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

Keywords:

• Overdose crisis
• opioids
• people who use drugs
• technology
• fentanyl

Acknowledgements

The authors would like to acknowledge and thank all interview and survey participants and our community partners – without whom we would not be able to elicit ways to move forward with development of innovative tools for overdose monitoring. The authors thank Health Canada, Substance Use and Addictions Program, and the BC Ministry of Health for providing financial support for this project. The authors acknowledge that they work and live on the unceded traditional territories of the Sḵwx̠wú7mesh (Squamish), Sel̓íl̓witulh (Tsleil-Waututh), and xʷməθkʷəy̓əm (Musqueam) Nations and that the Harm Reduction Client Survey was conducted across the unceded traditional territories of 198 First Nations in British Columbia.

Contributors

Author VWLT conducted literature review, interview participant recruitment and data collection, and drafted the article. Author KP conducted analyses, and data interpretation for the Harm Reduction Client Survey. Authors KP, AC, and JB contributed to data interpretation, revision and feedback. All authors approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported in part by a Health Canada Substance Use and Addictions Program (SUAP) Grant and by the British Columbia Ministry of Health. JB is the principal investigator for the Harm Reduction Client Survey project funded by Health Canada. The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.