Graduation Date


Document Type

Senior Thesis


Bachelor of Science

Primary Major

Health Sciences

Primary Minor

Public Health

Program Director

Michaela George, MPH, PhD

Thesis Advisor

Patti Culross, MD, MPH



There have been over 400,000 deaths related to prescription opioids in the US since 1999, with the highest prevalence among individuals aged 45-54 years old. However, adults between the ages of 18 and 34 have the highest prevalence of misuse of prescription opioids. With accidental overdoses as a leading cause of death, Marin County is just one community that is heavily impacted by this ongoing epidemic. Statistics related to non-fatal and fatal opioid overdoses are difficult to accurately count due to the differing ways counties may categorize cause of death, diagnoses, and other contributing factors. However, looking at 911 calls gives us a baseline for community-based non-fatal opioid overdoses encountered by Emergency Medical Services (EMS) to further characterize the burden of opioid overdoses.


A cross-sectional study was conducted by Marin County’s Health and Human Services using EMS data and death records. This study determined if an individual's disposition from EMS can be used to predict future outcomes for individuals with opioid use disorder. Whether the patient refuses treatment/transport or accepts treatment/transport may allow us to find patterns that will predict outcomes such as experiencing another overdose or being at a higher risk for all-cause or overdose mortality.


The bivariate analysis outcomes showed that age, year, repeat overdose, and disposition were all statistically significant for higher incidence of mortality. On average, individuals who were transported to the ER with lights and sirens had 1.59 times the odds of dying than individuals who were not transported to the ER with lights and sirens, after controlling for age, year of overdose and whether or not it was a repeat overdose event (95% CI = 1.052- 2.406). Additionally, individuals who were transported had 0.516 times the odds of dying than individuals who were not transported, after controlling for age, year of overdose and whether or not it was a repeat overdose event (95% CI = 0.271-0.984).


In addition to the overdose prevention and education programs already in place, programs specifically aimed at the at risk groups established in this study could help combat this crisis. Extending resources and educational services specifically to the 46+ population could help raise awareness and protect this group. Preventing first time overdoses from occuring in the first place could be achieved by openly discussing harm reduction strategies and making Narcan more readily available. Another step that can be taken to reach more individuals and ultimately combat the opioid crisis would be to implement a plan that allows EMS to connect patients to resources such as counseling, rehab centers, and harm reduction strategies.

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Available for download on Wednesday, June 01, 2022