Nonfatal Overdose Biosurveillance: A Cross-Sectional Pilot Study

Nonfatal overdoses provide critical insights into the substance use crisis, offering opportunities for timely interventions and prevention. This study pilots a nonfatal overdose biosurveillance strategy to analyze the demographic, clinical, and toxicological profiles of overdose patients, aiming to identify patterns and risk factors associated with these incidents.

We assessed residual urine specimens collected from emergency department patients experiencing a nonfatal overdose at 2 hospitals in Wisconsin from August 2022 through February 2024. We collected data on patient demographic characteristics, results of clinical toxicology screening, manner of overdose, risk factors for overdose, and discharge status. Statistical analyses identified associations and odds ratios (ORs) among patient characteristics, detected drugs, and discharge status.

Of the 79 patients in the study, many had risk factors for overdose, including substance use disorder (48%), history of a mental health condition (43%), and polysubstance use (72%). Synthetic opioids had a strong positive association with a history of overdose (OR = 3.86). The presence of stimulants and antidepressants showed moderate sex-based associations, while race was linked to differing discharge status. Polysubstance use had a positive association with some drug combinations, such as narcotic analgesics and cocaine (OR = 4.00).

This study highlights the prevalence of polysubstance use and identifies key demographic and clinical factors associated with nonfatal overdoses. These findings underscore the need for comprehensive, real-time biosurveillance to inform targeted public health interventions and improve patient outcomes. Enhanced understanding of these patterns can lead to more effective strategies for overdose prevention and management, addressing a critical gap in current public health approaches.