Preference for hotline versus mobile application/countdown-based mobile overdose response services: a qualitative study

Abstract Background In response to the exacerbated rates of morbidity and mortality associated with the overlapping overdose and COVID-19 epidemics, novel strategies have been developed, implemented, operationalized and scaled to reduce the harms resulting from this crisis. Since the emergence of mobile overdose response services (MORS), two strategies have aimed to help reduce the mortality associated with acute overdose including staffed hotline-based services and unstaffed timer-based services. In this article, we aim to gather the perspectives of various key interest groups on these technologies to determine which might best support service users. Methods Forty-seven participants from various interested groups including people who use substances who have and have not used MORS, healthcare workers, family members, harm reduction employees and MORS operators participated in semi-structured interviews. Transcripts were coded and analyzed using a thematic analysis approach. Results Four major themes emerged regarding participant perspectives on the differences between services, namely differences in connection, perceived safety, privacy and accessibility, alongside features that are recommended for MORS in the future. Conclusions Overall, participants noted that individuals who use substances vary in their desire for connection during a substance use session offered by hotline and timer-based service modalities. Participants perceived hotline-based approaches to be more reliable and thus potentially safer than their timer-based counterparts but noted that access to technology is a limitation of both approaches.
Highlights 1. Participant preferences varied regarding the desire for connection to peers through mobile overdose response services and as a result preferences of hotline versus timer-based services. 2. Participants believed that hotline services would be safer than their automatic timer counterparts 3. Access to technology is a major limitation of these services, and participants note that the varied access pathways promote accessibility of services. 4. The physical requirements of timer-based applications may pose additional challenges for people who use drugs by injection. 5. Participants made additional suggestions to improve both service modalities including hands-free timer refreshing, video calling methodologies and creation of online harm reduction communities.
Harm Reduction Journal. 2024 Feb 05;21(1):31