Faculty Bibliography

BACKGROUND:Overdose prevention centers (OPCs) may reduce public drug use and, with it, policing of people who use drugs in the communities surrounding these sites. We applied an augmented synthetic control method to assess changes in pedestrian stops before and after the November 2021 opening of two OPCs (Washington Heights and East Harlem) in New York City (NYC). METHODS:We retrieved pedestrian stop information from the New York Police Department's (NYPD) Stop, Question, and Frisk, program from January 2017 to December 2024, and created bimonthly averages using five- and ten-minute walking buffers surrounding the OPCs and 57 donor sites (syringe service and opioid treatment programs) as outcomes. Covariates were derived from American Community Survey, NYPD Calls for Services, and SafeGraph pedestrian mobility estimates. RESULTS:The opening of the Washington Heights OPC was associated with a reduction of 2.8 bimonthly average pedestrian stops in the post-intervention period when using five-minute walking buffers, although results were compatible with increases and reductions (95%CI=-9.4, 4.0). For ten-minute walking buffers, results were compatible with a wide range of reductions (ATT=-9.2 [95%CI=-18.3, -1.3]). East Harlem OPC showed larger point estimates when examining both distances (ATT=-8.4 [95%CI=-12.2, -4.5] and ATT=-13.7 [95%CI=-22.1, -4.2] with five- and ten-minute walking buffers, respectively). For both sites, permutation tests suggested that these reductions fell within the range of possible donor-unit placebo effects. CONCLUSIONS:Our study shows limited evidence of an effect of NYC's first two OPCs on pedestrian stops in their immediate vicinity, with a potential decrease concentrated in the first two years at the East Harlem location.

BACKGROUND/UNASSIGNED:The opioid overdose crisis remains a public health emergency in the United States. Evidence-based practices-including medications for opioid use disorder (MOUD) and naloxone distribution-can reduce harms, but their community-level cost-effectiveness is uncertain and may vary locally. We aimed to evaluate the cost-effectiveness of enhanced community-level implementation of evidence-based practices for opioid use disorder (OUD). METHODS/UNASSIGNED:We used a validated microsimulation model of OUD, calibrated with data from the HEALing Communities Study across 26 highly impacted communities in Massachusetts, New York, and Ohio. Six intervention scenarios for 2025-2030: maintaining 2024 evidence-based practice levels (status quo); improved naloxone distribution; improved MOUD retention; improved MOUD initiation; combined initiation and retention; and combined initiation, retention, and naloxone distribution. Outcomes included opioid overdose deaths (OODs), non-overdose opioid-related deaths, quality-adjusted life years (QALYs), costs (healthcare and societal), and incremental cost-effectiveness ratios (ICERs). FINDINGS/UNASSIGNED:Maintaining 2024 evidence-based practice levels was projected to yield OODs of 39-468 per 100,000 and non-overdose deaths of 238-3018 per 100,000 across communities. Enhancing MOUD initiation, retention, and naloxone distribution reduced OODs by 15-40% and non-overdose deaths by 7-24%, producing the largest QALY gains (1006-38,292). From the healthcare perspective, improved initiation plus retention was cost-effective in all communities (ICER US$11,765-US$91,058 per QALY); from the societal perspective, all enhanced scenarios were cost-saving (US$121 million-US$4.74 billion net savings). INTERPRETATION/UNASSIGNED:Community-level enhancement of MOUD initiation and retention, and for some communities also enhancing naloxone distribution, can substantially reduce opioid-related-overdose and non-overdose-deaths. These strategies are cost-effective from a healthcare perspective and cost-saving from a societal perspective, supporting investment in comprehensive, community-tailored interventions. FUNDING/UNASSIGNED:NIH HEAL Initiative.

IMPORTANCE/UNASSIGNED:Syringe services programs (SSPs) are evidence-based interventions that reduce bloodborne infections and injection-related harms among people who inject drugs, yet access remains limited and geographically uneven across the US. OBJECTIVE/UNASSIGNED:To quantify the travel time, distance, and cost required to reach the nearest SSP from population-weighted census tracts nationwide and to examine differences by urbanicity, state, and SSP legality. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cross-sectional geospatial study linked all known SSP locations as of August 2024 to the population-weighted centroids of census tracts in the 50 US states and the District of Columbia. Analyses were conducted between December 2024 and February 2026. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Population-weighted mean and median driving time, distance, and cost to access the nearest SSP, stratified by National Center for Health Statistics urban-rural county category and SSP legal status. Costs were estimated using 2024 Internal Revenue Service (IRS) medical mileage deduction rates and 2022 state-specific gasoline prices. RESULTS/UNASSIGNED:In 1338 SSPs across 83 780 census tracts, the population-weighted mean 1-way driving time to the nearest SSP was 46.1 minutes (95% CI, 45.7-46.5 minutes) and the median was 23.3 minutes (IQR, 12.2-58.5 minutes). Altogether, 23.1% of the population lived more than 60 minutes from an SSP and 12.6% lived over 120 minutes away. The mean 1-way driving distance was 41.8 miles (95% CI, 41.3-42.2 miles). The mean 1-way driving cost was $8.77 (95% CI, $8.68-$8.86) using the 2024 IRS mileage rate and $6.91 (95% CI, $6.84-$6.98) using state mean gasoline prices in 2022. In states where SSPs were legal, mean driving time was 30.1 minutes (95% CI, 29.8-30.4 minutes) and mean cost by IRS mileage rates was $4.94 (IQR, $4.88-$5.00), compared with 110.7 minutes (95% CI, 109.6-111.8 minutes) and $24.19 (IQR, $23.92-$24.46) in states where SSPs were illegal. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cross-sectional study of travel burden to SSPs found substantial geographic and financial barriers to accessing SSPs across the US, particularly in nonmetropolitan areas. Targeting new SSPs to areas with the greatest travel burden could improve utilization and reduce drug-related morbidity.

Despite robust evidence that medications for opioid use disorder (MOUD) reduce overdose and mortality, substantial care gaps remain following opioid-related hospital encounters. The opioid use disorder (OUD) Cascade of Care framework conceptualizes progression from identification to treatment initiation and retention, yet limited research has examined how real-world OUD treatment trajectories unfold, particularly across treatment episodes and multiple care settings. This paper describes an NIH-funded study protocol (1R01DA061367-01A1) to conduct a longitudinal observational study using linked administrative data across New York City to characterize OUD treatment trajectories following opioid-related hospital encounters. Using the OUD Cascade of Care framework, we will apply state sequence analysis to identify common patterns of OUD treatment engagement in the year following hospitalization, including transitions between treatment modalities and periods in and out of care. We will examine how care trajectories vary by individual and neighborhood characteristics, and assess associations between trajectories and key outcomes, including rehospitalization, overdose, and mortality. By applying novel data-driven longitudinal methods, this study will advance understanding of the complex, non-linear nature of OUD treatment engagement. Findings will inform health system and policy efforts to identify populations at elevated risk, hospital-based interventions, and opportunities to address gaps in care to reduce overdose-related harms.

BACKGROUND:Overdose rates in the U.S. rose dramatically during the COVID-19 pandemic. Well-documented racial and sociodemographic inequities in the impact of the pandemic suggest the potential for similar inequities for overdose. Our objective was to identify subgroups of New York State Medicaid enrollees who experienced the greatest increases in non-fatal opioid overdose risk following onset of the COVID-19 pandemic. METHODS:Data are from a retrospective cohort of 1,021,889 people enrolled in New York State Medicaid from 2019-2020. To identify subgroups with the greatest increased risk of non-fatal overdose following onset of the COVID-19 pandemic, we used Heterogeneous Treatment Effect (HTE)-Scan, a novel machine learning method developed for accurate and computationally efficient discovery of heterogeneous treatment effects in complex data. RESULTS:In the total sample, risk of non-fatal opioid overdose increased 22% after onset of the pandemic. We also identified two subgroups with elevated risk relative to the total sample: subgroup 1 (Black and Hispanic males aged 45-64 years old with no baseline documentation of opioid use disorder (OUD); N = 53,065) and subgroup 2 (people aged 45-64 years old with documented aged/blind/disabled status and no baseline documentation of OUD; N = 73,694). These subgroups experienced a 54% and 57% increase in non-fatal overdose risk, respectively. CONCLUSIONS:We estimated heterogeneous effects of onset of the COVID-19 pandemic on non-fatal overdose, with elevated risks estimated for older working-aged, structurally disadvantaged adults without documented OUD. These findings illustrate the importance of structural factors in driving heterogeneous risk of overdose following complex social events.

Overdose prevention centers (OPCs) are associated with improved community health and decreased crime, but opponents argue that OPCs depress nearby property values. We estimated the association of the opening of the first two public recognized OPC in the United States with neighborhood residential rents and real estate sales in the East Harlem and Washington Heights neighborhoods of New York City (NYC). Using augmented synthetic controls, we analyzed quarterly and semiannual rental listings and annual and semiannual sales within 300- and 500-meter buffers around the OPCs. Donor units were buffers around syringe service programs without OPCs and opioid treatment programs. Primary outcomes were median quarterly rental listing price and median annual sales price. Overall, we found no changes in neighborhood rental or sales prices. For quarterly rentals at 300 m, we estimated (ATT, 95% CI) $145 (-$780, $1070) in East Harlem and -$505 (-$1279, $269) in Washington Heights. For annual sales at 500 m, we estimated -$542 993 (-$1 228 024, $142038) in East Harlem and $1 121 706 (-$431 285, $2674697) in Washington Heights. Conformal inference identified no detectable time-point effects. Overall, OPC implementation in NYC was not associated with changes in rents or sales, suggesting these facilities may not generate appreciable effects on local housing values.

IMPORTANCE/UNASSIGNED:Overdose prevention centers (OPCs) are interventions to reduce overdose mortality and support health care engagement. In the US, concerns have been raised that OPCs may be associated with reduced economic activity in their surrounding neighborhoods. OBJECTIVE/UNASSIGNED:To evaluate changes in the local economic activity in New York City (NYC), measured by neighborhood-level foot traffic and consumer spending, following the opening of the first 2 publicly recognized OPCs in the US. DESIGN, SETTING, AND PARTICIPANTS/UNASSIGNED:This cohort study used anonymized mobility and spending data from June 1, 2021, to June 13, 2022, for the areas surrounding the East Harlem and Washington Heights OPCs in NYC. These neighborhoods were defined using 5-minute and 10-minute walking buffers and Business Improvement Districts (BIDs). Synthetic control donors included walking buffers and BIDs around syringe service programs without OPCs and opioid treatment programs that were operational as of OPCs' opening. Analyses were conducted from February to July 2025. EXPOSURES/UNASSIGNED:Opening of the 2 NYC OPCs on November 30, 2021. MAIN OUTCOMES AND MEASURES/UNASSIGNED:Primary outcomes were foot traffic and in-person consumer spending within 10-minute walking buffers. Secondary analyses considered 5-minute walking buffers and BIDs. Augmented synthetic control models were adjusted for neighborhood-level demographic and socioeconomic features, with fit assessed using root mean squared error before OPC opening. Permutation tests and conformal inference were used to assess significance. RESULTS/UNASSIGNED:A total of 27 biweekly observations (13 in pre-OPC and 14 in post-OPC periods) were analyzed. The 10-minute walking buffer analyses captured 1259 consumer spending sites and 7816 foot traffic sites across 2 treated buffers and 56 donor buffers. In East Harlem, the average treatment effect on the treated (ATT) estimate (SE) was -$21.96 ($40.53) for consumer spending (P = .16) and 1.28 (5.40) visits for foot traffic (P = .19). In Washington Heights, ATT (SE) estimates were $14.94 ($37.38) for consumer spending (P = .13) and 0.44 (3.54) visits for foot traffic (P = .97). Secondary analyses produced consistent results. No statistically significant results were observed at any post-OPC time point. CONCLUSIONS AND RELEVANCE/UNASSIGNED:This cohort study found that OPC opening was not associated with significant changes in local economic activity. Given the absence of observed economic harms, policy debates should instead focus on the public health implications of OPCs.

BACKGROUND AND AIMS/OBJECTIVE:The opioid crisis is still a public health emergency in the United States, despite recent declines in opioid overdose deaths (OODs) and increased availability of evidence-based practices (EBPs) for opioid use disorder (OUD). The geographic variability in OODs drives the need for localized decision-making, where interventions are tailored to the unique needs of communities. This study aimed to develop and calibrate a simulation model that evaluates the impact of enhanced implementation of EBP on OODs at the community-level. DESIGN/METHODS:We developed OPSiM (Opioid Policy Simulation Model), a community-level microsimulation model that simulates the course of opioid use, OUD, treatment, recovery and overdose-related events. The model was parameterized with data from the HEALing Communities Study and looked at six scenarios of EBPs implemented in 2025 with sustainment through 2030: (1) maintain 2024 EBP levels (status quo); (2) increase initiation of medications for opioid use disorder (MOUD); (3) increase MOUD retention; (4) increase MOUD initiation and retention; (5) increase distribution of naloxone; and (6) both scenarios 4 and 5. SETTING/METHODS:Twenty-nine communities in Massachusetts, New York, and Ohio, USA. PARTICIPANTS/METHODS:Simulated community residents with non-prescribed opioid use or OUD. MEASUREMENTS/METHODS:Estimated number of OODs per 100 000 individuals between 2025 and 2030 in each community, averaged across the 26 communities. FINDINGS/RESULTS:Under the status quo, the model projected 158 OODs (range across communities: 39-468) per 100 000 individuals between 2025 and 2030. Increasing medications for the treatment of OUD (MOUD) retention alone reduced OODs by 6% (range: 3-15%), while increasing MOUD initiation alone reduced OODs by 9% (range: 8-12%). Increasing both MOUD initiation and retention had a synergistic effect, reducing OODs by 21% (range: 15-31%). Reduction in OODs in response to increased MOUD initiation and/or retention was similar across urban and rural communities. The effect of increasing naloxone distribution varied substantially across communities due to differing saturation levels; in some communities, additional naloxone kits provided only marginal benefits. Rural communities were further from saturation whereas most urban communities were at or close to saturation. CONCLUSIONS:A tailored, multi-pronged approach that scales up medications for opioid use disorder alongside widespread naloxone distribution, and that addresses community-specific needs and capacities, will be most effective at reducing opioid overdose deaths in the United States.

Given substantial reporting delays in overdose deaths, state health departments increasingly use non-fatal overdose data to inform geographically targeted rapid overdose response efforts. We sought to evaluate the extent to which non-fatal overdose events were associated with concurrent and future overdose deaths in Rhode Island. We aggregated non-fatal overdose data from emergency medical services records (2019-2023) and fatal overdose data from the State Unintentional Drug Overdose Reporting System (2020-2023) in 1-, 3-, and 6-month intervals at census block group and census tract levels. Rates of fatal overdose were estimated, relative to non-fatal overdose lagged by 0-12 months, using negative binomial regression, and relative to monthly spikes in non-fatal overdose burden, using zero-inflated Poisson regression. Estimation was implemented using integrated nested Laplace approximation. Each additional non-fatal overdose event per census block group was associated with fatal overdose rates that were 48% higher (95% credible interval: 1.37-1.59) than expected in concurrent months, with smaller associations at the census tract level, in wider time intervals, and when non-fatal overdose data were lagged. Spikes in non-fatal overdose activity were associated with elevated overdose mortality in concurrent periods with fine temporal and geographic granularity, but not in larger time frames and geographic areas.

BACKGROUND:Between 2022 and 2023, overdose mortality decreased among non-Hispanic (NH) white people but stayed the same or increased among people of colour in the USA. County racialised economic segregation may contribute to overdose mortality. METHODS:measures, one for higher-income NH white and lower-income black residents and another for higher-income NH white and lower-income Hispanic residents. Models included random effects for county, year and county-year interaction, and fixed effects for proportion male, proportion aged 25-44, land area, state and year. We estimated relative risk (RR) by quintile (least vs most privileged) and the difference in overdose mortality per 100 000 (RD) had all counties shifted to the risk of the most advantaged counties (Q5). RESULTS:Counties with the highest proportion of lower-income racially minoritised residents (Q1) had an increased RR of overdose deaths compared with Q5 counties, both overall (aRRs 1.64 (1.51-1.78); 1.40 (1.29-1.52)), and among subgroups. Had all counties experienced the risk of Q5 counties, we estimated an average reduction in overdose deaths overall (RDs per 100 000: -7.20 (-8.25 to -6.10); -6.37 (-7.38 to -5.25)) and among subgroups. CONCLUSION/CONCLUSIONS:County racialised economic segregation was associated with overdose mortality risk in 2018-2022. Investment in evidence-based strategies to reduce overdose risk in places experiencing harms related to racialised economic segregation is critical.