"Moving at the speed of trust": development of a digital tool to improve community-driven overdose response

Background

The United States has been experiencing an opioid epidemic for the past two decades. This epidemic has worsened as the use of synthetic opioids, such as fentanyl and xylazine, and polysubstance use have significantly increased in recent years, creating a national public health emergency. The opioid overdose epidemic is quickly becoming a global crisis. Recent trends suggest the epidemic has expanded beyond the United States and is beginning to hit the European drug market among others. Considering the growing international concerns related to fentanyl and overdose fatalities, there is an urgent need to create a tool to support data-driven community-level response efforts. This qualitative study aimed to understand existing gaps in overdose data and perceived solutions from key stakeholders to inform development of a digital technology solution.

Methods

We used a co-design process with academic, community, and industry partners based on community-engaged research methods to develop TxCOPE. We conducted N=107 qualitative interviews among harm reduction workers, first responders, and people who use drugs to understand gaps in overdose data, perceived strategies to improve overdose data, and perspectives on the design of a digital tool to support community outreach efforts and real-time overdose data. Interviews were audio-recorded, transcribed verbatim, and transcripts were reviewed for accuracy. Transcripts were coded by two trained researchers. Coding discrepancies were discussed with a third coder. Data were entered into NVivo and analyses were conducted using applied thematic analysis.

Results

Data revealed the following themes related to gaps in overdose data: (1) disparate reporting systems, (2) failure to track key overdose metrics (e.g., non-fatal overdoses, naloxone administration, hospital transport); (3) failure to collect data among “hidden” populations who do not access traditional healthcare system; and (4) policies that impede data accuracy and harm reduction service utilization. Combined, these contributed to a lack of data to drive prevention and response efforts. Participants reported a need for real-time data, overdose hot spot identification, and a supply distribution tracking system. Additionally, harm reduction and community outreach workers indicated a need for training resources to improve data collection during their outreach efforts.

Conclusions and Implications 

This study informed development of an innovative digital tool, TxCOPE, to support community outreach workers and public health organizations for data-driven overdose response efforts. Community partnerships are essential for building and implementing an overdose reporting tool that will be trusted in the community, adopted among harm reduction organizations, and will provide reliable, near real-time overdose data to inform community response efforts.