Investigating the barriers to uptake and utilization of overdose response hotlines and apps: A study based on data from a national survey.

Objective: Overdose Response Hotlines and Apps (ORHAs) are novel technologies designed to avert fatal overdose associated with solitary use of illicit substances. While they can be a useful tool for those who cannot reach in-person harm reduction support, previous literature has cited potential barriers to their access. The aim of this study was to quantitatively evaluate the types of barriers that may hinder the uptake and utilization of ORHAs from the perspective of key stakeholders. Methods: The current study reports on the data obtained from Canadian National Questionnaire on Overdose Monitoring (CNQOM) focusing on people who currently use substances (PWUS-C), have used substances in the past (PWUS-P), and addiction service providers (ASP). A combination of purposive and representative sampling was used for recruitment. A list of potential partner organizations across Canada was contacted between July 2022 and May 2023. We explored logistical, technological, and social barriers to assess the acceptability of ORHAs. Results: A total of 971 participants were included in this study, consisting of 268 PWUS-C, 525 PWUS-P, and 178 ASP. Barriers to ORHA were categorized into: service delivery and quality barriers, technological barriers, and stigma/social barriers. More than half of the respondents across all groups rated the barriers as 4 (significant) or higher on the Likert scale. Ordinal logistic regression revealed that being an ASP was associated with higher likelihood of rating certain barriers as more significant compared to PWUS-C and PWUS-P. Conclusion: This study is the first to quantify concerns about potential barriers to the use of ORHAs from the perspectives of key Canadian interest groups and provide valuable information on how to improve accessibility and utility of overdose prevention technologies to a wider range of demographics.