"I think that that really could benefit a lonely user:" perceptions of overdose response hotlines among people who...

Overdose response hotlines, such as the SafeSpot and Never Use Alone phone hotlines and Brave smartphone application, are promising tools to reduce fatal overdose risk among people who use drugs (PWUD). These free and confidential services connect callers to a trained operator who monitors them for adverse reactions during and after drug use. We explored PWUD's perceptions of overdose response hotlines.

PWUD receiving substance use treatment in a facility in a Midwestern US city were screened for eligibility using the NIDA-Modified ASSIST questionnaire and invited to enroll if they had a moderate or severe substance involvement score for use of street or prescription opioids. Ten participants completed a 30-45-minute in-depth interview focused on overdose prevention, including perceptions and use of overdose response hotlines, in February 2022. Inductive content analysis was used to describe perspectives on overdose response hotlines.

Only 1 of the 10 participants had heard of overdose response hotlines, but most were optimistic about their potential benefits for PWUD. One participant said, "I believe that if word was out there, people would use it." Another stated, "I would trust it today. I know that there is [sic] people trying to change what's going on in our culture with opiates." Participants described several potential barriers to utilization, including distrust, especially in the context of drug-induced paranoia and concerns about being arrested, and the cost of an emergency medical response if an overdose occurred. One participant stated, "people get paranoid when they're using drugs. And to be like, 'I'm using!' over the phone, that's not too easy." Another said, "If you call 911, the police are coming and if you're using, you're going to jail."

Overdose response hotlines are acceptable and trustworthy fatal overdose prevention tools. However, several barriers may limit their utilization, including distrust, drug-induced paranoia, and the cost and potential consequences should an overdose occur, including arrest or cost of emergency response. Further study of utilization, acceptability, and policy and practical solutions addressing perceived barriers to utilizing these services are needed.