Examining the spatial risk environment tied to the opioid crisis through a unique public health, EMS, and academic research collaborative: Lowell, Massachusetts, 2008-2018

Abstract

Between 2015 and 2018, Lowell Massachusetts experienced outbreaks in opioid overdoses, HIV, and hepatitis C virus infections (HCV) among people who inject drugs. Through an innovative collaboration between emergency medical services (EMS), public health, and academic partners, we assessed the geographic distribution of opioid-related risks to inform intervention efforts. We analyzed data from three unique data sources for publicly discarded syringes, opioid-related incidents (ORIs), and fatal opioid overdoses in Lowell between 2008 and 2018. We assessed the risk environment over time using a geographic information system to identify and characterize hotspots and noted parallel trends within the syringe discard and ORI data. We identified two notable increases in ORIs per day: the first occurring between 2008 and 2010 (from 0.3 to 0.5), and the second between 2011 and 2014 (from 0.9 to 1.3), following the introduction of fentanyl within local drug markets. We also identified seasonal patterns in the syringe discard, ORI, and overdose data. Through our spatial analyses, we identified significant clusters of discarded syringes, ORIs, and fatal overdoses (p < 0.05), and neighborhoods where high densities of these outcomes overlapped. We found that areas with the highest densities shifted over time, expanding beyond the epicenter of the Downtown neighborhood. Data sharing and analyses among EMS, public health, and academic partners can foster better assessments of local risk environments. Our work, along with new public health efforts in Lowell, led to a city-funded position to improve pick-up and proper disposal of publicly discarded syringes, and better targeted harm reduction services.

Keywords: Lowell; Massachusetts; Opioids; Overdose; Syringe discard.

Fig. 1

Opioid related incident (ORI) calls and public syringe pick-up (PU) requests received by Trinity EMS, Lowell, Massachusetts, 2008–2018.

Fig. 2

Number of opioid-related incident (ORI) calls and percentage of all 911 calls that were ORI calls by season, Lowell, Massachusetts, 2013–2018.

Fig. 3

Sociodemographic characteristics of Lowell neighborhoods, 2012–2016: (A) Total population by census tract; (B) percent non-white population by census tract; (C) percent the population living in poverty. All maps are classified using quartiles.

Fig. 4

Optimized hotspot cluster analyses in Lowell Massachusetts, 2015–2017: (A) Public syringe discard clusters, 2011–2018; (B) fatal opioid overdose clusters, 2015–2017; (C) fatal opioid overdose clusters, 2015–2017 (hospital deaths removed from analysis); (D) decedent injury locations, 2015–2017.

Fig. 5

Density of opioid-related risks, Lowell, Massachusetts, 2015–2017: (A) Composite raster that sums the densities per square ¼ mile of fatal opioid overdose, public syringe discard, and decedent injury locations for 2015, 2016, 2017; (B) Composite raster that sums the same densities in Fig. 3A, without including hospital-recorded deaths. Maps are classified using Octiles.