(56) The Epidemiology of Pre-Hospital Care for Opioid Overdoses in a US-Border Town

Introduction: Deaths linked to opioid overdose rose to record numbers during the COVID-19 pandemic, particularly among those of low socioeconomic status and those living in Western states. Refusal of hospital transport following pre-hospital naloxone administration has likewise expanded. Furthermore, illicit fentanyl seizures have increased exponentially along the US-Mexico border. It is unknown whether the rate of overdoses involving illicit fentanyl is driven by user choice or whether local availability and market dynamics are behind this trend. Understanding patterns of illicit fentanyl use is critical as additional doses of naloxone are often required to prevent respiratory depression and subsequent administration of buprenorphine can be more complicated in this population due to greater risk of precipitated withdrawal. Additionally, prior work has shown that police presence and the resultant threat of criminal charges deters patients from calling emergency services during overdoses. Over the past year, investigators sought to better characterize patients who received pre-hospital care for an overdose in a rural, primarily Spanish speaking, US-Mexico border town during the COVID-19 pandemic.


Methods: This was a cross-sectional, retrospective study with data collection between October 2020 and October 2021. Electronic patient care records from a US-Mexico Border town’s sole 911-response agency were queried for primary or secondary impression of overdose. Patient demographics and provider narrative were then queried, and analysis subsequently performed.


Results: The majority of patients who received prehospital care related to an opioid OD in this border town were men (83.33%), with median age of 26.5 years (range 17-61 years). More than half of overdoses occurred at a private residence (58.33%). Police presence was noted for most cases (75%), two of which occurred at the Port of Entry. Almost all (91.67%) received naloxone by family (12.12%), police (42.42%), and/or EMS (63.64%). Approximately one third of patients refused subsequent transport to the ED and illicit fentanyl was the most frequently reported substance in this population (69.44%).


Conclusion: This was the first epidemiological study of pre-hospital care for overdoses in a US-Mexico border town in Arizona. Notably, data was collected during the COVID19 pandemic, a time during which overdoses were on the rise. This data suggests overdoses along the US-Mexico border are composed primarily of young men, occur at private residences, involve illicit fentanyl or M30s, and have police presence. Previous reports suggest patient’s fear police involvement due to associated risks of criminal charges, demonstrating the complexity of law enforcement presence at overdose calls. These trends, coupled with patient’s refusal of transport to the ED, point to the critical importance of pre-hospital distribution of naloxone kits in this setting to complement distribution by emergency department staff. With the rise of illicit fentanyl and the frequent need for repeated naloxone dosing in these cases, barriers to care must be addressed, including whether police should be routinely dispatched to overdose calls.

References: Han, Ying, et al. "The rising crisis of illicit fentanyl use, overdose, and potential therapeutic strategies." Translational psychiatry 9.1 (2019): 1-9.

Niles, Justin K., et al. "The opioid epidemic within the COVID-19 pandemic: drug testing in 2020." Population Health Management 24.S1 (2021): S-43.

Shover, Chelsea L., et al. "Steep increases in fentanyl-related mortality west of the Mississippi River: recent evidence from county and state surveillance." Drug and alcohol dependence 216 (2020): 108314.

Kuehn, Bridget M. "Accelerated overdose deaths linked with COVID-19." JAMA 325.6 (2021): 523-523.

van der Meulen, Emily, Sandra Ka Hon Chu, and Janet Butler-McPhee. "“That's why people don't call 911 ″: Ending routine police attendance at drug overdoses." International Journal of Drug Policy 88 (2021): 103039.

Diversity, Equity, and Inclusion: DEI Statement: Drug overdose is the leading cause of unintentional death in the United States and individuals identifying as BIPOC and those of low socioeconomic status are overrepresented in this statistic. Our study population is unique as it is primarily Spanish-speaking, rural, and located along the US-Mexico border. We sought to characterize the population experiencing opioid overdoses to better understand the needs of this population and where best to target interventions such as naloxone distribution to maximize efficacy and minimize mortality.