Women’s multiple uses of an overdose prevention technology to mitigate risks and harms within a supportive housing environment: a qualitative study

Abstract

Background North America is amidst an opioid overdose epidemic. In many settings, particularly Canada, the majority of overdose deaths occur indoors and impact structurally vulnerable people who use drugs alone, making targeted housing-based interventions a priority. Mobile applications have been developed that allow individuals to solicit help to prevent overdose death. We examine the experiences of women residents utilizing an overdose response button technology within a supportive housing environment. Methods In October 2019, we conducted semi-structured qualitative interviews with 14 residents of a women-only supportive housing building in an urban setting where the overdose response button technology was installed. Data was analyzed thematically and framed by theories of structural vulnerability. Results While participants described the utility and disadvantages of the technology for overdose response, most participants, unexpectedly described alternate adoptions of the technology. Participants used the technology for other emergency situations (e.g., gender-based violence), rather than its intended purpose of overdose response. Conclusions Our findings highlight the limitations of current technologies while also demonstrating the clear need for housing-based emergency response interventions that address not just overdose risk but also gender-based violence. These need to be implemented alongside larger strategies to address structural vulnerabilities and provide greater agency to marginalized women who use drugs.

Willingness to use a wearable device capable of detecting and reversing overdose among people who use opioids in Philadelphia

“…Surprisingly, there is no current means to address opioid overdoses in cases where people use alone [12,13]. Previous efforts to target such populations have relied on mobile applications, which, while potentially beneficial, still require bystander intervention and high community trust [14][15][16][17]. Reliable methods of detecting severe opioid overdoses in community settings could address these challenges.…”

A qualitative study on overdose response in the era of COVID-19 and beyond: how to spot someone so they never have to use alone

“…Informal or formal spotting are tools for PWUD in this longstanding overdose crisis to reduce the number of people who use alone. Some research suggests that mobile app based technology in British Columbia may be beneficial in not only overdose prevention but in preventing co-occurring issues such as gender-based violence [44]. While our participants agreed that improved access to overdose response was crucial for their survival, they expressed hesitation to use these services if calling 911 was the policy in the event of an overdose.…”

Digital Interventions to Save Lives From the Opioid Crisis Prior and During the SARS COVID-19 Pandemic: A Scoping Review of Australian and Canadian Experiences

“…The BRAVE Technology Cooperative ( 28 ) reported 189 instances of safer use, 80 overdose reversals, and 160 instances of violence prevention. However, Bardwell et al ( 29 ) conducted semi-structured qualitative interviews ( n = 14) to examine the experience of women using this type of digital intervention and found participants were not using this solution as intended for their own drug use. Rather, it was being used for other emergencies such as gender and/or sex-work-related violence.…”

“…PWUD need to be empowered to use their agency to assess their levels of perceived risk. This cohort of women did not perceive their overdose risk as high as those around them, demonstrating a unique learning opportunity to tailor interventions to meet the specific needs of women who use drugs alone to avoid gender-based violence ( 29 ).…”