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Ciatti JL, Vázquez-Guardado A, Brings VE, Park J, Ruyle B, Ober RA, McLuckie AJ, Talcott MR, Carter EA, Burrell AR, Sponenburg RA, Trueb J, Gupta P, Kim J, Avila R, Seong M, Slivicki RA, Kaplan MA, Villalpando-Hernandez B, Massaly N, Montana MC, Pet M, Huang Y, Morón JA, Gereau RW, Rogers JA. An autonomous implantable device for the prevention of death from opioid overdose. SCIENCE ADVANCES 2024; 10:eadr3567. [PMID: 39441938 PMCID: PMC11498215 DOI: 10.1126/sciadv.adr3567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Accepted: 09/17/2024] [Indexed: 10/25/2024]
Abstract
Opioid overdose accounts for nearly 75,000 deaths per year in the United States, now a leading cause of mortality among young people aged 18 to 45 years. At overdose levels, opioid-induced respiratory depression becomes fatal without the administration of naloxone within minutes. Currently, overdose survival relies on bystander intervention, requiring a nearby person to find the overdosed individual and have immediate access to naloxone to administer. To circumvent the bystander requirement, we developed the Naloximeter: a class of life-saving implantable devices that autonomously detect and treat overdose while simultaneously contacting first responders. We present three Naloximeter platforms, for fundamental research and clinical translation, all equipped with optical sensors, drug delivery mechanisms, and a supporting ecosystem of technology to counteract opioid-induced respiratory depression. In small and large animal studies, the Naloximeter rescues from otherwise fatal opioid overdose within minutes. This work introduces life-changing, clinically translatable technologies that can broadly benefit a susceptible population recovering from opioid use disorder.
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Affiliation(s)
- Joanna L. Ciatti
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Abraham Vázquez-Guardado
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Electrical and Computer Engineering, North Carolina State University, Raleigh, NC 27606, USA
| | - Victoria E. Brings
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Jihun Park
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Brian Ruyle
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University, St. Louis, MO 63110, USA
| | - Rebecca A. Ober
- Center for Comparative Medicine, Northwestern University, Evanston, IL 60208, USA
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Alicia J. McLuckie
- Center for Comparative Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Michael R. Talcott
- Division of Cardiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Emily A. Carter
- Center for Comparative Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Amy R. Burrell
- Center for Comparative Medicine, Northwestern University, Evanston, IL 60208, USA
| | - Rebecca A. Sponenburg
- Chemistry of Life Processes Institute (Quantitative Bio-element Imaging Center), Northwestern University, Evanston, IL 60208, USA
| | - Jacob Trueb
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Prashant Gupta
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Joohee Kim
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Raudel Avila
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Minho Seong
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Richard A. Slivicki
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Melanie A. Kaplan
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Bryan Villalpando-Hernandez
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
| | - Nicolas Massaly
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Michael C. Montana
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Mitchell Pet
- Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Yonggang Huang
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Mechanical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Jose A. Morón
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University, St. Louis, MO 63110, USA
| | - Robert W. Gereau
- Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
- Department of Neuroscience, Washington University, St. Louis, MO 63110, USA
- Department of Biomedical Engineering, Washington University, St. Louis, MO 63110, USA
| | - John A. Rogers
- Department of Materials Science and Engineering, Northwestern University, Evanston, IL 60208, USA
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL 60208, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL 60208, USA
- Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
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Daneshvar H, Carver H, Strachan G, Greenhalgh J, Matheson C. From Digital Inclusion to Digital Transformation in the Prevention of Drug-Related Deaths in Scotland: Qualitative Study. J Med Internet Res 2024; 26:e52345. [PMID: 39316786 PMCID: PMC11462095 DOI: 10.2196/52345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/23/2024] [Accepted: 07/31/2024] [Indexed: 09/26/2024] Open
Abstract
BACKGROUND Globally, drug-related deaths (DRDs) are increasing, posing a significant challenge. Scotland has the highest DRD rate in Europe and one of the highest globally. The Scottish Government launched the Digital Lifelines Scotland (DLS) program to increase the provision of digital technology in harm reduction services and other support services. Digital technology responses to DRDs can include education through digital platforms, improved access to treatment and support via telehealth and mobile apps, analysis of data to identify risk factors, and the use of digital tools for naloxone distribution. However, digital technology should be integrated into a comprehensive approach that increases access to services and addresses underlying causes. Digital transformation could enhance harm reduction service and support, but challenges must be addressed for successful implementation. The DLS program aims to enhance digital inclusion and improve health outcomes for people who use or are affected by drug use to reduce the risk of DRDs. OBJECTIVE This study aims to explore the role of digital technology as an enabler and supporter in enhancing existing services and innovating new solutions, rather than being a stand-alone solution. Specifically focusing on individuals who use drugs, the research investigates the potential of digital inclusion and technology provision for preventing DRDs within the context of the DLS program. METHODS Semistructured interviews were conducted with 47 people: 21 (45%) service users, 14 (30%) service providers, and 12 (26%) program staff who were all involved in DLS. Interviews were audio recorded, transcribed, and then coded. Analysis was done in three phases: (1) thematic analysis of interview data to identify the benefits of digital technologies in this sector; (2) identification of the challenges and enablers of using digital technologies using the Technology, People, Organizations, and Macroenvironment conceptual framework; and (3) mapping digital technology provision to services offered to understand the extent of digital transformation of the field. RESULTS Participants identified increased connectivity, enhanced access to services, and improved well-being as key benefits. Digital devices facilitated social connections, alleviated loneliness, and fostered a sense of community. Devices enabled engagement with services and support workers, providing better access to resources. In addition, digital technology was perceived as a preventive measure to reduce harmful drug use. Lack of technical knowledge, organizational constraints, and usability challenges, including device preferences and security issues, were identified. CONCLUSIONS The study found that digital inclusion through the provision of devices and connections has the potential to enhance support in the harm reduction sector. However, it highlighted the limitations of existing digital inclusion programs in achieving comprehensive digital transformation. To progress, there is a need for sustained engagement, cultural change, and economic considerations to overcome barriers.
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Affiliation(s)
- Hadi Daneshvar
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, United Kingdom
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Graeme Strachan
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Jessica Greenhalgh
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
| | - Catriona Matheson
- Faculty of Social Sciences, University of Stirling, Stirling, United Kingdom
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Ciatti JL, Vazquez-Guardado A, Brings VE, Park J, Ruyle B, Ober RA, McLuckie AJ, Talcott MR, Carter EA, Burrell AR, Sponenburg RA, Trueb J, Gupta P, Kim J, Avila R, Seong M, Slivicki RA, Kaplan MA, Villalpando-Hernandez B, Massaly N, Montana MC, Pet M, Huang Y, Morón JA, Gereau RW, Rogers JA. An Autonomous Implantable Device for the Prevention of Death from Opioid Overdose. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.06.27.600919. [PMID: 39005313 PMCID: PMC11244915 DOI: 10.1101/2024.06.27.600919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Opioid overdose accounts for nearly 75,000 deaths per year in the United States, representing a leading cause of mortality amongst the prime working age population (25-54 years). At overdose levels, opioid-induced respiratory depression becomes fatal without timely administration of the rescue drug naloxone. Currently, overdose survival relies entirely on bystander intervention, requiring a nearby person to discover and identify the overdosed individual, and have immediate access to naloxone to administer. Government efforts have focused on providing naloxone in abundance but do not address the equally critical component for overdose rescue: a willing and informed bystander. To address this unmet need, we developed the Naloximeter: a class of life-saving implantable devices that autonomously detect and treat overdose, with the ability to simultaneously contact first-responders. We present three Naloximeter platforms, for both fundamental research and clinical translation, all equipped with optical sensors, drug delivery mechanisms, and a supporting ecosystem of technology to counteract opioid-induced respiratory depression. In small and large animal studies, the Naloximeter rescues from otherwise fatal opioid overdose within minutes. This work introduces life-changing, clinically translatable technologies that broadly benefit a susceptible population recovering from opioid use disorder.
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Strachan G, Daneshvar H, Carver H, Greenhalgh J, Matheson C. Using digital technology to reduce drug-related harms: a targeted service users' perspective of the Digital Lifelines Scotland programme. Harm Reduct J 2024; 21:128. [PMID: 38951880 PMCID: PMC11218389 DOI: 10.1186/s12954-024-01012-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/30/2024] [Indexed: 07/03/2024] Open
Abstract
BACKGROUND Deaths due to drug overdose are an international issue, causing an estimated 128,000 global deaths in 2019. Scotland has the highest rate of drug-related deaths in Europe, with those in the most deprived areas at greater risk than those in affluent areas. There is a paucity of research on digital solutions, particularly from the perspective of those who use drugs who additionally access harm reduction and homelessness support services. The Digital Lifelines Scotland programme (DLS) provides vulnerable people who use/d drugs with digital devices to connect with services. METHODS This paper reports on the evaluation of the DLS from the perspective of service users who accessed services for those at risk of drug-related harms. A mixed methods approach was used including an online-survey (n = 19) and semi-structured interviews (n = 21). Survey data were analysed descriptively and interview data through inductive coding, informed by the Technology, People, Organisations and Macroenvironmental factors (TPOM) framework, to investigate the use, access, and availability of devices, and people's experiences and perceptions of them. RESULTS Most participants lived in social/council housing (63.2%, n = 12), many lived alone (68.4%, n = 13). They were mainly over 40 years old and lived in a city. Participants described a desire for data privacy, knowledge, and education, and placed a nascent social and personal value on digital devices. Participants pointed to the person-centred individuality of the service provision as one of the reasons to routinely engage with services. Service users experienced an increased sense of value and there was a palpable sense of community, connection and belonging developed through the programme, including interaction with services and devices. CONCLUSIONS This paper presents a unique perspective which documents the experiences of service users on the DLS. Participants illustrated a desire for life improvement and a collective and individual feeling of responsibility towards themselves and digital devices. Digital inclusion has the potential to provide avenues by which service users can safely and constructively access services and society to improve outcomes. This paper provides a foundation to further cultivate the insight of service users on digital solutions in this emerging area.
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Affiliation(s)
- Graeme Strachan
- Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Hadi Daneshvar
- Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK.
| | - Hannah Carver
- Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Jessica Greenhalgh
- Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Catriona Matheson
- Faculty of Social Sciences, University of Stirling, Stirling, FK9 4LA, UK
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Rioux W, Taplay P, Morris-Miller L, Ghosh SM. Implementing Canada's first national virtual phone based overdose prevention service: lessons learned from creating the National Overdose Response Service (NORS). Harm Reduct J 2024; 21:102. [PMID: 38807227 PMCID: PMC11131261 DOI: 10.1186/s12954-024-01017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 05/06/2024] [Indexed: 05/30/2024] Open
Abstract
The opioid epidemic remains one of the largest public health crises in North America to date. While there have been many diverse strategies developed to reduce the harms associated with substance use, these are primarily concentrated within a few large urban centers. As a result, there have been increased calls for equitable access to harm reduction services for those who cannot or choose not to access in-person harm reduction services. In December 2020, Canada's National Overdose Response Service (NORS) a telephone based overdose response hotline and virtual supervised consumption service, was established in collaboration with various agencies and people with lived and living experience of substance use (PWLLE) across Canada to expand access to harm reduction services using novel Opioid Response Technology. In this manuscript we explore the lessons learned from the establishment and continued operation of the service exploring topics related to the initial establishment of the service, securing a phone line, routing technology, EMS dispatch solutions, peer and volunteer recruitment, legal and ethical support, policy and procedure development, securing funding, and marketing. Furthermore, we detail how this service has grown and changed in response to the various needs of service users.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
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Rioux W, Kilby K, Jones S, Joshi P, Vandenberg S, Ghosh SM. Perspectives of healthcare workers on the integration of overdose detection technologies in acute care settings. Addict Sci Clin Pract 2024; 19:4. [PMID: 38217056 PMCID: PMC10785401 DOI: 10.1186/s13722-023-00433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/15/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND People who use drugs (PWUD) face disproportionately high rates of hospitalizations and patient-initiated discharge (leaving against medical advice), explained by a combination of stigma, withdrawal, judgment, blame, and improper pain management. In addition, evidence has shown that despite abstinence-based policies within healthcare settings, PWUD continue to use their substances in healthcare environments often hidden away from hospital staff, resulting in fatalities. Various novel overdose detection technologies (ODTs) have been developed with early adoption in a few settings to reduce the morbidity and mortality from risky substance use patterns within healthcare environments. Our study aimed to gain the perspectives of healthcare workers across Canada on implementing ODTs within these settings. METHOD We used purposive and snowball sampling to recruit 16 healthcare professionals to participate in semi-structured interviews completed by two evaluators. Interview transcripts were analyzed using thematic analysis to identify key themes and subthemes. RESULTS Participants recognized ODTs as a potentially feasible solution for increasing the safety of PWUD in healthcare settings. Our results suggest the mixed ability of these services to decrease stigma and build rapport with PWUD. Participants further highlighted barriers to implementing these services, including pre-established policies, legal recourse, and coordination of emergency responses to suspected overdoses. Lastly, participants highlight that ODTs should only be one part of a multifaceted approach to reducing harm in healthcare settings and could currently be integrated into discharge planning. CONCLUSION Healthcare professionals from across Canada found ODTs to be an acceptable intervention, but only as part of a larger suite of harm reduction interventions to reduce the harms associated with illicit drug use in healthcare settings. In contrast, participants noted institutional policies, stigma on behalf of healthcare workers and leadership would present significant challenges to their uptake and dissemination.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kyle Kilby
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Calgary, Calgary, AB, Canada
| | | | - Pamela Joshi
- Provincial Perinatal Substance Use Program, BC Women's Hospital & Health Center, Provincial Health Services Authority, Vancouver, Canada
| | | | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Tas B, Walker H, Lawn W, Matcham F, Traykova EV, Evans RAS, Strang J. What impacts the acceptability of wearable devices that detect opioid overdose in people who use opioids? A qualitative study. Drug Alcohol Rev 2024; 43:213-225. [PMID: 37596977 DOI: 10.1111/dar.13737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION Drug-related deaths involving an opioid are at all-time highs across the United Kingdom. Current overdose antidotes (naloxone) require events to be witnessed and recognised for reversal. Wearable technologies have potential for remote overdose detection or response but their acceptability among people who use opioids (PWUO) is not well understood. This study explored facilitators and barriers to wearable technology acceptability to PWUO. METHODS Twenty-four participants (79% male, average age 46 years) with current (n = 15) and past (n = 9) illicit heroin use and 54% (n = 13) who were engaged in opioid substitution therapy participated in semi-structured interviews (n = 7) and three focus groups (n = 17) in London and Nottingham from March to June 2022. Participants evaluated real devices, discussing characteristics, engagement factors, target populations, implementation strategies and preferences. Conversations were recorded, transcribed and thematically analysed. RESULTS Three themes emerged: device-, person- and environment-specific factors impacting acceptability. Facilitators included inconspicuousness under the device theme and targeting subpopulations of PWUO at the individual theme. Barriers included affordability of devices and limited technology access within the environment theme. Trust in device accuracy for high and overdose differentiation was a crucial facilitator, while trust between technology and PWUO was a significant environmental barrier. DISCUSSION AND CONCLUSIONS Determinants of acceptability can be categorised into device, person and environmental factors. PWUO, on the whole, require devices that are inconspicuous, comfortable, accessible, easy to use, controlled by trustworthy organisations and highly accurate. Device developers must consider how the type of end-user and their environment moderate acceptability of the device.
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Affiliation(s)
- Basak Tas
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Hollie Walker
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Will Lawn
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Clinical Psychopharmacology Unit, University College London, London, UK
| | - Faith Matcham
- School of Psychology, University of Sussex, Falmer, UK
| | - Elena V Traykova
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rebecca A S Evans
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Strang
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
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Scheibein F, Caballeria E, Taher MA, Arya S, Bancroft A, Dannatt L, De Kock C, Chaudhary NI, Gayo RP, Ghosh A, Gelberg L, Goos C, Gordon R, Gual A, Hill P, Jeziorska I, Kurcevič E, Lakhov A, Maharjan I, Matrai S, Morgan N, Paraskevopoulos I, Puharić Z, Sibeko G, Stola J, Tiburcio M, Tay Wee Teck J, Tsereteli Z, López-Pelayo H. Optimizing Digital Tools for the Field of Substance Use and Substance Use Disorders: Backcasting Exercise. JMIR Hum Factors 2023; 10:e46678. [PMID: 38085569 PMCID: PMC10751634 DOI: 10.2196/46678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 07/14/2023] [Accepted: 08/12/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Substance use trends are complex; they often rapidly evolve and necessitate an intersectional approach in research, service, and policy making. Current and emerging digital tools related to substance use are promising but also create a range of challenges and opportunities. OBJECTIVE This paper reports on a backcasting exercise aimed at the development of a roadmap that identifies values, challenges, facilitators, and milestones to achieve optimal use of digital tools in the substance use field by 2030. METHODS A backcasting exercise method was adopted, wherein the core elements are identifying key values, challenges, facilitators, milestones, cornerstones and a current, desired, and future scenario. A structured approach was used by means of (1) an Open Science Framework page as a web-based collaborative working space and (2) key stakeholders' collaborative engagement during the 2022 Lisbon Addiction Conference. RESULTS The identified key values were digital rights, evidence-based tools, user-friendliness, accessibility and availability, and person-centeredness. The key challenges identified were ethical funding, regulations, commercialization, best practice models, digital literacy, and access or reach. The key facilitators identified were scientific research, interoperable infrastructure and a culture of innovation, expertise, ethical funding, user-friendly designs, and digital rights and regulations. A range of milestones were identified. The overarching identified cornerstones consisted of creating ethical frameworks, increasing access to digital tools, and continuous trend analysis. CONCLUSIONS The use of digital tools in the field of substance use is linked to a range of risks and opportunities that need to be managed. The current trajectories of the use of such tools are heavily influenced by large multinational for-profit companies with relatively little involvement of key stakeholders such as people who use drugs, service providers, and researchers. The current funding models are problematic and lack the necessary flexibility associated with best practice business approaches such as lean and agile principles to design and execute customer discovery methods. Accessibility and availability, digital rights, user-friendly design, and person-focused approaches should be at the forefront in the further development of digital tools. Global legislative and technical infrastructures by means of a global action plan and strategy are necessary and should include ethical frameworks, accessibility of digital tools for substance use, and continuous trend analysis as cornerstones.
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Affiliation(s)
- Florian Scheibein
- School of Health Sciences, South East Technological University, Waterford, Ireland
| | - Elsa Caballeria
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Md Abu Taher
- United Nations Office of Drugs and Crime, Dhaka, Bangladesh
| | - Sidharth Arya
- Institute of Mental Health, Pandit Bhagwat Dayal Sharma University of Health Sciences, Rohtak, India
| | - Angus Bancroft
- School of Social and Political Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Lisa Dannatt
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Charlotte De Kock
- Institute for Social Drug Research, Ghent University, Ghent, Belgium
| | - Nazish Idrees Chaudhary
- International Grace Rehab, Lahore School of Behavioral Sciences, The University of Lahore, Lahore, Pakistan
| | | | - Abhishek Ghosh
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Lillian Gelberg
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cees Goos
- European Centre for Social Welfare Policy and Research, Vienna, Austria
| | - Rebecca Gordon
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Antoni Gual
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Penelope Hill
- The National Centre for Clinical Research on Emerging Drugs, Randwick, Australia
- The National Drug and Alcohol Research Centre, University of New South Wales, Randwick, Australia
- National Drug Research Institute, Curtin University, Melbourne, Australia
| | - Iga Jeziorska
- Correlation European Harm Reduction Network, Amsterdam, Netherlands
- Department of Public Policy, Institute of Social and Political Sciences, Corvinus University of Budapest, Budapest, Hungary
| | | | - Aleksey Lakhov
- Humanitarian Action Charitable Fund, St Petersburg, Russian Federation
| | | | - Silvia Matrai
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
| | - Nirvana Morgan
- Network of Early Career Professionals in Addiction Medicine, Seligenstadt, Germany
| | | | - Zrinka Puharić
- Faculty of Dental Medicine and Health Osijek, Bjelovar University of Applied Sciences, Bjelovar, Croatia
| | - Goodman Sibeko
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Jan Stola
- Youth Organisations for Drug Action, Warsaw, Poland
| | - Marcela Tiburcio
- Head of the Department of Social Sciences in Health, Directorate of Epidemiological and Psychosocial Research, Mexico City, Mexico
| | - Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science, School of Medicine, University of St. Andrews, St Andrews, United Kingdom
| | - Zaza Tsereteli
- Alcohol and Substance Use Expert Group, Northern Dimension Partnership in Public Health and Social Well-Being, Tallinn, Estonia
| | - Hugo López-Pelayo
- Health and Addictions Research Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer, University of Barcelona, Barcelona, Spain
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Litvinova O, Hammerle FP, Stoyanov J, Ksepka N, Matin M, Ławiński M, Atanasov AG, Willschke H. Patent and Bibliometric Analysis of the Scientific Landscape of the Use of Pulse Oximeters and Their Prospects in the Field of Digital Medicine. Healthcare (Basel) 2023; 11:3003. [PMID: 37998496 PMCID: PMC10671755 DOI: 10.3390/healthcare11223003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/02/2023] [Accepted: 11/11/2023] [Indexed: 11/25/2023] Open
Abstract
This study conducted a comprehensive patent and bibliometric analysis to elucidate the evolving scientific landscape surrounding the development and application of pulse oximeters, including in the field of digital medicine. Utilizing data from the Lens database for the period of 2000-2023, we identified the United States, China, the Republic of Korea, Japan, Canada, Australia, Taiwan, and the United Kingdom as the predominant countries in patent issuance for pulse oximeter technology. Our bibliometric analysis revealed a consistent temporal trend in both the volume of publications and citations, underscoring the growing importance of pulse oximeters in digitally-enabled medical practice. Using the VOSviewer software(version 1.6.18), we discerned six primary research clusters: (1) measurement accuracy; (2) integration with the Internet of Things; (3) applicability across diverse pathologies; (4) telemedicine and mobile applications; (5) artificial intelligence and deep learning; and (6) utilization in anesthesiology, resuscitation, and intensive care departments. The findings of this study indicate the prospects for leveraging digital technologies in the use of pulse oximetry in various fields of medicine, with implications for advancing the understanding, diagnosis, prevention, and treatment of cardio-respiratory pathologies. The conducted patent and bibliometric analysis allowed the identification of technical solutions to reduce the risks associated with pulse oximetry: improving precision and validity, technically improved clinical diagnostic use, and the use of machine learning.
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Affiliation(s)
- Olena Litvinova
- Department of Management and Quality Assurance in Pharmacy, National University of Pharmacy, Ministry of Health of Ukraine, 61002 Kharkiv, Ukraine
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria;
| | - Fabian Peter Hammerle
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Anesthesia, General Intensiv Care and Pain Management, Medical University of Vienna, 1090 Vienna, Austria
| | | | - Natalia Ksepka
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Magdalenka, Poland; (N.K.); (M.M.); (M.Ł.)
| | - Maima Matin
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Magdalenka, Poland; (N.K.); (M.M.); (M.Ł.)
| | - Michał Ławiński
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Magdalenka, Poland; (N.K.); (M.M.); (M.Ł.)
- Department of General, Gastroenterologic and Oncologic Surgery, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Atanas G. Atanasov
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria;
- Institute of Genetics and Animal Biotechnology of the Polish Academy of Sciences, 05-552 Magdalenka, Poland; (N.K.); (M.M.); (M.Ł.)
| | - Harald Willschke
- Ludwig Boltzmann Institute Digital Health and Patient Safety, Medical University of Vienna, 1090 Vienna, Austria;
- Department of Anesthesia, General Intensiv Care and Pain Management, Medical University of Vienna, 1090 Vienna, Austria
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Rioux W, Enns B, Ghosh SM. Virtual overdose monitoring services/mobile overdose response services: estimated number of potentially averted drug poisoning fatality events by various telephone and digital-based overdose prevention/harm reduction services in North America. Front Public Health 2023; 11:1242795. [PMID: 37927877 PMCID: PMC10622778 DOI: 10.3389/fpubh.2023.1242795] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/27/2023] [Indexed: 11/07/2023] Open
Abstract
Background Virtual overdose monitoring services or Mobile Overdose Response Services (MORS) are novel virtual harm reduction tools which have gained popularity as an adjunct public health intervention especially for those who cannot access harm reduction resources through traditional means. At this time, relatively little is known about their ability to reach their goals of reducing overdose mortality. Our study aims to summarize the potential effectiveness of various MORS collectively to avoid potential mortality from a drug poisoning event/drug overdose. Methods Utilizing publicly available data from various MORS alongside some usage data provided by these services for this study, we model the impact of these services on fatal drug poisoning/overdose. In order to calculate the number of deaths averted, a Monte Carlo simulation was used to calculate point estimates with 95% confidence for fatal drug poisonings/drug overdose potentially averted through the utilization of various MORS. Results From the earliest mention of MORS in current literature (2019), a total of 299 drug poisoning/overdose events occurred across these services. Noting the broad range of mortality statistics available in current literature, these technologies have potentially prevented between 33 to 243 deaths. Our Monte Carlo estimates 135 potentially fatal drug poisonings/overdose were overall averted by the various MORS. Conclusions While there is yet to be a robust data set proving the effectiveness of these services, conservative estimates show that MORS can reduce mortality associated with substance use and therefore should be considered as a viable harm-reduction strategy but as an adjunct to more established harm reduction services such as supervised consumption sites and supervised injection facilities. While more research is needed, clinicians and practitioners should consider the suggestion of these tools for patients who use drugs.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Benjamin Enns
- British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - S. Monty Ghosh
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- Department of Internal Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
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Rioux W, Enns B, Jackson J, Quereshi H, Irvine M, Ghosh SM. A cost benefit analysis of a virtual overdose monitoring service/mobile overdose response service: the national overdose response service. Subst Abuse Treat Prev Policy 2023; 18:57. [PMID: 37794482 PMCID: PMC10548617 DOI: 10.1186/s13011-023-00565-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/25/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND The overdose crisis continues across Canada which calls for novel harm reduction strategies. Previous research indicates that a majority of eHealth solutions are cost-effective however current literature on the cost-benefit of eHealth for harm reduction is sparse. The National Overdose Response Service (NORS) is a Canada-wide telephone-based harm reduction service. Service users can call the phone number and connect to a peer who can virtually monitor the substance use session and dispatch appropriate interventions in the case of overdose. OBJECTIVES OF THE RESEARCH/PROJECT We aim to assess the cost-benefit of NORS by comparing the estimated cost-savings from prevented overdose mortality to the operating costs of the program, alongside healthcare costs associated with its operation. METHODS Data around systems costs and operational costs were gathered for our calculations. Our primary outcome was cost-benefit ratios, derived from estimates and models of mortality rates in current literature and value of life lost. We presented our main results across a range of values for costs and the probability of death following an unwitnessed overdose. These values were utilized to calculate cost-benefit ratios and value per dollar spent on service provision by NORS over the length of the program's operation (December 2020-2022). RESULTS Over the total funded lifespan of the program, and using a Monte Carlo estimate, the benefit-to-cost ratio of the NORS program was 8.59 (1.53-15.28) per dollar spent, depending on estimated mortality rates following unwitnessed overdose and program operation costs. Further, we conservatively estimate that early community-based naloxone intervention results in healthcare system savings of $4470.82 per overdose response. CONCLUSIONS We found the NORS program to have a positive benefit-to-cost ratio when the probability of death following an unwitnessed overdose was greater than 5%. NORS and potentially other virtual overdose monitoring services have the potential to be cost-effective solutions for managing the drug poisoning crisis.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Benjamin Enns
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | | | - Hena Quereshi
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mike Irvine
- British Columbia Centre for Disease Control (BCCDC), Vancouver, BC, Canada
| | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
- Department of Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada.
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Rioux W, Marshall T, Ghosh SM. Virtual overdose monitoring services and overdose prevention technologies: Opportunities, limitations, and future directions. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 119:104121. [PMID: 37453373 DOI: 10.1016/j.drugpo.2023.104121] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Overdose mortality has continued to rise in North America and across the globe in people who use drugs. Current harm reduction strategies such as supervised consumption sites and naloxone kit distribution have been important public health strategies implemented to decrease the harms associated with illicit drug use however have key limitations which prevent their scalability. This is represented in statistics which indicate that the vast majority of overdose mortality occur in individuals who use drugs by themselves. To address this, virtual overdose monitoring services and overdose detection technologies have emerged as an adjunct solution that may help improve access to harm reduction services for those that cannot or choose not to access current in-person services. This article outlines the current limitations of harm reduction services, the opportunities, challenges, and controversies of these technologies and services, and suggests avenues for additional research and policy development.
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Affiliation(s)
- William Rioux
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tyler Marshall
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S Monty Ghosh
- Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of General Internal Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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Tay Wee Teck J, Oteo A, Baldacchino A. Rapid opioid overdose response system technologies. Curr Opin Psychiatry 2023:00001504-990000000-00063. [PMID: 37185583 DOI: 10.1097/yco.0000000000000870] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
PURPOSE OF REVIEW Opioid overdose events are a time sensitive medical emergency, which is often reversible with naloxone administration if detected in time. Many countries are facing rising opioid overdose deaths and have been implementing rapid opioid overdose response Systems (ROORS). We describe how technology is increasingly being used in ROORS design, implementation and delivery. RECENT FINDINGS Technology can contribute in significant ways to ROORS design, implementation, and delivery. Artificial intelligence-based modelling and simulations alongside wastewater-based epidemiology can be used to inform policy decisions around naloxone access laws and effective naloxone distribution strategies. Data linkage and machine learning projects can support service delivery organizations to mobilize and distribute community resources in support of ROORS. Digital phenotyping is an advancement in data linkage and machine learning projects, potentially leading to precision overdose responses. At the coalface, opioid overdose detection devices through fixed location or wearable sensors, improved connectivity, smartphone applications and drone-based emergency naloxone delivery all have a role in improving outcomes from opioid overdose. Data driven technologies also have an important role in empowering community responses to opioid overdose. SUMMARY This review highlights the importance of technology applied to every aspect of ROORS. Key areas of development include the need to protect marginalized groups from algorithmic bias, a better understanding of individual overdose trajectories and new reversal agents and improved drug delivery methods.
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Affiliation(s)
- Joseph Tay Wee Teck
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
- Forward Leeds and Humankind Charity, Durham, UK
| | - Alberto Oteo
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
| | - Alexander Baldacchino
- DigitAS Project, Population and Behavioural Science Division, School of Medicine, University of St Andrews, St Andrews
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Dumbrell J, Daneshvar H, Oteo A, Baldacchino A, Matheson C. The acceptability of overdose alert and response technologies: introducing the TPOM-ODART framework. Harm Reduct J 2023; 20:40. [PMID: 36967388 PMCID: PMC10040083 DOI: 10.1186/s12954-023-00763-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 03/03/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND Opioids were implicated in approximately 88,000 fatal overdoses (OD) globally. However, in principle all opioid OD are reversible with the timely administration of naloxone hydrochloride. Despite the widespread availability of naloxone among people who use opioids (PWUO), many who suffer fatal OD use alone, without others present to administer the reversal agent. Recognising this key aspect of the challenge calls for innovations, a number of technological approaches have emerged which aim to connect OD victims with naloxone. However, the acceptability of OD response technologies to PWUO is of key concern. METHODS Drawing on the Technology People Organisations Macroenvironment (TPOM) framework, this study sought to integrate acceptability-related findings in this space with primary research data from PWUO, affected family members and service providers to understand the factors involved in harm reduction technology acceptability. A qualitative study using a focus group methodology was conducted. The participant groups were people with lived experience of problem opioid use, affected family members and service providers. Data analysis followed a multi-stage approach to thematic analysis and utilised both inductive and deductive methods. RESULTS Thirty individuals participated in one of six focus groups between November 2021 and September 2022. The analysis generated six major themes, three of which are reported in this article-selected for their close relevance to PWUO and their importance to developers of digital technologies for this group. 'Trust-in technologies, systems and people' was a major theme and was closely linked to data security, privacy and confidentiality. 'Balancing harm reduction, safety and ambivalence' reflects the delicate balance technological solutions must achieve to be acceptable to PWUO. Lastly, 'readiness-a double bind' encapsulates the perception shared across participant groups, that those at the highest risk, may be the least able to engage with interventions. CONCLUSION Effective digital strategies to prevent fatal OD must be sensitive to the complex relationships between technological, social/human, organisational and wider macroenvironmental factors which can enable or impede intervention delivery. Trust, readiness and performance are central to technology acceptability for PWUO. An augmented TPOM was developed (the TPOM-ODART).
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Affiliation(s)
- Josh Dumbrell
- Drugs Research Network Scotland, University of Stirling, Stirling, UK.
| | - Hadi Daneshvar
- Faculty of Social Science, University of Stirling, Stirling, UK
| | - Alberto Oteo
- University of St Andrews Medical School, University of St Andrews, St Andrews, UK
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