Locations of emergency medical services attended non-fatal opioid-involved overdoses, 888 counties, USA, 2022-2024

Emergency medical service (EMS) encounters for non-fatal opioid overdose in the USA increased from 2018 to 2022, and persons treated for an overdose by EMS increasingly refuse EMS transport to emergency departments after an overdose. Understanding where non-fatal overdoses occur can inform overdose prevention and response efforts.

EMS data from biospatial by ImageTrend were queried from 888 counties reporting consistently during January 2022 to December 2024, representing approximately 30.6% of the US population. Frequencies and proportions of non-fatal opioid-involved overdose (hereafter, 'non-fatal overdose') EMS encounters were calculated by location, sex, race and ethnicity, age group and US Census Bureau region. Quarterly trends in proportions were also examined.

Private residences (55.3%) were the most common location of non-fatal overdoses, followed by streets and highways (19.5%), across all demographic groups. Non-fatal overdose encounters were also common in schools and public administrative buildings among persons aged < 19 years, and in healthcare facilities among persons ≥ 55 years. Minor declines (average quarterly percent change (AQPC): -0.9) were observed from January 2022 through September 2024 in private residences but not in streets and highways.

Tailoring risk reduction efforts, such as training potential bystanders on opioid overdose reversal medication (OORM) administration and increasing OORM availability in public and private locations, to settings where non-fatal overdose is most common may help reduce overdose morbidity and mortality.