Overdose Alert and Response Technologies: State-of-the-art Review

Abstract

Background Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated in 2019. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer it. There is an emerging body of research and development in technologies that can detect the early signs of an overdose and facilitate timely responses. Objective Our aim was to identify and classify overdose-specific digital technologies being developed, implemented, and evaluated. Methods We conducted a “state-of-the-art review.” A systematic search was conducted in MEDLINE, Embase, Web of Science, Scopus, ACM, IEEE Xplore, and SciELO. We also searched references from articles and scanned the gray literature. The search included terms related to telehealth and digital technologies, drugs, and overdose and papers published since 2010. We classified our findings by type of technology and its function, year of publication, country of study, study design, and theme. We performed a thematic analysis to classify the papers according to the main subject. Results Included in the selection were 17 original research papers, 2 proof-of-concept studies, 4 reviews, 3 US government grant registries, and 6 commercial devices that had not been named in peer-reviewed literature. All articles were published between 2017 and 2022, with a marked increase since 2019. All were based in or referred to the United States or Canada and concerned opioid overdose. In total, 39% (9/23) of the papers either evaluated or described devices designed to monitor vital signs and prompt an alert once a certain threshold indicating a potential overdose has been reached. A total of 43% (10/23) of the papers focused on technologies to alert potential responders to overdoses and facilitate response. In total, 48% (11/23) of the papers and 67% (4/6) of the commercial devices described combined alert and response devices. Sensors monitor a range of vital signs, such as oxygen saturation level, respiratory rate, or movement. Response devices are mostly smartphone apps enabling responders to arrive earlier to an overdose site. Closed-loop devices that can detect an overdose through a sensor and automatically administer naloxone without any external intervention are still in the experimental or proof-of-concept phase. The studies were grouped into 4 themes: acceptability (7/23, 30%), efficacy or effectiveness (5/23, 22%), device use and decision-making (3/23, 13%), and description of devices (6/23, 26%). Conclusions There has been increasing interest in the research and application of these technologies in recent years. Literature suggests willingness to use these devices by people who use drugs and affected communities. More real-life studies are needed to test the effectiveness of these technologies to adapt them to the different settings and populations that might benefit from them.

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

“…The development of overdose alert and response technologies (ODART) follows shifts over the past decade towards digitally mediated support options [ 18 , 19 ], while research in this area increased significantly during the COVID-19 pandemic, driven by restrictions on face-to-face service provision [ 20 , 21 ]. Yet, the acceptability of such technologies to PWUO remains a key concern [ 22 ], anticipating a negative impact to the uptake of, and engagement in, these interventions.…”

“…Oteo et al [ 19 ] offered an overview of different technologies developed internationally to address fatal overdose. In summary, their review identified [ 1 ] wearable devices and sonar-based room sensors which detect indices of overdose and broadcast alerts, and [ 2 ] smartphone applications which monitor drug use, provide OD prevention information and/or support the development of naloxone responder networks.…”

Rapid opioid overdose response system technologies

“…Smartphone applications are perhaps the commonest form of ROOST [20 ▪▪ ,44 ▪▪ ]. Smartphones are a prerequisite to the functionality of several other ROORS technologies, for example, in providing connectivity to wearable sensors, to collect EMA data, and geolocating individuals at risk of an opioid overdose [45].…”

“…Smartphones are a prerequisite to the functionality of several other ROORS technologies, for example, in providing connectivity to wearable sensors, to collect EMA data, and geolocating individuals at risk of an opioid overdose [45]. Specific to ROORS delivery, smartphone applications have been used to identify locations where naloxone is available, to provide training in the use of naloxone, and to link people who are at risk of an opioid overdose to volunteer community based first responders and emergency services [20 ▪▪ ,44 ▪▪ ,46].…”

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

“…Respiratory depression is a physiological hallmark of opioid overdose, in which there is disruption of the regular breathing rhythm, suppression of breathing and potential respiratory failure. Devices are now being designed [9] and repurposed [10,11] with the aim of detecting opioid overdose using various measures or responding to crises events [12][13][14]. Determining the acceptability of wearable devices and the facilitators and barriers of use is a necessary step in the development of new technologies demonstrated in a range of medical conditions [15][16][17][18].…”