Developing the Evidence Base for Overdose Policies: A Multilevel Analysis of NHBS

This research integrates CDC National HIV Behavioral Surveillance data on ~38,800 people who inject drugs living in 20+ US metropolitan statistical areas in 2009, 2012, 2015, and 2018 with existing data on the places where these PWID live to learn whether and how specific drug- and health-related laws and place characteristics (e.g., spatial access to substance use disorder treatment) relate to a variety of overdose related outcomes among people who inject drugs, overall and by race/ethnicity, gender, age, and HIV status. Results will provide some of the first evidence to help develop laws and place-based interventions to combat ODs among PWID, a growing and yet neglected population at the epicenter of the US OD epidemic.

The overdose (OD) epidemic is one of the worst crises of the 21st century US, and people who inject drugs (PWID) are at its epicenter. ODs are the leading cause of death for PWID, and the number of PWID is rising.

We are, though, routinely missing opportunities to develop the evidence base for interventions for PWID. Many states are enacting laws to combat the opioid epidemic (Prescription Drug Monitoring Programs [PDMPs], Naloxone Access Laws, Good Samaritan Laws), and a high-impact body of research is now analyzing how these laws, and other health policies (Medicaid Expansion, Medical Marijuana Laws [MMLs]), affect ODs in the general population.

To date, though, this research has ignored PWID, a highly vulnerable population that may respond differently to these laws than members of the general population. The growing body of research on place characteristics (e.g., neighborhood poverty rates) and ODs has also neglected PWID.

The range and impact of place-based exposures, however, may differ for PWID. NIDA prioritizes generating scientific evidence to guide policy. As policymakers confront this health crisis, however, they are crafting laws with scant evidence about their possible effects on PWID.

Likewise, the lack of scientific evidence about the effects of place characteristics on ODs among PWID cuts off whole arenas of place-based interventions, interventions that have proven effective for other health outcomes among PWID.

Guided by the Risk Environment Model and Public Health Law Research principles, we will integrate CDC National HIV Behavioral Surveillance (NHBS) data on ~38,800 PWID in 20+ US metropolitan statistical areas (MSAs) in 2009, 2012, 2015, and 2018 with existing data on state laws and on characteristics of the MSAs, counties, and ZIP codes where these PWID live.