New Jersey’s Opioid Gap Persists as High-Risk Counties Fall Further Behind

Socially vulnerable counties face higher overdose deaths and treatment needs, findings that could help prioritize funding and programming responses, according to Rutgers researchers

Opioids such as fentanyl are “indiscriminate killers,” that can be misused by people from all walks of life. But where you live may be more influential than previously realized, according to researchers at Rutgers University.

In a study of New Jersey counties, researchers discovered that between 2014 and 2022, the likelihood of being treated for an opioid use disorder or dying from an overdose was sharply higher in counties with elevated social vulnerability scores.

Additionally, the gap in opioid risk between counties with high and low vulnerability hasn’t budged in more than a decade. On some measures, it has widened.

“Our findings demonstrate that high vulnerability counties had greater upward trends for all substance use disorder treatment and overdose measures, as well as higher baseline and peak rates,” said Jamey Lister, an associate professor at the Rutgers School of Social Work, and the principal investigator and corresponding author of the study published in the journal Addictive Behaviors Reports. 

“Taken together, our analysis shows why high vulnerability counties should receive prioritized efforts, while also illustrating a practical example of how data can offer a simple tool for policymakers and system leaders to use when implementing behavioral health service and workforce expansion efforts,” Lister said.

In the mid-2010s, New Jersey experienced a surge in opioid overdose fatalities, going from 14.71 deaths per 100,000 residents in 2014 to a high of 34.01 deaths in 2019. Programs, such as the expansion of overdose reversal medications and evidence-based treatment services providing buprenorphine or methadone, helped to halt the climb. In 2022, the rate was 31.34 deaths per 100,000. 

But the slight decline wasn’t universal, and the disparity at the county level remains significant. In 2023, drug-related overdose deaths – including from opioids – ranged from 9.2 per 100,000 in Somerset County to 58.1 in Atlantic County, according to the National Center for Health Statistics.

To assess and compare opioid-related treatment admissions and overdose patterns over time in New Jersey, Lister and his student research mentees from the Rutgers School of Social Work created a dataset to identify differences in county-level risk and need.

First, the research team, which includes collaborators from the Rutgers Center for Integrated Care, determined regional risk levels for hazards and community-level stressors, such as disease burden and natural disasters. Using the Social Vulnerability Index (SVI), a U.S. Centers for Disease Control and Prevention tool that tracks variables such as socio-economic status and availability of public transportation, they grouped counties as either “high” or “low” social vulnerability.

Next, they collated public data for all 21 New Jersey counties during the study period. County-level data was sourced from the state’s Division of Mental Health and Addiction Services, the N.J. Office of the Attorney General and the U.S. Census Bureau. Measures included substance use treatment admissions, opioid-specific treatment admissions, overdose deaths and naloxone administrations by law enforcement and medical workers.

By merging the public data with SVI rankings, the researchers found high vulnerability counties (such as Atlantic) exhibited consistently higher rates of adverse opioid-related outcomes compared with low-vulnerability counties (such as Somerset).

They also found gaps between high- and low-vulnerability communities remained the same or widened during the study period. For instance, opioid-specific treatment admissions and naloxone administrations in low SVI counties peaked in 2017 and then decreased. In high SVI counties, rates either plateaued or increased after 2017. 

Additionally, in high SVI counties, after overdose death rates peaked in 2017, they continued to increase marginally year over year. In low SVI counties, rates of overdose deaths plateaued. 

Taken together, the findings highlight “a need for expanded substance use services along the continuum of care for vulnerable areas,” the researchers wrote. 

More research is needed to understand the drivers linking social vulnerability with poor opioid outcomes, said Lister, adding that past research in other states has shown counties with more disadvantages have fewer addiction services, suggesting that opioid-treatment policies should focus first on more vulnerable communities.

“Things were bad a decade ago,” said Sarah Cooper, a doctoral student at the Rutgers University School of Social Work and first author of the study. “They’re slightly better today. But progress hasn’t been universal. As these data demonstrate, opioid risk vulnerability varies by county. Initiatives designed to tackle the ongoing health crisis must consider this disparity of need.”