After a year-long pilot program in Kensington, the center of Philadelphia’s drug overdose crisis, researchers are hoping to test a smartphone app that helps citizens respond to overdoses citywide.
Researchers at Drexel University, the University of Pennsylvania, and Bar-Ilan and Tel Aviv Universities in Israel published their initial findings on the app this month in the journal EClinicalMedicine.
The app, called UnityPhilly, allows users to send out an alert when they encounter a person overdosing. The app automatically calls 911 — and also alerts other app users in the area who could respond even more quickly than medics with naloxone, the overdose-reversing drug.
In the spring of 2019, the study authors recruited 112 participants, gave them two nasal-spray dispensers of naloxone each, and trained them to dispense it and use the app.
Over a year, the volunteers — a mix of Kensington residents who use opioids and those who don’t — reported 291 overdoses through the app, of which 89 were false alarms. In the 202 cases where a victim was overdosing, 74 app users rendered aid themselves.
In 52 of those cases, an app user summoned help and then administered the first dose of naloxone. (In some cases, multiple doses are required.) For the other 22 times, app users encountered an overdose victim, called for help, and were aided by other app users, who arrived on the scene and gave the first naloxone dose.
More than 95% of the victims treated by study participants were successfully revived, and in more than half of the cases where study participants dispensed naloxone, they did so more than five minutes before medics arrived on the scene, the study found.
That statistic is at the heart of researchers’ motivation to develop an app to respond to overdoses, study authors said. The longer it takes to administer naloxone to an overdose victim, the higher the risk of serious health complications or death.
“The big issue is that people would see overdoses more often than they had the naloxone to respond to them,” said Ben Cocciaro, a study author and physician at Prevention Point Philadelphia, a Kensington-based public health organization and needle exchange. “If you see an overdose and you don’t have naloxone, what’s the next step? You can call 911, but response times can vary considerably, and they can be quite long, especially in a time when seconds matter.”
An app to help address those long response times has been in the works since 2016. That’s when Stephen Lankenau, associate dean for research at Drexel’s Dornsife School of Public Health and the study’s principal investigator, and David Schwartz, a business professor at Bar-Ilan, began discussing the idea, inspired by similar research around apps that help bystanders treat heart-attack victims.
“It’s something that’s become normalized, using defibrillators to respond to heart attacks,” Lankenau said. “We thought [an overdose] was kind of an analogous situation, where there’s an emergency that happens in the community and an intervention [that] needs to be delivered as soon as possible. [An overdose-reversal app] is also a way of trying to destigmatize the problem. Heart attacks happen for all sorts of reasons, and rarely is someone blamed for having one.”
Though the study’s response rate may seem low, Lankenau said, the Kensington pilot was simply looking at whether UnityPhilly could be developed, if people would be willing to use it, and if it would lead them to reverse overdoses. The study’s rates of response to overdoses were similar to the response rates in studies testing apps to respond to heart attacks, the study authors noted.
“An average of twice a month, someone got an alert, showed up, and delivered Narcan [a brand name of naloxone],” Lankenau said. “It’s unknown whether they wouldn’t have received Narcan in those 22 cases, but it’s possible that lives were saved through the use of the app.”
The next step is operating the app on a wider scale, Lankenau said. “The indicators are that this is a viable intervention,” he said. “It’s a question of scaling it up to increase the response rate, so that when these alerts do go out, that there’s a greater likelihood someone shows up. And if no one does show up, EMS has still been alerted, and it turns into a regular phone call to EMS.”
Study authors said they were encouraged by how eager study participants were to use the app. Some had lost friends or loved ones to overdoses, Lankenau said. Many were already experienced in reversing overdoses on their own, without the help of an app.
“This is not a tool that creates a community — this is a tool that diffuses through the community, and helps them do what they’re already doing,” Cocchiaro said.