JMIR Publications

ABSTRACT

Background:

Drug overdose deaths, particularly from opioids, are a major global burden, with 128,000 deaths estimated globally. The US, Canada and some European countries are particularly affected, with sharp increases in the last decade often linked to the emergence of new synthetic opioids. Opioid overdoses can be reversed through the timely administration of naloxone but only if responders are able to administer it in the short time frame since symptoms appear. There is an emerging body of research and development in technologies that can detect early signs of an overdose and facilitate timely responses. However, there is no overview of the state of the art in this emerging field.

Objective:

Our aim was to identify OD-specific digital technologies being developed, implemented, and evaluated. We classified the various technologies based on their characteristics and functionality as well as describing and classifying studies thematically.

Methods:

We conducted a ‘state-of-the-art review’. A systematic search was conducted in Medline, Embase, Web of Science, Scopus, ACM, IEEE and SciELO. We also searched references from articles and scanned the grey literature, including industry websites and forums. The search included terms relating to telehealth and digital technologies, drugs and overdose, and included 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 thematic analysis to classify papers according to main subject.

Results:

Included in the selection were 17 original research papers, two proof-of-concept, four reviews, three US government grant registries and six commercial devices that had not been named in peer-reviewed literature. All were published between 2017 and 2022, with a marked increase since 2019. All were based in or referred to US or Canada and concerned opioid overdose. Nine 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. Ten papers focussed on technologies to alert potential responders to an overdose and facilitate response. Eleven papers and four commercial devices described combined alert and response devices. Sensors monitor a range of vital signs, like SPO2 level, breathing rate or movement. Response devices are mostly smartphone apps to enable responders to arrive earlier to an overdose site. Closed-loop devices to detect overdose and administer naloxone are still in an experimental or proof-of-concept phase. Studies were grouped into four themes: acceptability (n=7), efficacy/effectiveness (n=5), device usage and decision-making (n=3), and description of devices (n=6). Studies showed a high level of acceptability among potential users.

Conclusions:

There has been increasing interest in 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 effectiveness studies in different countries are needed to further develop these technologies and adapt them to the different populations that might benefit from them.