Understanding Naloxone Uptake from an Emergency Department Distribution Program Using a Low-Energy Bluetooth Real-time L
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ORIGINAL ARTICLE
Understanding Naloxone Uptake from an Emergency Department Distribution Program Using a Low-Energy Bluetooth Real-time Location System Jeffrey T. Lai 1 & Brittany P. Chapman 1 & Stephanie P. Carreiro 1 & Kavita M. Babu 1 & Edward W. Boyer 2 & Peter R. Chai 2 Received: 16 January 2020 / Revised: 19 March 2020 / Accepted: 24 March 2020 # American College of Medical Toxicology 2020
Abstract Introduction Emergency department (ED)–based naloxone distribution programs are a widespread harm reduction strategy. However, data describing the community penetrance of naloxone distributed from these programs are lacking. This study gauges acceptance of naloxone use and monitoring technology among people who use drugs (PWUD), and explores the use of real-time location systems (RTLS) in monitoring naloxone movements. Methods A prospective observational study was conducted on a convenience sample of individuals (N = 30) presenting to a tertiary-care academic medical center ED for an opioid-related complaint. A naloxone kit equipped with a low-energy Bluetooth (BLE) tracking system was employed to detect movement of naloxone off the hospital campus as a proxy for community penetrance, followed by a qualitative interview to gauge participant acceptance of naloxone use and monitoring technology. Results Detection of BLE signals verified transit of 24 distributed naloxone kits off our hospital campus. Three participants whose BLE signals were not captured reported taking their kits with them following discharge, suggesting technological errors occurred; another three participants were lost to follow-up. Qualitative interviews demonstrated that participants accepted ED-based naloxone distribution programs and passive tracking technologies, but revealed concerns regarding hypothetical continuous monitoring systems and problematic interactions with first responders and law enforcement personnel. Conclusions Based on acquired BLE signals, 80% of dispensed naloxone kits left the hospital campus. Use of RTLS to passively geolocate naloxone rescue kits is feasible, but detection can be adversely affected by technological errors. PWUD are amenable to transient monitoring technologies but identified barriers to implementation. Keywords Technology . Harm reduction . Opioids . Naloxone . Digital health
Introduction Portions of this manuscript were presented at the Hawaii International Conference on System Sciences (2018) and the Toxicology and Poisons Network Australasia Scientific Meeting (2018). Supervising Editor: David H. Jang, MD, MSc * Jeffrey T. Lai [email protected] 1
Division of Medical Toxicology, Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave North LA-218, Worcester, MA 01655, USA
2
Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
Opioid overdoses and deaths continue to affect the USA at epidemic proportions; in 2017, 47,600 individuals died from drug overdoses involving
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