(5) EMS-Attended Overdoses Before and After the COVID-19 Pandemic in Camden, New Jersey

Background & Introduction: Only 10% of those suffering from a substance use disorder have received treatment for their substance use, according to a 2024 report from the Agency of Healthcare Research and Quality. To bridge this gap in care, various harm reduction programs have mobilized access to sterile drug paraphernalia and opioid overdose reversal medications in order to increase protective factors against overdose within their own communities. During the COVID-19 pandemic, drug supply chains changed and access to harm reduction interventions and medical care were limited, exacerbating the overdose crisis. Given these changes, it is important to characterize these incidents based on their geographic location, the time of year they occurred in, and the demographics of each respective patient in order to highlight more opportunity for intervention. In this study, we explored the geospatial, temporal, and demographic differences in overdoses attended by a hospital-associated emergency medical service (EMS) before and after the COVID-19 pandemic in Camden City, New Jersey.

Methods: We used routine data collected by Cooper EMS to identify clinical impressions of overdose encounters that occurred between two time periods (January 1, 2017 – December 31, 2019 and January 1, 2022 – December 31, 2024). Patient age, race and ethnicity, sex at birth, date, and spatial coordinates were obtained for each overdose event. Using R spatstat and forecast packages, we performed Ripley’s K function and ARIMA modeling to determine spatial clustering and seasonality patterns of overdoses for each time period. Chi-squared tests for differences in race and ethnicity were conducted. This study was determined to be exempt by the Cooper University Hospital Institutional Review Board.

Results: Between January 1, 2017 and December 31, 2019, there were 1,603 overdose encounters recorded by our EMS team. Most of those patients were men (73.5%, n=1,178) as compared to women (24.6%, n=394), while 31 patients were of unknown sex at birth (1.9%). Most of the patients were Non-Hispanic White (42.4%, n=679,) followed by Non-Hispanic Black (27.7%, n=444), Unknown or Other Race (15.6%, n=249), Hispanic White (12.9%, n=206), and Hispanic Black (1.6%, n=25). The median age of these patients was 36 years of age.

Between January 1, 2022, and December 31, 2024, there were 1,522 overdoses recorded. Similarly, most of these patients were men (72.7%, n=1,107) as compared to women (24%, n=366), while there were 48 patients of unknown sex at birth (3.2%). Alternatively, most patients were Non-Hispanic Black (36.9%, n=561), followed by Non-Hispanic White (25.7%, n=391), Unknown or Other Race (22.6%, n=344), Hispanic White (13.3%, n=203), and Hispanic Black (1.6%, n=24). The proportion of overdoses among those that are Non-Hispanic Black increased (p < 0.01) while Non-Hispanic White overdoses decreased (p < 0.01) between the years 2022 - 2024 as compared to 2017 – 2019. Mood’s median test showed that the age of patients between 2022 - 2024 at 43 years of age represented an older population of people who had overdosed than in the earlier time period (p < 0.01).

Although overdoses were clustered in both time periods (p < 0.05 for both K functions), cross K-function analysis with Monte Carlo simulations showed less density in clustering between the years 2022 – 2024 when compared to the previous time cohort (p < 0.05). When analyzing temporal trends, there were increased seasonal patterns noted between 2022 – 2024 vs. 2017 – 2019 with the highest incidence of overdose between 2022 - 2024 occurring in the summer season (p < 0.05). Most notably, there was an earlier rise in Non-Hispanic Black individual overdoses vs. Non-Hispanic White overdoses in the early spring season between the years 2022 - 2024.

Conclusion & Discussion: Our results showed that EMS-attended overdoses in Camden following the pandemic were less densely concentrated, more seasonal, and represented more non-Hispanic Black and older individuals than before the pandemic. These results offer an opportunity to investigate shifting geographical patterns of overdoses that can inform new opportunities for outreach intervention such as naloxone distribution in more vulnerable locations. Our study is limited by the proportions of unknown race (15% and 23%) in both time cohorts, highlighting a greater need to investigate how patient demographic information is recorded in the field setting. It also should be noted that the location of where patients purchased their substance of choice, where they live, and where they use it can vary. Therefore, further characterization of the locations we have identified can inform options for interventions. In addition to a geographic location, temporal patterns within 2022 – 2024 which peaked during the summer months offer further opportunity to intervene and prepare for peaks during the year. When considering Non-Hispanic Black individuals’ earlier rise in overdose during the spring seasons between 2022 – 2024, further study should be conducted to understand potential barriers to care that have led to the disproportionate rates of overdose noted.

References: 1. Substance Abuse and Mental Health Services Administration: SAMHSA Overdose Prevention and Response Toolkit.
Publication No. PEP23-03-00-001, Substance Abuse and Mental Health Services Administration, 2025.
2. Centers for Disease Control and Prevention. Social Vulnerability Index. ASTDR. October 22, 2024. Accessed October 24, 2025. https://www.atsdr.cdc.gov/place-health/php/svi/index.html
3. Salisbury-Afshar E, Gale B, Mossburg S. Harm Reduction Strategies to Improve Safety for People Who Use Substances . PSNet [internet]. Rockville (MD): Agency for Healthcare Research and Quality, US Department of Health and Human Services. 2024
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