A Proposal for Digital Supervised Drug Consumption Sites (Preprint)

UNSTRUCTURED This paper proposes a novel digital health solution to the ongoing opioid crisis that attempts to address barriers to patient access to Supervised Drug Consumption sites (SDCs). SDCs are facilities where an individual can consume a previously obtained drug substance under supervision of trained staff experienced in rescuing individuals who overdose. SDCs have grown as a public health measure for fatal overdose prevention, with the first sanctioned facilities in the US opening in 2021, yet there is no evidence that SDCs reduce community rates of fatal overdose. SDCs may engage a small subset of people who use drugs, as individuals face barriers of distance, facility capacity, and stigma, thereby limiting their effectiveness in preventing fatal overdose. We suggest instead a digital health solution of ‘Tele-SDCs’ whereby teams of overdose prevention specialists can virtually monitor individuals who have consumed drugs for signs of an overdose via mobile application, and route emergency medical services to their location if needed. This has the benefit of allowing individuals to consume drugs in their preferred location and reducing access, capacity, and stigma barriers of physical SDCs, while maintaining a similar level of overdose prevention services. Further, this can allow for better clinical data collection for measurement-based care, which is often difficult in the context of overdoses, and the development of more digital health interventions in the future. We believe there may be some limitations of an app-based digital health solution, such as acceptance, recruitment of users, and fewer social resources as an in-person facility, which we discuss.