The nexus of environmental heat, health risk, and drug overdoses in America’s hottest metropolitan region - PROJECT SUMMARY Overdose deaths remain a significant public health problem in the US. Arizona overdose mortality data show seasonal variation with significant surge in overdose deaths in the summer months. Despite increasing concerns about the health impacts of environmental heat, there has been a limited understanding of how extreme heat conditions interact with drug-related risks and associated psychosocial vulnerabilities. Given rapidly increasing frequency of extreme heat events in the US and globally due to climate change, there is an urgent need to generate actionable data on the intersection of environmental heat and dug use-related risks to develop effective policies and harm reduction interventions. The overarching goal of the proposed multi-PI R01 study (NOT-ES-22-006: Notice of Special Interest: Climate Change and Health) is to investigate the association between environmental heat and drug overdose- related risks among persons who use drugs in Phoenix, Arizona, America’s hottest metropolitan area. Our multidisciplinary team includes researchers from ASU College of Health Solutions, Urban Climate Research Center, and School of Social Work, along with the key community partners including the City of Phoenix Office of Public Health, Arizona's Medicaid agency (AHCCCS), and Southwest Recovery Alliance, a grassroots harm reduction organization. The proposed study builds on a mixed-methods approach and innovative integration of a) big data analytics of Arizona Medicaid and hospital discharge data on drug-related emergency department visits and death certificate data on overdose deaths (2017-2025), along with high-precision climate data, b) in-depth, qualitative interviews with persons who use drugs (N=80), and c) key stakeholder focus groups (N=30) to provide a comprehensive and multi-faceted assessment of heat-related risks and impacts on people who use drugs in Metro Phoenix, Arizona. Specific aims are: Aim 1: Leverage big data analytics to identify the specific urban heat characteristics, person-level and housing factors, and mediating effects of service use that impact fatal and non-fatal drug-related overdose and hospital events in the Phoenix metro area. Aim 2: Through in-depth, qualitative interviews (N=80), characterize how individuals who use drugs perceive, experience, and navigate heat-related risks in the context of their daily drug use practices, access to services, and other structural and social vulnerabilities. Aim 3: Identify priority intervention and policy response strategies to address the heat-related risks for persons who use drugs through focus groups with key stakeholders (N=30), including public health practitioners, treatment providers, harm reduction coordinators, and other service providers and policymakers. The study is highly significant because it will provide actionable data on the intersection of environmental heat and drug-related risks to help identify key needs and potential solutions in the context of climate change.
