Associations between short-term ambient temperature exposure and emergency department visits for amphetamine, cocaine, and opioid use in California from 2005 to 2019

• Type of Material: Article
• Authors: Howard Chang, Emory University; Haisu Zhang, Emory University; Amanda D. Latimore, Johns Hopkins University; Brian P. Murray, Wright State University; Rohan DSouza, Emory University; Noah C Scovronick, Emory University; Matthew O. Gribble, University of Alabama, Birmingham; Stefanie Ebelt, Emory University
• Language: English
• Date: 2023-09-27
• Publisher: Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2023 The Authors. Published by Elsevier Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): https://doi.org/10.1016/j.envint.2023.108233
• Title of Journal or Parent Work: Environment International
• Volume: 181
• Start Page: 108233
• Grant/Funding Information: This research was partially supported by funding from the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) under award numbers R01ES027892.
• Keywords: Temperature; Substance use; Overdose stimulant; Cocaine; Heat; Opioid
• Research Categories: Health Sciences, Public Health; Health Sciences, Epidemiology

Abstract

Substance use disorder is a growing public health challenge in the United States. People who use drugs may be more vulnerable to ambient heat due to the effects of drugs on thermoregulation and their risk environment. There have been limited population-based studies of ambient temperature and drug-related morbidity. We examined short-term associations between daily ambient temperature and emergency department (ED) visits for use or overdose of amphetamine, cocaine and opioids in California during the period 2005 to 2019. Daily ZIP code-level maximum, mean, and minimum temperature exposures were derived from 1-km data Daymet products. A time-stratified case-crossover design was used to estimate cumulative non-linear associations of daily temperature for lag days 0 to 3. Stratified analyses by patient sex, race, and ethnicity were also conducted. The study included over 3.4 million drug-related ED visits. We found positive associations between daily temperature and ED visits for all outcomes examined. An increase in daily mean temperature from the 50th to the 95th percentile was associated with ED visits for amphetamine use (OR = 1.072, 95% CI: 1.058, 1.086), cocaine use (OR = 1.044, 95% CI: 1.021, 1.068 and opioid use (OR = 1.041, 95% CI: 1.025, 1.057). Stronger positive associations were also observed for overdose: amphetamine overdose (OR = 1.150, 95% CI: 1.085, 1.218), cocaine overdose (OR = 1.159, 95% CI: 1.053, 1.276), and opioid overdose (OR = 1.079, 95% CI: 1.054, 1.106). In summary, people who use stimulants and opioids may be a subpopulation sensitive to short-term higher ambient temperature. Mitigating heat exposure can be considered in harm reduction strategies in response to the substance use epidemic and global climate change.