JMIR Publications

ABSTRACT

Background:

Opioids account for 76% of drug overdose deaths in the US, with nearly 80,000 opioid overdose deaths annually. Overdose risk is dynamic and influenced by rapidly changing behaviors and contexts that are not well captured by retrospective or infrequent assessments. Ecological momentary assessment (EMA) allows for repeated, near real-time reporting of behaviors and experiences in natural settings.

Objective:

This study evaluated the feasibility and acceptability of smartphone-based EMA for monitoring opioid use, overdose experiences, and naloxone access among people who use opioids (PWUO).

Methods:

Participants were recruited through the New Haven Syringe Services Program (NHSSP) in New Haven, Connecticut, and completed twice-daily EMA prompts for 30 days using a smartphone application. EMA measures included opioid craving, plans to use drugs, opioid use, overdose experiences, and naloxone access. Feasibility was assessed through recruitment, retention, and EMA completion rates, as well as reporting of drug use-related behaviors. Acceptability was evaluated using exit surveys assessing ease of use, burden, and privacy, along with qualitative interviews.

Results:

Of 13 individuals screened, 10 were enrolled and completed baseline assessment. Nine participants (90%) completed EMA assessments and responded to 411 prompts with an overall compliance rate of 85.0% (SD 8.7%). Compliance was similar across morning (84.2%) and evening (85.8%) surveys. Participants reported opioid cravings (257 reports), plans to use any illicit drugs (235 reports), and opioid use (385 reports) during the study period. Two participants reported overdose events (5 reports) and were carrying naloxone during each overdose report. Acceptability ratings were high: all participants reported that surveys were easy to understand and private, and most did not find them burdensome. Qualitative feedback further highlighted the ease of use, integration into daily routines, and increased self-awareness, while some participants reported emotional discomfort when reflecting on substance use.

Conclusions:

Smartphone-based EMA was feasible and acceptable among PWUO recruited through a syringe service program. EMA may support real-time monitoring of opioid use, overdose experiences, and naloxone use and may inform future digital health interventions aimed at reducing overdose risk among PWUO.