Abstract Given substantial reporting delays in overdose deaths, state health departments increasingly use non-fatal overdose data to inform geographically targeted rapid overdose response efforts. We sought to evaluate the extent to which non-fatal overdose events were associated with concurrent and future overdose deaths in Rhode Island. We aggregated non-fatal overdose data from emergency medical services records (2019–2023) and fatal overdose data from the State Unintentional Drug Overdose Reporting System (2020–2023) in 1-, 3-, and 6-month intervals at census block group and census tract levels. Rates of fatal overdose were estimated, relative to non-fatal overdose lagged by 0–12 months, using negative binomial regression, and relative to monthly spikes in non-fatal overdose burden, using zero-inflated Poisson regression. Estimation was implemented using integrated nested Laplace approximation. Each additional non-fatal overdose event per census block group was associated with fatal overdose rates that were 48% higher (95% credible interval: 1.37–1.59) than expected in concurrent months, with smaller associations at the census tract level, in wider time intervals, and when non-fatal overdose data were lagged. Spikes in non-fatal overdose activity were associated with elevated overdose mortality in concurrent periods with fine temporal and geographic granularity, but not in larger time frames and geographic areas.
Skinner et al. (Mon,) studied this question.