Overdose Response Network

Why Did We Create the Overdose Response Network?

In a crisis of opioid overdoses, those who use alone are at heightened risk. The ORN team sought to address underinvestment in mitigation strategies for the harmful effects of using alone.

Project Contact

Craig Madho

Thank You Collaborators

Fred Victor, Peterson Foundation, Telus, Street Health, Health Commons Solutions Lab, Code the Change Foundation, St. Stephen’s House, Sistering, Moss Park Safe Consumption Site

Thank You Funders

Peterson Foundation

Behind The Solution

The Issue

Opioid overdoses have risen dramatically in recent times. The successful implementation of solutions — such as safe injection sites, the distribution of naloxone rescue kits, the Good Samaritan Drug Overdose Act— depend on users being with other people in the event of an overdose. However, over 80% of people who inject drugs report that they inject alone. In 75% of overdose deaths, the person was likely alone at the time of the overdose. For these individuals, there is currently no viable harm reduction solution other than hoping that, by chance, someone will stumble upon the situation and that the person has or can access naloxone. Studies also show that 90% of opioid-related deaths occur indoors and that, in 2020, fatalities doubled at supportive housing buildings. There are many barriers that cause people to use alone, including stigma, social isolation, lack of availability of safe consumption sites nearby, and the COVID-19 pandemic, which added an extra barrier to the availability of harm reduction services and the ability of PWUD to access them. Compounding these issues is an increasingly toxic drug supply.

Sources

Bayoumi AM and Strike C (co-principal investigators), Jairam J, Watson T, Enns E, Kolla G, Lee
A, Shepherd S, Hopkins S, Millson M, Leonard L, Zaric G, Luce J, Degani N, Fischer B, Glazier
R, O’Campo P, Smith C, Penn R, Brandeau M. Report of the Toronto and Ottawa Supervised
Consumption Assessment Study, 2012. Toronto, Ontario: St. Michael’s Hospital and the Dalla Lana School of Public Health, University of Toronto.

Marshall BD, Milloy MJ, Wood E, Montaner JS, Kerr T. Reduction in overdose mortality after the opening of North America's first medically supervised safer injecting facility: a retrospective population-based study. Lancet. 2011 Apr 23;377(9775):1429-37. doi: 10.1016/S0140-6736(10)62353-7. Epub 2011 Apr 15. PMID: 21497898.

Ontario Drug Policy Research Network; Office of the Chief Coroner for Ontario/Ontario Forensic Pathology Service; Ontario Agency for Health Protection and Promotion (Public Health Ontario); Centre on Drug Policy Evaluation. Preliminary Patterns in Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic. Toronto, ON: Ontario Drug Policy Research Network; 2020.

The Approach

The core of this project revolves around taking a community driven approach to creating the app. The OpenLab team has spent a lot of time physically in communities trying to understand needs by going to support groups, safe consumption sites and naloxone production sites, and talking to people who use drugs. To date, we have spoken to over 100 individuals with lived experience either as PWUD or harm reduction workers and we have had people with lived experience join the team. As the ORN app evolves, the team will maintain a community driven approach.

The Design Solution

The ORN app uses technology to network PWUD with their peers nearby with naloxone. The aim is to take the concept of the safe consumption site virtual.

The app allows those who join to both support their peers and be supported by their peers. If someone wants to use drugs, they set a time on the timer feature. The person starts the timer and then uses drugs. Once the timer nears the final countdown, it will prompt the user to check in with the app and confirm they are okay. If the person does not stop the timer to confirm they are okay, the app will send a push notification requesting help to their peers in the immediate vicinity. The responders then confirm if they can help. App users provide instructions on how to access their location (e.g. apartment unit) prior to using drugs, and this information along with their location is shared with the responder who accepts the call for support.

The Feasibility Test

In the summer of 2022, a month-long feasibility test was conducted in partnership with Fred Victor. Three sites were chosen for this test: the Fred Victor supportive housing building at Queen and Jarvis, the Edward Village Hotel, and the Fred Victor Respite Site. Each site was provided with phones that had the ORN app preloaded and, with Fred Victor staff acting as a safety net, the phones were given to users to test in live scenarios. During the test, the ORN app supported the reversal of 9 overdoses. The team is now hoping to implement learnings from the feasibility test to refine and scale this product into a production level app.

One of the biggest ways that we are innovating is how we handle data and privacy. Privacy was a key issue flagged by the community, and we are working to make the app secure and private.

Over

of people who inject drugs report that they inject alone.

In over

of overdose deaths, the person was likely alone at the time of the overdose.

For these individuals, there is currently no viable harm reduction solution other than hoping that, by chance, someone will stumble upon the situation and that the person has or can access naloxone.

The core of this project revolves around taking a community-driven approach to developing the app.

Project