Willingness to use a wearable device capable of detecting and reversing overdose among people who use opioids in Philadelphia

Abstract

Background The incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic. Naloxone can reverse opioid overdose, lower death rates, and enable a transition to medication for opioid use disorder. Though current formulations for community use of naloxone have been shown to be safe and effective public health interventions, they rely on bystander presence. We sought to understand the preferences and minimum necessary conditions for wearing a device capable of sensing and reversing opioid overdose among people who regularly use opioids. Methods We conducted a combined cross-sectional survey and semi-structured interview at a respite center, shelter, and syringe exchange drop-in program in Philadelphia, Pennsylvania, USA, during the COVID-19 pandemic in August and September 2020. The primary aim was to explore the proportion of participants who would use a wearable device to detect and reverse overdose. Preferences regarding designs and functionalities were collected via a questionnaire with items having Likert-based response options and a semi-structured interview intended to elicit feedback on prototype designs. Independent variables included demographics, opioid use habits, and previous experience with overdose. Results A total of 97 adults with an opioid use history of at least 3 months were interviewed. A majority of survey participants (76%) reported a willingness to use a device capable of detecting an overdose and automatically administering a reversal agent upon initial survey. When reflecting on the prototype, most respondents (75.5%) reported that they would wear the device always or most of the time. Respondents indicated discreetness and comfort as important factors that increased their chance of uptake. Respondents suggested that people experiencing homelessness and those with low tolerance for opioids would be in greatest need of the device. Conclusions The majority of people sampled with a history of opioid use in an urban setting were interested in having access to a device capable of detecting and reversing an opioid overdose. Participants emphasized privacy and comfort as the most important factors influencing their willingness to use such a device. Trial registration NCT04530591.

Perceptions on wearable sensor-based interventions for monitoring of opioid therapy: A qualitative study

“…Numerous individual-level factors are known to impact the acceptability of wearable sensor-based health interventions, including cognitive ability, social characteristics, technical knowledge, and cultural norms (23)(24)(25)(26)(27). Within the SUD treatment space, our work and other investigators have found generally high acceptability among individuals who are actively using drugs (including cocaine and opioids) and those in recovery from SUDs (28)(29)(30). However understanding the specific factors that impact usability and create barriers to use will be critical: user experience, specifically stigma and device discreetness need to be evaluated in the target populations under unsupervised conditions to determine feasibility of device deployment.…”

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

“…We classified technologies into 3 main groups according to their main function, namely, “OD alert,” “OD response,” and “combined OD alert and response.” These are shown in Tables 1 - 3 . Multimedia Appendix 2 [ 24 - 38 , 40 - 47 ] displays more detailed information about each study (ie, intervention, function, focus, device, theme, and study design). Although there is frequently a degree of overlap between the first 2 groups, as all devices ultimately need to combine OD alert and response, this classification is based on the main focus of the study.…”

“…At present, the studies we identified are in the prototype phase and are more focused on the antidote dispenser than on the sensor. A total of 9% (1/11) of the studies simply suggested such a device as a concept to assess its acceptability in a survey [ 38 ].…”

Closed-loop wearable naloxone injector system

“…Opioid overdoses can be reversed rapidly with naloxone, a drug that is widely available to emergency medical services (EMS) and increasingly the general public. However, up to 51.8% of fatal overdoses occur when the person is alone, and in 27.4% of cases bystanders do not recognize the symptoms of an overdose and are not able to react in a timely manner 28 . Additionally, EMS may not always be able to respond promptly if the overdosed patient is in a less accessible location, such as in rural areas.…”

“…Subsequent human factor studies are needed to assess the comfort and discreetness of the device when worn for longer periods of time, particularly in unsupervised settings. In a recent study 28 involving 97 adults with an opioid-use history of at least three months 76% of participants were willing to wear a closed-loop device for sensing an overdose and delivering a reversal agent upon detection. Almost all (75.5%) respondents indicated a willingness to wear the device all or most of the time.…”