Abstract
BackgroundThe 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.MethodsWe 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.ResultsA 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.ConclusionsThe 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 registrationNCT04530591.
Highlights
The incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic
According to the Centers for Disease Control and Prevention (CDC), 47,600 people died of an opioid overdose in the USA in 2017 alone, representing over two-thirds of all drug overdose deaths [2]
The CDC reports that the number of overdose deaths attributable to fentanyl increased by over 1100% between 2013, when the increase began, and 2016 [4]
Summary
The incidence of opioid-related overdose deaths has been rising for 30 years and has been further exacerbated amidst the COVID-19 pandemic. The USA has recorded unprecedented increases in drug overdose mortality over the past 30 years, especially related to the class of opioids that includes prescription analgesics (e.g., oxycodone), heroin, and fentanyl [1]. Non-fatal overdoses cause significant physiological complications, including brain hypoxia, and have been correlated with decreased cognitive performance, increased depressive symptoms, and increased suicidal ideation [6]. Those who experience a non-fatal overdose are at greater risk of experiencing a subsequent overdose, both fatal and non-fatal. Harm reduction efforts to mitigate the long-term effects of opioid overdose are essential, with estimates of overdose rates—including both fatal and non-fatal—among people who inject drugs as high as one in five each year [7]
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