Prevalence of Nonfatal Opioid Overdoses and Interactions With the Health Care System Prior to Death Among Opioid...

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.

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.

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.

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.