Virtual overdose monitoring services: a novel adjunctive harm reduction approach for addressing the overdose crisis

Abstract

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.

Overdose Detection Technologies—A New Frontier in Preventing Solitary Drug Overdose Deaths

“…Community members, organizations, and researchers have developed novel ODTs that actively or passively monitor, detect, and alert responders of a potential overdose event (Table). Based on existing literature, company websites, and our knowledge, we categorized ODTs as (1) telephone-based technologies; (2) mobile apps; (3) stationary wired or wireless devices; and (4) wearable biosensors. Lower-technology approaches such as scheduled room checks, callbacks, and timers are sometimes used but are time intensive and lack the consistency and reliability that ODTs can offer.…”

“…However, unlike telephone services, a benefit of encrypted app-based services such as Brave is user privacy, as they disclose the individual’s location and telephone number to EMS only during emergencies. This is similar to telephone-based peer networks that use “spotting,” in which drug use events are supervised over the telephone by trusted neighbors equipped with naloxone and remain undisclosed to authorities …”

“…The training and equipping of responders must be a key component of ODT interventions. The development of some ODT-assisted interventions (eg, Never Use Alone and Brave) has been led by people with lived experience through community participatory approaches, which prioritize meaningful participation by drug users in the intervention development process . More work to engage and reach specific populations such as minoritized groups and youth will encourage the adoption of these technologies.…”

“…emotional support, and linkage to ancillary services. 6,7 In the case of apps, such as Canary-Prevent Overdose and Brave, 7,8 regular access to a smartphone, electricity, and internet connection is required, which can be a challenge among individuals experiencing homelessness or economic disadvantage. Additionally, these services require a predetermined, trained bystander to respond to each event.…”

Receiving and providing virtual harm reduction and peer-based support

“…In February 2021, Jessica began using the National Overdose Response Service (NORS), a virtual supervised consumption program that operates 24/7 across all 10 provinces and 3 territories. 1 Jessica used the service when she could not make it to the physical SCS. Over time, she formed relationships with the peer and trauma-informed operators she talked to on the phone.…”