title: Urban overdose hotspots: a 12-month prospective study in Dublin ambulance services.
abstract: BACKGROUND
  Opioid overdose (OD) is the primary cause of death among drug users globally. Personal and social determinants of overdose have been studied before, but the environmental factors lacked research attention. Area deprivation or presence of addiction clinics may contribute to overdose.
  
  
  OBJECTIVE
  The objective of the study is to examine the baseline incidence of all new ODs in an ambulance service and their relationship with urban deprivation and presence of addiction services.
  
  
  METHODS
  A prospective chart review of prehospital advanced life support patients was performed on confirmed OD calls. Demographic, geographic, and clinical information, that is, presentation, treatment, and outcomes, was collected for each call. The census data were used to calculate deprivation. Geographical information software mapped the urban deprivation and addiction services against the overdose locations.
  
  
  RESULTS
  There were 469 overdoses, 13 of which were fatal; most were male (80%), of a young age (32 years), with a high rate of repeated overdoses (26%) and common polydrug use (9.6%). Most occurred in daytime (275) and on the streets (212). Overdoses were more likely in more affluent areas (r = .15; P < .05) and in a 1000-m radius of addiction services. Residential overdoses were in more deprived areas than street overdoses (mean difference, 7.8; t170 = 3.99; P < .001). Street overdoses were more common in the city center than suburbs (χ(2)(1) = 33.04; P < .001).
  
  
  CONCLUSIONS
  The identified clusters of increased incidence-urban overdose hotspots-suggest a link between environment characteristics and overdoses. This highlights a need to establish overdose education and naloxone distribution in the overdose hotspots.
authors.affiliation: Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland. Electronic address: jan.klimas@ucd.ie.
authors.forename: Jan
authors.initials: J
authors.lastname: Klimas
authors.affiliation: Dublin Fire Brigade, Dublin, Ireland.
authors.forename: Martin
authors.initials: M
authors.lastname: O'Reilly
authors.affiliation: Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Mairead
authors.initials: M
authors.lastname: Egan
authors.affiliation: Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Helen
authors.initials: H
authors.lastname: Tobin
authors.affiliation: Centre for Emergency Medical Science, School of Medicine and Medical Science, University College Dublin, Dublin, Ireland.
authors.forename: Gerard
authors.initials: G
authors.lastname: Bury
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data*; D000701:Analgesics, Opioid / Q000506:poisoning; D000928:Antidepressive Agents / Q000506:poisoning; D001569:Benzodiazepines / Q000506:poisoning; D002492:Central Nervous System Depressants / Q000506:poisoning; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D062787:Drug Overdose / Q000453:epidemiology* / Q000209:etiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D000431:Ethanol / Q000506:poisoning; D005260:Female; D040362:Geographic Information Systems; D062305:Geographic Mapping; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000534:rehabilitation; D011446:Prospective Studies; D017678:Sex Distribution; D016320:Substance Abuse Treatment Centers / Q000600:supply & distribution; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000534:rehabilitation; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D002492:Central Nervous System Depressants; D001569:Benzodiazepines; D000431:Ethanol