Trends in recurrent overdose and treatment initiation following emergency department visits for opioid overdose between 2016 and 2021

Background: Overdose remains a pressing public health concern in the United States, particularly with the emergence of fentanyl and other potent synthetic opioids in the drug supply. We evaluated trends in recurrent overdose and opioid use disorder (OUD) treatment initiation following emergency department (ED) visits for opioid overdose to inform response efforts. Methods: This retrospective cohort study used electronic health record and statewide administrative data from Rhode Island residents who visited EDs for opioid overdose between July 1, 2016, and June 30, 2021, a period with fentanyl predominance in the local drug supply. The primary outcome was recurrent overdose in the 365 days following the initial ED visit. OUD treatment initiation within 180 days following the initial ED visit was considered as a secondary outcome. Trends in study outcomes were summarized by year of the initial ED visit. Results: Among 1745 patients attending EDs for opioid overdose, 20 % (n =352) experienced a recurrent overdose within 365 days, and this percentage was similar by year (p =0.12). Among patients who experienced any recurrent overdose, the median time to first recurrent overdose was 88 days (interquartile range =23 -208), with 85 % (n =299/352) being non-fatal. Among patients not engaged in OUD treatment at their initial ED visit, 33 % (n =448/1370) initiated treatment within 180 days; this was similar by year (p =0.98). Conclusions: Following ED visits for opioid overdose in Rhode Island from 2016 -2021, the one-year risk of recurrent overdose and six-month treatment initiation rate remained stable over time. Innovative prevention strategies and improved treatment access are needed.