Study pinpoints nonfatal overdose hotspots in Palm Beach County

Fatal drug overdoses have long been the focus of the nation’s overdose crisis, but nonfatal overdoses occur far more frequently. These events often bring people to emergency departments, creating opportunities to connect them with lifesaving treatment and prevention services.

Yet many patients do not receive follow-up care. At the same time, overdose patterns are becoming increasingly complex, driven by illicit fentanyl, stimulants, alcohol and polysubstance use. Florida reported more than 31,000 suspected overdose-related emergency department visits in 2024, including more than 5,000 in Palm Beach County.

New research from Florida Atlantic University’s Charles E. Schmidt College of Medicine is revealing important geographic patterns in nonfatal overdoses, offering new insight into where nonfatal overdoses are concentrated and where prevention efforts could potentially have the greatest impact. The findings also point to environmental and social factors that may influence where overdoses occur.

Using the Florida Department of Health’s overdose surveillance data, researchers mapped nonfatal overdoses across Palm Beach County and compared indoor and outdoor events by demographic and social characteristics. They also examined associations between overdose locations and built-environment features, including gas stations and major transportation corridors.

The results of the study, published in the journal Drug and Alcohol Dependence, show that nonfatal overdoses were not randomly distributed across Palm Beach County but instead clustered in specific geographic areas, particularly near major transportation corridors and gas stations. Of the 1,661 nonfatal overdose events analyzed, 39.6% occurred outdoors, and these events were more frequently located near gas stations and major transportation corridors than indoor overdoses.

Outdoor overdoses also differed significantly from indoor events in the substances involved and the demographic and social characteristics of those affected. They were more likely to involve stimulants and alcohol and were more common among men, younger adults, people experiencing housing instability and people without health insurance.

Housing instability emerged as the strongest factor associated with outdoor overdose. The relationship was particularly pronounced near gas stations: Among people experiencing nonfatal overdose, those identified as unstably housed had more than five times the odds of the overdose occurring within a quarter mile (0.4 kilometer) of a gas station compared with those in stable housing. Transitional housing and lack of health insurance also were associated with greater odds of an overdose occurring near a gas station.

Spatial analyses found that nearly half of outdoor overdoses occurred within a quarter mile (0.4 kilometer) of a gas station, compared with 23.5% of indoor overdoses. Outdoor overdoses were also more likely to occur near major highways or interstates (33.6% vs. 21.2%) and in nonresidential areas (68.2% vs. 32.8%). These patterns were particularly evident in eastern Palm Beach County, where overdose hotspots frequently followed major transportation corridors.

Overall, 91% of mapped areas showed alignment between overdose and gas station distributions, with 45.5% showing statistically significant hotspot overlap. Gas stations may be relevant because they are highly accessible, often open for extended hours and commonly located along major transportation corridors. While the findings do not suggest that gas stations themselves cause overdoses, these locations may help identify areas where targeted prevention, naloxone access and outreach could reach people at increased risk.

“These findings show us that understanding overdose risk requires us to look beyond the individual and consider the places where people live, travel and spend time,” said Maria C. Mejia, MD, senior author and professor of population health, Schmidt College of Medicine. “If we know where nonfatal overdoses are clustering and which populations are most affected, we can be more strategic about where prevention and intervention resources are placed. That could mean expanding naloxone access, deploying outreach teams or connecting people to treatment and other services in the places where they are most likely to be encountered.”

The strong relationship between housing instability and outdoor overdose also underscores the importance of integrating health, housing and social services into overdose prevention strategies. Spatial surveillance could help public health officials identify priority locations and better understand the populations most in need of targeted support.

The study’s first author is Whitney Van Arsdale of the Florida Department of Health in Palm Beach County. Co-authors are Lea Sacca, PhD, assistant professor of population health, Schmidt College of Medicine; Stephanie Barajas, Florida Department of Health in Palm Beach County; Nathan Flothe, FAU medical student; and Lewis S. Nelson, MD, dean and chief of health affairs, Schmidt College of Medicine.

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