Fueled by an Epidemic: A Spatial Analysis of Opioid-Positive Drivers Fatally Injured in Motor Vehicle Collisions in West Virginia, 2011-2015.

Background: Narcotics usage is associated with an increased risk of motor vehicle collision and opioid overdose deaths are elevated in West Virginia compared to other states in the United States. This analysis sought to determine the prevalence of narcotics among drivers fatally injured in motor vehicle collisions in West Virginia and to determine if these collisions were clustered in areas of the state where opioid use/abuse is high. Methodology/Principal Findings: Fatal crash data from 2011-2015 were obtained from the Fatality Analysis Reporting System and the locations of the collisions were plotted with spatial software. Spatial analyses, including nearest neighbor indexes, heat maps and hot-spots, were conducted to determine if and where clusters of opioid-positive crashes existed. The results of the spatial analyses were visually compared to the rates of opioid overdose deaths by county, which served as a proxy of opioid use/abuse. Of the 486 drivers, 19% (n=94) tested positive for opioids. A clustering of opioid positive crashes was detected in the state overall (nearest neighbor index=0.89, p-value=0.055). Hot-spots were detected in the lower regions of the state, which overlapped counties with the highest rates of opioid overdose deaths, and cold-spots were detected in areas with lower opioid overdose death rates. Conclusions/Significance: Individuals using narcotics may still operate motor vehicles, which may pose a threat to all road users in West Virginia. Public health interventions, education, or enforcement may be needed in areas of high opioid use/abuse to raise awareness of driving under the influence of drugs.