{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T00:09:31Z","timestamp":1758931771018,"version":"3.44.0"},"reference-count":19,"publisher":"BMJ","issue":"5","funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"crossref","award":["6NU17CE924961","OD2A"],"award-info":[{"award-number":["6NU17CE924961","OD2A"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Data on fatal and non-fatal overdose provide important information about the magnitude of the overdose crisis. We consider these metrics in tandem and estimated the ratio of opioid overdose-related emergency department (ED) visits to opioid overdose deaths. A lower ratio could indicate more fatal overdoses, fewer overdose reversals with naloxone or a combination of both.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data are from the Maryland Vital Statistics Administration (opioid overdose deaths), the Health Services Cost Review Commission (non-fatal ED visits for opioid overdose). We generated 2020 annual rates of fatal and non-fatal opioid overdose deaths for the state of Maryland and its 24 jurisdictions and estimated the ratio of opioid overdose-related ED visits to deaths.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The 2020 visit-to-death ratio for Maryland was 1.7, and ranged from 0.9 to 3.8 across jurisdictions. We identified five counties that had above-median rates of opioid overdose-related ED visits and deaths, and low visit-to-death ratios.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Our findings indicate that there were nearly two ED visits for each opioid overdose death in Maryland, and there was substantial variation across counties. The visit-to-death ratio enables a better understanding of the relationship between fatal and non-fatal opioid overdose and is essential to averting deaths and evaluating overdose prevention efforts.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/ip-2023-045116","type":"journal-article","created":{"date-parts":[[2024,10,8]],"date-time":"2024-10-08T23:05:22Z","timestamp":1728428722000},"page":"408-411","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Ratio of emergency department visits to deaths for opioid overdose"],"prefix":"10.1136","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5621-8867","authenticated-orcid":false,"given":"Himani","family":"Byregowda","sequence":"first","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryoko","family":"Susukida","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Masoumeh","family":"Amin-Esmaeili","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Monique","family":"Wilson","sequence":"additional","affiliation":[{"name":"Vital Statistics Administration, Maryland Department of Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Stratton","sequence":"additional","affiliation":[{"name":"Public Health Services, Maryland Department of Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5083-8686","authenticated-orcid":false,"given":"Renee M","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,10,8]]},"reference":[{"key":"2025092606264660000_31.5.408.1","unstructured":"Centers for Disease Control and Prevention . DOSE dashboard: nonfatal overdose data. 2023. Available: https:\/\/www.cdc.gov\/drugoverdose\/nonfatal\/dashboard\/ [Accessed 11 Mar 2023]."},{"key":"2025092606264660000_31.5.408.2","unstructured":"Centers for Disease Control and Prevention . SUDORS dashboard: fatal overdose data. 2023. Available: https:\/\/www.cdc.gov\/drugoverdose\/fatal\/dashboard\/index.html [Accessed 2 Mar 2023]."},{"key":"2025092606264660000_31.5.408.3","doi-asserted-by":"crossref","first-page":"103435","DOI":"10.1016\/j.drugpo.2021.103435","article-title":"Targeting community-based naloxone distribution using opioid overdose death rates: A descriptive analysis of naloxone rescue kits and opioid overdose deaths in Massachusetts and Rhode Island","volume":"98","author":"Zang","year":"2021","journal-title":"Int J Drug Policy"},{"key":"2025092606264660000_31.5.408.4","first-page":"235","article-title":"Reducing Fatal Opioid Overdose: Prevention, Treatment and Harm Reduction Strategies","volume":"88","author":"Hawk","year":"2015","journal-title":"Yale J Biol Med"},{"key":"2025092606264660000_31.5.408.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.annepidem.2021.03.004"},{"key":"2025092606264660000_31.5.408.6","doi-asserted-by":"crossref","first-page":"101184","DOI":"10.1016\/j.pmedr.2020.101184","article-title":"Modeling dynamics of fatal opioid overdose by state and across time","volume":"20","author":"Lyle Cooper","year":"2020","journal-title":"Prev Med Rep"},{"key":"2025092606264660000_31.5.408.7","doi-asserted-by":"crossref","first-page":"2464","DOI":"10.1111\/add.15902","article-title":"Insights from biosurveillance: non-fatal opioid overdoses in Rhode Island 2019-21","volume":"117","author":"King","year":"2022","journal-title":"Addiction"},{"key":"2025092606264660000_31.5.408.8","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1111\/dar.12451","article-title":"Circumstances surrounding non-fatal opioid overdoses attended by ambulance services","volume":"36","author":"Madah-Amiri","year":"2017","journal-title":"Drug Alcohol Rev"},{"key":"2025092606264660000_31.5.408.9","doi-asserted-by":"crossref","first-page":"1169","DOI":"10.1046\/j.1360-0443.2003.00474.x","article-title":"The ratio of non-fatal to fatal heroin overdose","volume":"98","author":"Darke","year":"2003","journal-title":"Addiction"},{"key":"2025092606264660000_31.5.408.10","doi-asserted-by":"publisher","DOI":"10.1136\/ip-2023-045091"},{"key":"2025092606264660000_31.5.408.11","unstructured":"Centers for Disease Control and Prevention . Drug overdose mortality by state. 2022. Available: https:\/\/www.cdc.gov\/nchs\/pressroom\/sosmap\/drug_poisoning_mortality\/drug_poisoning.htm [Accessed 6 Mar 2023]."},{"key":"2025092606264660000_31.5.408.12","unstructured":"US Census Bureau . 2020 census results. Available: https:\/\/www.census.gov\/programs-surveys\/decennial-census\/decade\/2020\/2020-census-results.html [Accessed 13 Sep 2023]."},{"key":"2025092606264660000_31.5.408.13","unstructured":"Maryland Vital Statistics Administration . Annual 2020 drug intoxication report. Available: https:\/\/health.maryland.gov\/vsa\/Documents\/Overdose\/Annual_2020_Drug_Intox_Report.pdf"},{"key":"2025092606264660000_31.5.408.14","unstructured":"The Maryland Health Services Cost Review Commission . HSCRC policy documents. Available: https:\/\/hscrc.maryland.gov\/Pages\/pdr-annual-reports.aspx [accessed 3 Mar 2023]"},{"key":"2025092606264660000_31.5.408.15","unstructured":"Maryland.gov . Maryland department of health oper home. enterprise agency template. Available: https:\/\/health.maryland.gov\/oper\/Pages\/Home.aspx [Accessed 10 Apr 2024]."},{"key":"2025092606264660000_31.5.408.16","unstructured":"CRISP . About CRISP - improve outcomes and enhance the patient experience. Improve outcomes and enhance the patient experience. 2020. Available: https:\/\/www.crisphealth.org\/about-crisp\/ [Accessed 13 Sep 2023]."},{"key":"2025092606264660000_31.5.408.17","doi-asserted-by":"publisher","DOI":"10.1136\/ip.2005.011056"},{"key":"2025092606264660000_31.5.408.18","doi-asserted-by":"crossref","first-page":"100173","DOI":"10.1016\/j.dadr.2023.100173","article-title":"Disruptions to naloxone training among lay and occupational responders in Maryland during the emergence of COVID-19: Early impacts, recovery, and lessons learned","volume":"8","author":"Byregowda","year":"2023","journal-title":"Drug Alcohol Depend Rep"},{"key":"2025092606264660000_31.5.408.19","doi-asserted-by":"crossref","DOI":"10.1001\/jamahealthforum.2022.0093","article-title":"Trends in Engagement With Opioid Use Disorder Treatment Among Medicaid Beneficiaries During the COVID-19 Pandemic","volume":"3","author":"Tilhou","year":"2022","journal-title":"JAMA Health Forum"}],"container-title":["Injury Prevention"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/ip-2023-045116","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,26]],"date-time":"2025-09-26T13:26:59Z","timestamp":1758893219000},"score":1,"resource":{"primary":{"URL":"https:\/\/injuryprevention.bmj.com\/lookup\/doi\/10.1136\/ip-2023-045116"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,8]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2025,9,23]]},"published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1136\/ip-2023-045116"],"URL":"https:\/\/doi.org\/10.1136\/ip-2023-045116","relation":{},"ISSN":["1353-8047","1475-5785"],"issn-type":[{"type":"print","value":"1353-8047"},{"type":"electronic","value":"1475-5785"}],"subject":[],"published":{"date-parts":[[2024,10,8]]}}}