A Mobile Health Application to Support Reductions in Overdose Risk Behaviors: A Pilot Study

Mobile health (mHealth) applications are positioned to provide information and support anywhere and anytime, though few focus on overdose-related harm reduction. We aimed to describe the use of an e-harm reduction smartphone application theoretically based on self-determination theory among people who inject drugs.

We enrolled 60 clients from 3 syringe services programs in Wisconsin in a single-arm, pre-post pilot study between December 2022 and June 2023. Eligible participants used opioids and injected drugs within the past week. Participants received a smartphone, unlimited data plan, and e-harm reduction focused mHealth application based on the self-determination theory principles of autonomy, competence, and relatedness. The app was used to deliver a 12-week overdose risk reduction intervention. Every week, participants self-selected 1 of 11 available overdose-focused harm reduction goals and received tailored education, resources, and support from study staff through the smartphone application. We evaluated the use of app features, intervention adherence, and described the most commonly selected overdose risk reduction goals.

Of available app features, participants most often used private messaging (median, interquartile range [IQR] days used: 28 [18-53]), viewed a motivational "thought of the day" (median [IQR] days used: 24 [15-47]), and interacted with discussion boards (median [IQR] days used: 12 [5-24]). Of 12 available weekly goal-setting intervention activities, participants completed a median of 9 (IQR: 4-11). Of 448 completed goal-setting activities, reducing drug injection and reducing drug use were the most commonly selected goals (chosen N = 86 [19.2%] and N = 81 [18.1%] times, respectively) followed by quitting use (N = 69 times, 15.4%), and reducing solitary drug use (N = 54 times, 12.1%).

An e-harm reduction mHealth application was used by participants for overdose risk reduction goal setting, messaging, and viewing motivational content. Future studies will evaluate benefits of engaging with e-harm reduction mHealth applications for overdose prevention intervention relative to a control group.