The changing epidemiology of opioid overdose in Baltimore, Maryland, 2012–2017: insights from emergency medical services

Figures & data

Figure 1. Flowchart of the breakdown of incidents included/excluded.

Figure 2. The number of EMS-related non-fatal naloxone administrations per month and number of fatal opioid-related overdoses per year within Baltimore City.

Table 1. Demographics distribution and percentages of EMS encounters with naloxone administration within Baltimore City for patients age 15 or older from 2012 to 2017.

	2012		2013		2014		2015		2016		2017		Total
	N	(%)	N	(%)	N	(%)	N	(%)	N	(%)	N	(%)	N	(%)
Total	1,546	(7.51)	1,799	(8.74)	2,267	(11.01)	2,953	(14.34)	5,519	(26.80)	6,508	(31.60)	20,592	(100.00)
Sex
Female	484	(31.31)	613	(34.07)	691	(30.48)	900	(30.48)	1,486	(26.93)	1,665	(25.58)	5,839	(28.36)
Male	1,035	(66.95)	1,123	(62.42)	1,561	(68.86)	2,034	(68.88)	3,936	(71.32)	4,660	(71.60)	14,349	(69.68)
Missing	27	(1.75)	63	(3.50)	15	(0.66)	19	(0.64)	97	(1.76)	183	(2.81)	404	(1.96)
Race
White	391	(25.29)	513	(28.52)	600	(26.47)	773	(26.18)	1,386	(25.11)	1,570	(24.12)	5,233	(25.41)
African American	615	(39.78)	829	(46.08)	1,089	(48.04)	1,548	(52.42)	3,113	(56.41)	3,631	(55.79)	10,825	(52.57)
Other	41	(2.65)	38	(2.11)	53	(2.34)	81	(2.74)	134	(2.43)	185	(2.84)	532	(2.58)
Missing	499	(32.28)	419	(23.29)	525	(23.16)	551	(18.66)	886	(16.05)	1,122	(17.24)	4,002	(19.43)
Age
15–19	26	(1.68)	27	(1.50)	21	(0.93)	28	(0.95)	34	(0.62)	26	(0.40)	162	(0.79)
20–24	79	(5.11)	87	(4.84)	107	(4.72)	132	(4.47)	237	(4.29)	239	(3.67)	881	(4.28)
25–29	110	(7.12)	136	(7.56)	171	(7.54)	235	(7.96)	404	(7.32)	508	(7.81)	1,564	(7.60)
30–34	99	(6.40)	155	(8.62)	165	(7.28)	214	(7.25)	409	(7.41)	525	(8.07)	1,567	(7.61)
35–39	83	(5.37)	122	(6.78)	157	(6.93)	231	(7.82)	386	(6.99)	454	(6.98)	1,433	(6.96)
40–44	145	(9.38)	172	(9.56)	227	(10.01)	253	(8.57)	407	(7.37)	448	(6.88)	1,652	(8.02)
45–49	193	(12.48)	229	(12.73)	294	(12.97)	407	(13.78)	742	(13.44)	812	(12.48)	2,677	(13.00)
50–54	230	(14.88)	298	(16.56)	375	(16.54)	492	(16.66)	870	(15.76)	1,048	(16.10)	3,313	(16.09)
55–59	164	(10.61)	222	(12.34)	293	(12.92)	395	(13.38)	901	(16.33)	1,001	(15.38)	2,976	(14.45)
60–64	105	(6.79)	133	(7.39)	192	(8.47)	221	(7.48)	458	(8.30)	554	(8.51)	1,663	(8.08)
65–69	51	(3.30)	62	(3.45)	79	(3.48)	124	(4.20)	266	(4.82)	315	(4.84)	897	(4.36)
70–74	18	(1.16)	28	(1.56)	57	(2.51)	67	(2.27)	96	(1.74)	109	(1.67)	375	(1.82)
75–79	10	(0.65)	18	(1.00)	49	(2.16)	30	(1.02)	64	(1.16)	63	(0.97)	234	(1.14)
80–84	12	(0.78)	22	(1.22)	13	(0.57)	34	(1.15)	37	(0.67)	45	(0.69)	163	(0.79)
85 or older	16	(1.03)	21	(1.17)	35	(1.54)	42	(1.42)	42	(0.76)	39	(0.60)	195	(0.95)
Missing	205	(13.26)	67	(3.72)	32	(1.41)	48	(1.63)	166	(3.01)	322	(4.95)	840	(4.08)

Figure 3. The incidence rate of EMS encounters with naloxone administration in Baltimore City by census tract, 2013, 2015 and 2017. EMS encounters among 15 years of age or older. Year-specific population estimates from Census tract [20].

Figure 4. Incidence rates of EMS encounters with naloxone administration by sex, Baltimore City, 2012–2017. EMS encounters among 15 years of age or older. Year-specific population estimates from US Census [20].

Table 2. Incidence rate (IR) of naloxone administration per 1,000 person-years and incidence rate ratios (IRR) for 2015 vs. 2013 and 2017 vs. 2015 by demographic characteristics.

	2013		2015		2017		2015 vs. 2013		2017 vs. 2015
	IR	(95% CI)	IR	(95% CI)	IR	(95% CI)	IRR	(95% CI)	IRR	(95% CI)
Total	3.2	(1.2, 8.1)	5.4	(2.1, 13.9)	11	(4.3, 28.3)	1.6	(1.6, 1.7)	2.2	(2.1, 2.3)
Sex
Female	2.2	(2.1, 2.4)	3.3	(3.1, 3.5)	6.1	(5.8, 6.4)	1.5	(1.3, 1.6)	1.8	(1.7, 2.0)
Male	4.8	(4.5, 5.0)	8.6	(8.3, 9.0)	19.7	(19.2, 20.3)	1.8	(1.7, 2.0)	2.3	(2.2, 2.4)
	χ^2 (1)=226.4, p < .001		χ^2 (1)=226.4, p < .001		χ^2 (1)=1713.2, p < .001		χ^2 (1)=10.3, p = .001		χ^2 (1)=20.2, p < .001
Race/ethnicity
White	3.4	(3.1, 3.7)	5.1	(4.7, 5.4)	10.3	(9.8, 10.8)	1.5	(1.3, 1.7)	2.0	(1.9, 2.2)
African American	2.6	(2.5, 2.8)	5.0	(4.7, 5.2)	11.6	(11.2, 12.0)	1.9	(1.7, 2.0)	2.3	(2.2, 2.5)
Other	0.9	(0.6, 1.2)	1.8	(1.5, 2.3)	4.2	(3.6, 4.8)	2.1	(1.4, 3.1)	2.3	(1.8, 3.0)
	χ^2 (2)=73.5, p < .001		χ^2 (2)=79.6, p < .001		χ^2 (2)=188.4, p < .001		χ^2 (2)=10.4, p = .006		χ^2 (2)=7.5, p = .02
Age
15–19	0.7	(0.5, 1.1)	0.8	(0.5, 1.1)	0.7	(0.5, 1.0)	1.0	(0.6, 1.8)	0.9	(0.5, 1.6)
20–24	1.9	(1.5, 2.3)	2.8	(2.3, 3.3)	5.0	(4.4, 5.7)	1.5	(1.1, 2.0)	1.8	(1.5, 2.2)
25–29	2.2	(1.8, 2.6)	3.7	(3.3, 4.2)	8.1	(7.4, 8.8)	1.7	(1.4, 2.1)	2.2	(1.9, 2.5)
30–34	2.9	(2.5, 3.4)	4.0	(3.5, 4.6)	9.8	(9.0, 10.7)	1.4	(1.1, 1.7)	2.4	(2.1, 2.9)
35–39	3.0	(2.5, 3.6)	5.7	(5.0, 6.5)	11.2	(10.2, 12.3)	1.9	(1.5, 2.4)	2.0	(1.7, 2.3)
40–44	5.0	(4.3, 5.8)	7.3	(6.5, 8.3)	13.0	(11.8, 14.2)	1.5	(1.2, 1.8)	1.8	(1.5, 2.1)
45–49	6.2	(5.4, 7.0)	11.0	(10.0, 12.2)	22.0	(20.5, 23.6)	1.8	(1.5, 2.1)	2.0	(1.8, 2.2)
50–54	7.1	(6.4, 8.0)	11.8	(10.8, 12.9)	25.1	(23.6, 26.7)	1.6	(1.4, 1.9)	2.1	(1.9, 2.4)
55–59	5.3	(4.6, 6.0)	9.5	(8.6, 10.5)	23.9	(22.4, 25.4)	1.8	(1.5, 2.1)	2.5	(2.2, 2.8)
60–64	3.7	(3.2, 4.4)	6.2	(5.5, 7.1)	15.7	(14.4, 17.0)	1.7	(1.3, 2.1)	2.5	(2.2, 2.9)
65–69	2.2	(1.8, 2.9)	4.5	(3.8, 5.4)	11.4	(10.2, 12.8)	2.0	(1.5, 2.7)	2.5	(2.0, 3.1)
70–74	1.5	(1.0, 2.2)	3.6	(2.8, 4.6)	5.9	(4.9, 7.1)	2.4	(1.5, 3.7)	1.6	(1.2, 2.2)
75–79	1.4	(0.9, 2.2)	2.5	(1.8, 3.5)	4.8	(3.7, 6.1)	1.8	(1.0, 3.3)	1.9	(1.3, 2.9)
80–84	2.3	(1.5, 3.5)	3.7	(2.7, 5.2)	4.8	(3.6, 6.4)	1.6	(1.0, 2.8)	1.3	(0.8, 2.0)
85 or older	2.0	(1.3, 3.1)	4.0	(3.0, 5.4)	3.7	(2.7, 5.1)	2.0	(1.2, 3.4)	0.9	(0.6, 1.4)
	χ^2 (14)=461.2, p < .001		χ^2 (14)=785.9, p < .001		χ^2 (14)=1819.4, p < .001		χ^2 (14)=15.9, p = .33		χ^2 (14)=59.7, p < .001

*Chi-Square tests used for testing significant variation in each demographic characteristic group.

Figure 5. Incidence rates of EMS encounters with naloxone administration by race, Baltimore City, 2012–2017. EMS encounters among 15 years of age or older. Year-specific population estimates from US Census [20].

Figure 6. Incidence rates of EMS encounters with naloxone administration by year and age group, Baltimore City, 2012–2017. EMS encounters among 15 years of age or older. Year-specific population estimates from US Census [20].

Zozula A, Neth MR, Hogan AN, et al. Non-transport after prehospital naloxone administration is associated with higher risk of subsequent non-fatal overdose. Prehosp Emerg Care. 2022;26(2):272–279.

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Data availability statement

Data generated at a central, large-scale facility, available upon request.