UnityPhilly 2.0

In a Philadelphia neighbourhood where opioid overdoses are frequent, neighbors used a smartphone app to request and give help for a victim of suspected overdose. A one-year study demonstrated the feasibility of this approach, which empowered the local community to save lives and even respond to overdoses faster than emergency medical services. UnityPhilly is an app designed as an Emergency Response Community, to support laypersons in signaling and responding to opioid overdose incidents3,4. 9olunteers signal an overdose incident with a single button press, initiating an automated alert to other nearby volunteer app users who answer the alert if they can respond to the scene. Design of the app was informed by needs assessment in the form of interviews and focus groups with end users4. Signalling an Overdose App users signal an alert when they encounter a suspected opioid overdose, administer naloxone if they have any, and speak with 11 through a phone call initiated by the app. Concurrent with sending the alert, a call is initiated from the signaler's smartphone to a dedicated phone number connecting to the Philadelphia Police EMS (Emergency Medical Services) dispatch unit. Smartphone operating system constraints result in slightly different EMS call behavior for Android and Apple-based phones. On Android handsets, calls are placed immediately when the signaling button is pressed. On Apple iOS handsets, a pop-up with the EMS phone number appears requiring the caller to confirm the dial request. Location data from the volunteer's smartphone are transmitted to UnityPhilly servers which automatically check for other nearby volunteers and send dispatch alerts with the overdose location to the four closest. For our pilot study, 'nearby' was defined as within a 15-minute estimated time of arrival to the overdose site, calculated dynamically based on the participants' declared transport mode foot, car, etc.). CONCLUSION The distribution of naloxone to those who are likely to witness an overdose is a key evidence-based strategy for addressing the opioid epidemic. Smartphone applications are a novel medium for facilitating naloxone distribution and administration, and policy efforts are encouraging their development. Our findings support the benefits of equipping community members with naloxone and an emergency response community smartphone app, for alerting EMS and nearby laypersons to provide additional naloxone. Individuals affected by opioid use and overdose reacted positively to the concept and use of our UnityPhilly app, which they perceived as a useful tool that could help combat the high rate of opioid overdose fatalities in their neighborhood. A sense of unity with others who have shared their experiences could be leveraged to connect willing volunteers with victims of overdose, but risk must be mitigated for layperson responders.

Background Rapid naloxone administration is crucial in reversing an opioid overdose. We investigated whether equipping community members, including people who use opioids (PWUO), with a smartphone application enabling them to signal and respond to suspected overdose would support naloxone administration in advance of Emrgency Medical Services (EMS). Methods This observational cohort study of opioid overdose intervention used a dedicated smartphone app, UnityPhilly, activated by volunteers witnessing an overdose to signal other nearby volunteers in Philadelphia (March 2019 - February 2020). Alerted volunteers chose to respond, or declined to respond, or ignored/missed the alert. Witnessing volunteer was connected to 9-1-1 through a semi-automated telephone call. The primary outcome was layperson-initiated overdose reversal before EMS arrival, and a secondary outcome was hospital transfer. This study is registered with ClinicalTrials.gov, NCT03305497. Findings 112 volunteers, including 57 PWUO and 55 community members, signaled 291 suspected opioid overdose alerts. 89 (30?6%) were false alarms. For 202 true alerts, the rate of layperson initiated naloxone use was 36?6% (74/202 cases). Most naloxone-use cases occurred in the street (58?11% (43/74)) and some in home settings (22?98% (17/74)). The first naloxone dose was provided by a nearby volunteer responding to the alert in 29?73% (22/74) of cases and by the signaling volunteer in 70?27% (52/74) of cases. Successful reversal was reported in 95?9% (71/74) of cases. Layperson intervention preceded EMS by 5 min or more in 59?5% of cases. Recovery without hospital transport was reported in 52?7% (39/74) of cases. Interpretation Our findings support the benefits of equipping community members, potentially witnessing suspected opioid overdose, with naloxone and an emergency response community smartphone app, alerting EMS and nearby laypersons to provide additional naloxone.