Summary of literature on virtual overdose monitoring services
| Study, year | Study design | Population | Intervention or technology | Main findings |
|---|---|---|---|---|
| Carrà et al., 2017 (9) | Pilot study | 194 opioid-dependent, treatment-seeking individuals from the United Kingdom, Germany, Italy and Denmark | The Overdose Risk Information (ORION) tool: The ORION program provided relevant information to opioid-dependent individuals about the risk of suffering a drug overdose as a result of high risk and dysfunctional behaviours. | The ORION e-health tool was successful in identifying individuals using opioids who were at high risk of drug-related overdose and subsequently provided them with information aimed at mitigating risks. |
| Kazemi et al., 2017 (8) | Systematic review* | Adolescents and adults who reported using substances | Various mobile health interventions that would assist adolescents and adults who use any kind of substance. This included technology or programs that helped with educating, reducing adverse events and cessation or reduction of substance usage. | The 12 studies included in this systematic review explored a variety of Internet- and (smart)phone-based applications in the areas of harm reduction. These technologies showed potential as future solutions for safer substance use. |
| Ferreri et al., 2018 (7) | Systematic narrative review* | People with substance use disorders | Web-based interventions and e-health program, machine learning, computerized adaptive testing, wearable devices and digital phenotyping, ecological momentary assessment, biofeedback and virtual reality for treating substance use disorder. | The 92 articles included in this review showed a potential benefit of using modern technologies in addictions and substance use management. However, the review emphasized that, for these technologies to be implemented effectively, further work must be done to clearly define their roles and their appropriateness for various populations and environments. |
| Nandakumar et al., 2019 (10) | Pilot testing and algorithm development of instrument to detect overdoses | 209 self-injection instances (194 participants); 115 injection events were used as a development set, and 94 were used as an evaluation set to measure algorithm performance | A contactless smartphone-based system using short-range active sonar system, designed to detect overdose precursors, particularly opioid-induced respiratory depression and central apnea. | An algorithm-based system for early overdose detection was able to successfully identify postopioid use apnea with a sensitivity and specificity of 96% and 98%, respectively, as well as respiratory depression with a sensitivity of 87% and specificity of 89%. Given the possibility of integrating this algorithmic system into a smartphone-based application that alerts bystanders or EMS of potential overdose, this could serve as a successful harm reduction intervention. |
| Tsang et al., 2021 (11) | Feasibility study | People in British Columbia | No intervention or technology. Surveys regarding technology ownership and uptake were administered to people who use substances across the province of British Columbia. Structured interviews with people who use substances in Vancouver were conducted to gather perspectives on overdose prevention technology that either monitors people or issues an alert for help. | Of 443 respondents, 212 (48%) owned a cellphone, of which 168 also had Internet access on their phone. Of those with a cellphone and Internet access, 115 (68%) stated they were willing to try some kind of technology intervention to prevent overdoses. Concerns were raised about the effectiveness of these programs to keep people safe given sporadic access to technology or Internet, privacy and how these services could affect people’s transient lifestyles. More investigation is required in this area to improve technology-based overdose prevention services to fully meet people’s needs. |
| Schwartz et al., 2020 (12) | Prospective observational cohort | 112 volunteers, including 57 people who use opioids and 55 community members in Philadelphia | Volunteers enrolled into an application-based overdose monitoring program. The UnityPhilly app would alert enrolled participants if someone was having a suspected overdose and provide information about their location allowing for earlier EMS activation, and for first aid and naloxone to be administered. | The program had 291 alerts, with 89 (30.6%) false alarms. Of the 202 true alerts, volunteers administered naloxone in 74 (36.6%) of cases; 43 (58.1%) incidents took place on the street and 17 (23.0%) took place in a home. Overall, 71 of the incidents were successfully reversed and 39 (52.7%) had the person recover without the need for hospital transport. |
| Perri et al., 2021 (13) | Qualitative research | 20 individuals who were involved in informal spotting between August and November 2020 | Drug spotting is an informal process whereby a person who intends to use drugs reaches out to a friend, family member, colleague or person with lived or living experience of drug use by text, phone or video and asks the spotter to monitor their drug use. | The practice of spotting may serve as a helpful addition to existing harm reduction services. However, additional policy work is needed to make this practice safer and more effective. The ongoing criminalization of drug use creates barriers for uptake and growth of spotting as a formal service. |
Note: EMS = emergency medical services.
↵* The reviews include articles that describe interventions that happen in the wider context of harm reduction, and some do not focus on virtual overdose monitoring services specifically; however, their inclusion is important for contextualizing the innovative approaches to overdose prevention.