Top 5 Takeaways

  1. Increasing Trend of Nonfatal Opioid Overdoses: The rate of nonfatal opioid-involved overdose EMS encounters rose on average by 4.0% quarterly from 98.1 to 179.1 per 10,000 EMS encounters during the study period.
  2. Diverse Demographic Impact: Significant increases were observed across most sociodemographic groups, with the highest rates among non-Hispanic White and Native Hawaiian or other Pacific Islander persons. Non-Hispanic Black and Hispanic or Latino persons experienced the largest increases.
  3. Urban and Rural Disparities: Both urban and rural counties saw increases in overdose rates, with the highest rates and largest increases in urban areas and counties with higher unemployment rates.
  4. Importance of EMS Data: EMS data provide a near real-time view of overdose trends, aiding in identifying disproportionately affected communities and guiding equitable response and prevention efforts.
  5. Public Health Implications: The findings underscore the need for focused outreach, harm reduction services, and linkage to care and treatment, especially in communities with higher levels of unemployment and among racial and ethnic minority groups.

Original Article Author and Citation

Corresponding Author

Shannon M. Casillas,

Suggested Citation

Casillas SM, Pickens CM, Stokes EK, Walters J, Vivolo-Kantor A. 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;71:1073–1080. DOI:


The study analyzed EMS encounter data for nonfatal opioid-involved overdoses across 491 counties in 21 states from January 2018 to March 2022. It found a significant quarterly increase in overdose rates, highlighting the growing impact of opioid misuse across various demographic and county-level characteristics.


Utilizing data from biospatial, Inc., the study applied CSTE standard guidance for querying EMS data to identify suspected nonfatal opioid-involved overdose encounters. Trends were analyzed by patient characteristics, incident disposition, and county-level characteristics using joinpoint regression.


The study emphasizes the utility of EMS data in monitoring nonfatal opioid overdoses, revealing significant increases across most sociodemographic and county-level characteristics. It also highlights the need for addressing disparities that contribute to overdose risk, especially in minority populations and communities with higher unemployment rates.


Monitoring EMS data for nonfatal opioid overdoses can identify communities at disproportionate risk, guiding targeted public health responses. The study calls for increased access to harm reduction services and treatment, especially in areas with high unemployment and among racial and ethnic minority groups.

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