Excessive Overdoses Where Treatment Centers Are Concentrated: A Case Study of Orange County, California

BACKGROUND: This study examines an unusual context in which a large drug treatment community may be associated with an increase in drug overdoses, in Orange County, California. The greater availability of treatment services attracts many non-local visitors to this county, particularly from other states, leading to the overrepresentation of those who use drugs in the local population. This, in addition to a recent rise in predatory practices in connection to fraudulent overbilling at local treatment centers, may further contribute to overdose risk. OBJECTIVES: This study examined emergency department records in California over a three-year period. Odds ratios were calculated for overdoses in Orange County cities with the highest concentration of treatment facilities (the exposure region) relative to other parts of California. Local residents and two groups of visitors were analyzed separately. RESULTS: Overdose among local residents in the exposure region were slightly elevated and more substantially elevated among visitors from other counties in California. Most notably, overdose ratios were exceptionally high for out-of-state visitors in the exposure region, consistent with prior reports that these visitors have been the primary group exploited in overbilling schemes. CONCLUSIONS: Overdoses were disproportionately high for people visiting Orange County from other U.S. states. Discussion highlights the need for stronger regulatory oversight of unethical practices in the local addiction treatment industry.