Identifying and Treating Overdose Hotspots: A Randomized Controlled Trial of Place-Based Harm Reduction Strategies

Research has shown that the 21st century overdose crisis has affected some places much more than others. However, far less work has examined how overdoses are concentrated in micro-level places or “hotspots.” In addition, almost no research has conducted randomized controlled trials of place-based interventions targeting overdose hotspots.

The current project seeks to address these issues through a collaborative partnership between the Hamilton County Office of Addiction Response (HC-OAR) (a multi-agency partnership) and researchers at the University of Cincinnati. This project has two goals developed based on field-initiated needs identified by the HC-OAR.

First, the project will identify overdose hotspots in Cincinnati, Ohio using spatial analysis of overdose incidents from three data sources: (1) Emergency Medical Service (EMS) calls, (2) Overdose Quick Response Team (QRT) records, and (3) Hamilton County coroner death records. 

Second, the project will use a randomized controlled trial to implement and assess the impact of place-based, harm-reduction interventions at overdose hotspots. Specifically, project staff will install public, free-to-use “NaloxBoxes” (emergency naloxone kits) and Fentanyl Test Strip dispensers at randomized hotspots, along with additional “need-based” interventions at some hotspots (e.g., educational materials, drug treatment resources). Researchers will select hotspots (36 total) to be randomly assigned to treatment or control groups. The project will use a pretest-posttest design to assess the impact of these interventions, comparing EMS and QRT overdose incidents across hotspots for the 6 months pre- and post-interventions. The project will also include anonymous surveys pre- and post-intervention to gain insight about experiences at treatment and control hotspots.

This project has several important implications. First, identifying overdose hotspots can help local communities more effectively use scarce resources to target overdose responses. Theoretically, this is also important for assessing the degree to which the “law of crime concentration” applies to overdoses. Second, assessing the effectiveness of free, public access harm-reduction supplies on overdose incidents is urgent as these strategies become more widely adopted across U.S. locales. Last, these interventions also hold promise for helping underserved minority communities overcome treatment barriers to access harm-reduction supplies.

Project outcomes include timely submission of all research-related products (e.g., progress reports, final report, and data) in accordance with NIJ’s expectations and scholarly publications in top-tier journals. Project findings will also be disseminated more broadly through public talks, policy briefs posted on a dedicated project website, and through interviews and informational pieces featured in public outlets. CA/NCF