Are virtual harm reduction interventions right for everyone?: A qualitative study of the appropriateness of overdose response hotlines and applications for different subgroups of people who use substances.

Introduction: Overdose response hotlines and apps are novel virtual harm reduction technologies that allow remote monitoring of individuals while they use substances (especially if they use alone) through electronic means. The authors explored partner perspectives to determine which groups of people who use substances (PWUS) these services would be most appropriate for, with the aim of better informing service providers on how to target their use to maximize benefit for clients.

Methods: The study conducted 64 semi-structured interviews with participants from a variety of backgrounds (individuals with lived or living experience of substance use, lay persons, health care providers, harm reduction workers, and operational experts). All information from interviews was kept confidential, de-identified, and stored on a secure server. Inductive thematic analysis identified major themes and subthemes. Two evaluators coded transcripts using Dedoose software. Once initial coding was complete, transcript coders selected quotes and shared them with a consulting project manager to cross-validate themes. The study conducted interviews until thematic saturation across all participants was reached based on the consensus of the two evaluators and the primary investigator.

Results: Overall, the study determined that overdose response hotlines and apps would potentially have at least some utility for any PWUS. However, some were found to have a varying level of appropriateness for specific subgroups of PWUS. There were 11 different subgroups identified in this study and of these subgroups, the majority were identified as groups for whom virtual harm reduction services would be appropriate interventions.

Conclusions: Overdose response hotlines and apps are helpful and potentially life-saving adjunctive options which may be more appropriate for some subgroups of PWUS than others. These results may help service providers to target groups with the most potential to benefit.