Virtual overdose monitoring services use digital technologies, such as smartphone applications or phone lines, to provide a variety of supports focused on harm reduction, such as overdose monitoring, harm reduction education, and referrals to health and social services.• They can facilitate timely and anonymous access to emergency care for people who use substances.• During the first 14 months of operations, the National Overdose Response System monitored 2172 substance use events; 53 adverse events required emergency response and no fatalities were reported.• Based on emerging evidence, physicians may consider suggesting virtual overdose monitoring services as an additional option for harm reduction for people who are actively using substances and may require timely emergency support.• Further high-quality studies of promising virtual monitoring interventions that may improve outcomes for people who use substances are needed.
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