Acceptability and usability of a respiratory biosensor for drug overdose detection and first responder notification: a qualitative evaluation of perspectives from people who use drugs and wider stakeholders

Background and aims Overdose induced by illicit drug use is a significant public health threat in many settings globally. Many such overdoses occur in the context of lone use in private spaces, in the absence of potential first responders. Chest-worn biosensors have the potential to detect respiratory depression which signal overdose and alert first responders, enabling rapid reversal. However, the acceptability of this approach to people who use drugs and other key stakeholders are not known. We aimed to investigate these outcomes in this qualitative sub-study, which is part of a larger trial investigating this intervention. Methods Semi-structured interviews and focus groups were conducted with participants who completed the study protocol (n = 20), partially completed the study protocol (n = 1) and stakeholder groups (n = 8) about device acceptability. Verbatim transcripts were analysed using reflexive thematic analysis. Factors influencing device acceptability for PWUD were interpreted using the concepts of the COM-B behaviour model. Discussions around implementation with stakeholder groups utilised Normalisation Process Theory to further appraise the intervention and its integration into existing services. Results Experiences with overdose or drug-related deaths (DRD) were identified within qualitative data as motivating factors for device wear. First responder groups stressed the importance of patient choice and device accuracy. The accelerometer sensor was found to be acceptable to people who use drugs (PWUD) and was utilised to monitor respiratory patterns. Stakeholders recognised the potential of these devices to play a part in the management of overdose and identified necessary requirements to ensure successful implementation of the device, such as funding allocation, potential barriers and integration into existing services. Conclusions The chest-worn biosensor was acceptable to PWUD, driven by personal experiences with overdose risks, and were viewed by stakeholders as a promising tool for overdose management. Successful implementation will require ensuring device accuracy, respecting patient choice, securing funding, and integrating the technology into existing services. (307 words)