Perceptions of overdose response hotlines and applications among rural and remote individuals who use drugs in Canada: a qualitative study.

Introduction: The overdose epidemic continues to be one of the largest public health crises in Canada. Various harm reduction supports have been implemented to curb this epidemic; however, they remain concentrated within urban settings. To address this limitation, overdose response hotlines and applications (ORHA) are novel, technologybased harm reduction services that may reduce drug-related mortality for people who use substances (PWUS) living in rural communities through virtual supervised consumption. These services enable more timely and remote activation of emergency responses, should an individual become unresponsive. We aimed to explore the experiences, perceptions and attitudes surrounding ORHA of individuals living in rural areas.

Methods: We conducted semistructured interviews with 15 PWUS (7 [46.7%] male, 9 [60%] Indigenous) who lived in rural, remote or Indigenous communities. Interviews were conducted until data saturation was reached. Data were analyzed using thematic analysis.

Results: Six key themes emerged: (1) participants viewed ORHA as a pragmatic intervention for rural areas but noted potential limitations to its uptake and effectiveness; (2) rural geography may hinder EMS response times, reducing the efficacy of ORHA; (3) ORHA uptake may be limited due to significant stigma faced by PWUS in these communities; (4) lack of access to technology remains a barrier to ORHA access; (5) harm reduction awareness is often limited in rural communities; and (6) there are unique social implications around substance use and harm reduction for rural Indigenous PWUS.

Conclusion: While participants believed that ORHA may be a feasible harm reduction strategy for rural PWUS, limitations, including response times, technological access and substance use stigma, remain.