Spatial patterns of non-fatal overdose in relation to the built environment in Palm Beach County, Florida

Limited evidence describes how geographic context and the built environment relate to non-fatal overdose. We examined demographic and spatial patterns of non-fatal overdoses in Palm Beach County, Florida, including differences between indoor and outdoor events and proximity to built environment features.

Emergency department encounters for suspected non-fatal overdoses were obtained from Florida's Overdose Data to Action surveillance system for 2024. Multivariable logistic regression examined factors associated with outdoor overdose and proximity to gas stations. Spatial analyses assessed proximity to gas stations and major roadways and identified geographic clustering.

Among 1661 non-fatal overdose events, 39.6% occurred outdoors. Outdoor overdoses were more common among men, younger adults, uninsured individuals, and those identified as unstably housed, with housing status showing the strongest association. Overdoses involving stimulants and combined drug and alcohol use were also more likely to occur outdoors. In the gas-station proximity model, unstable housing was associated with more than fivefold higher odds of an overdose occurring within 0.25 miles of a gas station. Outdoor overdoses clustered in eastern PBC along major transportation corridors. Nearly 44% of outdoor overdoses occurred within 0.25 miles of a gas station and 33.6% within 0.25 miles of a major highway, proportions significantly higher than for indoor overdoses.

Non-fatal overdoses in PBC show distinct spatial patterns by setting. Outdoor overdoses were concentrated near transportation corridors and gas stations and are more commonly observed among individuals experiencing housing instability. Spatial surveillance may inform targeted overdose intervention, outreach, and linkage to treatment.