Abstract
BACKGROUND: Since 1999, drug overdose deaths have surged in the United States. There is considerable geographic variability in overdose patterns, state laws, overdose prevention infrastructure, and opioid settlement amounts and investments. To guide localized overdose prevention, it is important to analyze these data and understand heterogeneity. METHODS: In this descriptive analysis across six states-Massachusetts, Minnesota, Missouri, Nevada, New York, and Rhode Island, we compared five key domains essential to understanding overdose epidemics, prevention, and policy responses: (1) drug overdose mortality trends by substance and race/ethnicity (2018-2023); (2) state harm reduction laws; (3) availability and coverage of overdose prevention services; (4) opioid settlement funding and spending; and (5) availability and comprehensiveness of publicly available overdose-related data. Data were drawn from publicly available sources and legal information confirmed using Westlaw. RESULTS: All states experienced rising overdose death rates between 2018 and 2023, with significant racial/ethnic disparities. All states have enacted laws to increase access to naloxone. Naloxone distribution rates vary widely, but most states have high availability. Implementation of other harm reduction services differed across states, as well as drug paraphernalia laws. Opioid settlement funding per capita and transparency in spending and planning also differed across states. Some dashboards provided detailed fatal and nonfatal overdose and intervention data stratified by sociodemographics. CONCLUSION: State-specific differences in overdose patterns, harm reduction laws, prevention infrastructure, and settlement spending underscore the need for localized, tailored strategies. This study's state-specific profiles lay the groundwork for more advanced decision-support tools to guide effective overdose prevention.