Acceptability of Technological Solutions for Overdose Monitoring: Perspectives of People who use Drugs

Abstract

Introduction Rising overdose deaths are a devastating problem across the United States and Canada. Despite the availability of observed consumption sites in British Columbia (BC), data suggest people who use drugs (PWUD) alone in private residences are most at risk of overdose death. These individuals may not use consumption sites due to fear of stigmatization, lack of privacy, or personal preference. It is this population that would benefit from overdose monitoring alternatives. Methods This 2018 study employed two sources of data. (1) A provincial harm reduction distribution site client survey administered at 27 sites across BC asked about cell phone possession and functionality. (2) Structured interviews with PWUD in Vancouver gathered perspectives regarding monitoring devices and alerting systems. Results The client survey was administered to 486 individuals. Among 443 respondents, 48% ( n = 212) owned a cellphone and 68% ( n = 115) of individuals with a cellphone with access to internet ( n = 168) would use an application to mitigate opioid-related overdose deaths. Thirty qualitative interviews were performed; thematic analysis of the responses identified three major themes – safety, public versus private drug use, and technological monitoring and function. The relevance of technological devices was affected by the inconsistent availability of cellphones, concerns about anonymity, as well as personal comfort while using drugs. Conclusions Technological applications may not be suitable for clients with transient lifestyles, no permanent home, and lack of consistent access to a mobile device. Thorough needs assessments, considerations of lifestyle limitations, and understanding perceptions around cellphone and overdose monitoring can increase the potential that devices will be used. Highlights • 45% ( n = 219) of client survey respondents owned a cellphone • Out of cellphone owners, 59% ( n = 102) of client survey respondents had access to internet • Of 168 with internet access, 68% willing to use any applications for overdose response • Applications not suitable for transient lifestyles, no permanent home, and lack of consistent access to cellphone

Convenience and comfort: reasons reported for using drugs alone among clients of harm reduction sites in British Columbia, Canada

“…A previous study conducted by Small et al [ 21 ] showed that one of the factors PWUD take into consideration in their choice of environment is protection from law enforcement and from potential street violence or harassment, which impacts their comfort or anxiety level [ 21 ]. Individuals may also have specific rituals and preferences that influence their environment of choice when using substances [ 22 ]. Additionally, some participants’ responses implied that they had no alternative but to use alone.…”

“…While 67.4% of participants that reported using alone had a naloxone kit, the opportunity to respond may not be possible if using alone. However, some PWUD may inform friends or neighbours they are going to use, leave their door unlocked, and ask that they check on them [ 22 ]. Similarly, McLean details occurrences of people who ‘overdosed while using alone, yet were saved by friends or family who were somehow alerted to the danger’, such as hearing a thud [ 49 ].…”

“…Data collection for this study was conducted from May to August 2018 through the 2018 Harm Reduction Client Survey, which was administered at 27 harm reduction supply distribution sites across BC. The methods of site and individual recruitment have been previously described [ 11 , 15 , 22 ].…”

“…However, restrictions at observed consumption sites can create barriers for PWUD to access these services. These include limited sites that allow observed smoking, long wait times, crowded environments, and geographic inaccessibility [ 21 , 22 ]. Furthermore, women may feel safer using alone than in male-dominated OPS site environments [ 23 , 24 ].…”

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

“…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. In addition, mobile apps come with distinct limitations such as accessibility concerns and general technology barriers [45].…”