Overdose as a complex contagion: modelling the community spread of overdose events following law enforcement efforts to disrupt the drug market.
Journal of Epidemiology and Community Health · 2024-10-11 · Observational study
Abstract
BACKGROUND: The opioid overdose mortality crisis in the USA is an ongoing public health epidemic. Ongoing law enforcement strategies to disrupt local unregulated drug markets can have an iatrogenic effect of increasing overdose by driving consumers towards new suppliers with unpredictable drug products of unknown potency. METHODS: Cross-sectional study using point-level information on law enforcement opioid-related drug seizures from property room data, opioid-related non-fatal overdose events from emergency medical services and block group-level social determinants of health data from multiple sources. Using an endemic-epidemic spatiotemporal regression model, we estimated the degree to which exposure to drug supply disruptions triggers future overdose events within small space-time distances in Indianapolis, Indiana. RESULTS: Neighbourhoods with more structural racism, economic deprivation or urban blight were associated with higher rates of non-fatal overdose. Exposure to an opioid-related drug seizure event had a significant and positive effect on the epidemic probability of non-fatal overdose. An opioid seizure that occurred within 250 m and 3 days, 250 m and 7 days, and 250 m and 14 days of an overdose event increased the risk of a new non-fatal overdose by 2.62 (rate ratio (RR)=2.62, 95% CI 1.87 to 3.67), 2.17 (RR=2.17, 95% CI 1.87 to 2.59) and 1.83 (RR=1.83, 95% CI 1.66 to 2.02), respectively. Similar spatiotemporal patterns were observed in a smaller spatial bandwidth. CONCLUSIONS: Results demonstrated that overdoses exhibit a community spread process, which is exacerbated following law enforcement strategies to disrupt the unregulated drug market. We discuss decriminalisation and increasing resources that promote safer drug use to combat this public health crisis.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Equity & disparities · Poisoning & substance use · Urban
Related articles
- Racial differences in overdose events and polydrug detection in Indianapolis, Indiana. (Drug Alcohol Depend, 2020)
- Patient-Level and County-Level Trends in Nonfatal Opioid-Involved Overdose Emergency Medical Services Encounters - 491 Counties, United States, January 2018-March 2022. (MMWR Morb Mortal Wkly Rep, 2022)
- Suspected heroin-related overdoses incidents in Cincinnati, Ohio: A spatiotemporal analysis. (PLoS Med, 2019)
- Disparity in naloxone administration by emergency medical service providers and the burden of drug overdose in US rural communities. (Am J Public Health, 2015)
- "All You Can Do is What You Know to Do": Naloxone Knowledge and Uncertainty Among People Who Use Drugs in Maryland amid a Volatile Drug Market. (Subst Use Misuse, 2025)
- Trends in Suspected Opioid Drug Overdose Events in Emergency Medical Service Encounters in South Carolina, 2019-2022. (Public Health Rep, 2024)