Spatial associations between alcohol detection in opioid overdose deaths and alcohol outlets

Alcohol enhances the depressant effect of opioids on the central nervous system, increasing overdose risk and mortality. The built environment influences substance use patterns and overdose risk. Little research has explored the impact of alcohol outlets on opioid overdose death.

We calculated the distance between the location of each fatal overdose event in Connecticut in 2019 and 2020 and the nearest alcohol outlet, similarly calculating the distance between each decedent's residence and the nearest alcohol outlet. We also calculated the density of alcohol outlets and number of ethanoldetected opioid overdose deaths in each census tract. We used regression models to determine how the spatial distribution of alcohol outlets at the individual and ecological levels related to ethanol detection in opioid overdose deaths. We conducted sensitivity analyses limiting our sample to off-premise alcohol outlets (e.g., package stores, supermarkets).

Ethanol was detected in one-third (33.6 %) of all opioid overdose deaths. Alcohol outlet proximity was associated with increased odds of ethanol detection in opioid overdose death; this association did not remain significant after controlling for age and sex. Alcohol outlet density was positively associated with the number ethanol-detected opioid overdose deaths at the census tract level even after controlling for social vulnerability. This association remained significant when analysis was limited to off-premise alcohol outlets.

These findings highlight the importance of incorporating alcohol outlets into overdose education and naloxone distribution efforts as well as the critical role of community investment.