Of nearly 192,000 accidental or undetermined-intent drug overdose deaths in the United States from 2022 to 2024, 76% occurred when the decedent was alone, highlighting the need for targeted messaging and wider distribution of opioid antagonist medications, according to a Public Health Alerts report today.
Public Health Alerts, a collaboration between NEJM Evidence and CIDRAP, fills a gap in reliable data, offering expert-reviewed reports that translate frontline observations into actionable public health evidence. An NEJM Evidence editorial explains the initiative further.
“Timeliness of drug overdose response efforts may be improved when bystanders are present to provide life-saving care,” wrote the Centers for Disease Control and Prevention (CDC) authors.
Most deaths occurred in home
The researchers used the CDC’s State Unintentional Drug Overdose Reporting System (SUDORS) to identify 191,577 accidental or undetermined-intent overdose deaths with known settings in 46 states and Washington, DC, from January 2022 through December 2024.
Three-quarters (75.5%) of the deaths occurred when the decedent was alone (ie, with no evidence of a witness present or nearby). Of these deaths, 72.9% happened when he or she was alone in a house or apartment, and 23.2% took place in settings such as a car, sidewalk, or bar. A bystander was absent for 70.4% of deaths that happened in isolation in a house or apartment and 86.3% of those documented in other settings.
A spatially separated intimate partner or family member (eg, one in a different room) was present for 20.2% of deaths that occurred in isolation in a house or apartment, and for 2.7% of those that took place elsewhere. And a spatially separated bystander of another type (eg, roommate, friend) was present for 8.8% of deaths in isolation in a house or apartment and 10.6% of those in isolation in other settings.
Fast responses save lives
The authors noted that most US overdose deaths continue to involve synthetic opioids such as illegally made fentanyl, which caused 65% of the 79,384 such deaths in 2024. “Because fentanyl is fast acting and can quickly cause respiratory depression and overdose, rapid response to overdose (including use of opioid overdose reversal medications such as naloxone [eg, Narcan]) is important,” they wrote.
Emerging technological approaches, in addition to improvements in overdose education and distribution of opioid overdose reversal medications, may help address the challenge of preventing death among individuals who use drugs in isolation.
The findings underscore the importance of tailoring overdose prevention and messaging to people who use drugs alone to lower their overdose risk, the researchers said. In addition, new and existing technologies such as phone-based apps and wearable devices that monitor vital signs, could inform first responders of overdoses to enable rapid intervention.
“Emerging technological approaches, in addition to improvements in overdose education and distribution of opioid overdose reversal medications, may help address the challenge of preventing death among individuals who use drugs in isolation, particularly in the home,” the researchers concluded.
