necessitating multifaceted approaches for the treatment and prevention of opioid abuse.
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Registered trials
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