Willingness to Use Wearable Devices for Overdose Detection and Response: A Cross-Sectional Survey of People Who Use Drugs in Rural Appalachian Kentucky

Background: Wearable devices with biosensors that can detect opioid overdoses and alert first responders are already available. Devices capable of injecting naloxone are currently in development. Yet, little is known about whether people who use drugs (PWUD) are willing to wear these devices. This study examines the willingness to wear an overdose detection and response wristband among PWUD in rural Appalachian Kentucky. Method: Rural PWUD were recruited through respondent-driven sampling and outreach from 2018 to 2020. Eligibility criteria included being at least age 18, a five-county resident, and having used opioids/injected drugs in the past 30 days. Respondents completed interviewer-administered questionnaires on demographics, behaviors, and willingness to wear wristbands for alerting emergency responders or administering naloxone. Log-binomial regression was used to identify correlates to willingness to wear these devices. Results: Of the 154 respondents included in the analysis, most reported being willing to wear a wristband that would detect an overdose and alert emergency responders or would detect an overdose and inject naloxone (77.9%). Men were less likely to use a first-responder alert device than women (PR = 0.79, 95% CI [0.67, 0.93], p =.005), while those with internet access (PR = 0.81, 95% CI [0.70, 0.94], p =.004) and less than a high school education (PR =1.32, 95% CI [1.08, 1.61], p =.008) were more likely to use a naloxone auto-injector. Conclusion: This study is the first to assess willingness among rural PWUD to use wearable overdose detection and response devices, finding broad acceptance but significant differences by gender, education, and internet access.