The acceptability of overdose alert and response technologies: introducing the TPOM-ODART framework

Abstract

Background Opioids were implicated in approximately 88,000 fatal overdoses (OD) globally. However, in principle all opioid OD are reversible with the timely administration of naloxone hydrochloride. Despite the widespread availability of naloxone among people who use opioids (PWUO), many who suffer fatal OD use alone, without others present to administer the reversal agent. Recognising this key aspect of the challenge calls for innovations, a number of technological approaches have emerged which aim to connect OD victims with naloxone. However, the acceptability of OD response technologies to PWUO is of key concern. Methods Drawing on the Technology People Organisations Macroenvironment (TPOM) framework, this study sought to integrate acceptability-related findings in this space with primary research data from PWUO, affected family members and service providers to understand the factors involved in harm reduction technology acceptability. A qualitative study using a focus group methodology was conducted. The participant groups were people with lived experience of problem opioid use, affected family members and service providers. Data analysis followed a multi-stage approach to thematic analysis and utilised both inductive and deductive methods. Results Thirty individuals participated in one of six focus groups between November 2021 and September 2022. The analysis generated six major themes, three of which are reported in this article—selected for their close relevance to PWUO and their importance to developers of digital technologies for this group. ‘Trust—in technologies, systems and people’ was a major theme and was closely linked to data security, privacy and confidentiality. ‘Balancing harm reduction, safety and ambivalence’ reflects the delicate balance technological solutions must achieve to be acceptable to PWUO. Lastly, ‘readiness—a double bind’ encapsulates the perception shared across participant groups, that those at the highest risk, may be the least able to engage with interventions. Conclusion Effective digital strategies to prevent fatal OD must be sensitive to the complex relationships between technological, social/human, organisational and wider macroenvironmental factors which can enable or impede intervention delivery. Trust, readiness and performance are central to technology acceptability for PWUO. An augmented TPOM was developed (the TPOM-ODART).

What impacts the acceptability of wearable devices that detect opioid overdose in people who use opioids? A qualitative study

“…Accuracy of detection was unanimously found to facilitate acceptance and was of increased importance in our findings than when implicated in other studies [21,25,27]. An inaccurate device, unable to detect an overdose and differentiate between an optimal state of being high and an overdose, would be unacceptable, cause irritation and discontinuation of device use.…”

“…However, our analysis identified that individuals of 'high risk-high benefit' faced multi-thematic barriersencompassing device, individual and environment and were therefore perceived to lack the facilities for meaningful engagement and reduced efficacy of intervention. Research in Scotland found similar results, whereby willingness to engage and individuals in high need of solutions were considered not compatible, constituting a 'readiness double bind' dilemma [25]. Readiness to accept an intervention was considered a recovery decision, echoed in part within our stage of addiction recovery subtheme.…”

“…Building on previous studies [21], our results indicate discretion would facilitate acceptability across all device types, driven by a desire to avoid stigmatisation. Discretion as a facilitator for use of wearables is not unique to PWUO [31][32][33] but the ability of a device to identify PWUO to employers, police or members of the public and face potential maltreatment, reinforces the need for inconspicuousness [25]. Training for non-specialist professionals is recommended to combat stigmatising attitudes towards PWUO.…”

“…Our participants did, however, identify opportunities to overcome the double-bind which often presented at points of involuntary engagement with peripheral services and where risk of overdose is increased (prison-release, probation and release from hospital admission). Despite findings across wearable device acceptability research indicating addiction and harm-minimisation services to be conducive to developing trust in an intervention [21,25,27], identification of peripheral services as potential stakeholders should be investigated as alternate routes to reaching underserved populations.…”

“…In Northern Ireland, focus groups of people who previously used illicit opioids found a commercial smartwatch to be generally acceptable and subsequently demonstrated successful device data transfer from participants (n = 3) to the study team [24]. A qualitative study from Scotland explored acceptability among PWUO (n = 9), affected family members (n = 4) and service workers (n = 17) and identified high overall willingness to use these devices and crucial modulating factors such as trust, the type of end-user and avoiding interruption of the 'high' [25].…”