Smartphone apps for problem drug users

The European Monitoring Centre for Drugs and Drug Addiction surveys the latest apps responding to drug use and associated harms.

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Regular readers will know that I frequently cover the growth in digital interventions in the drug and alcohol, mental health and desistance sectors. Another indicator that digital help is becoming mainstream came just before Christmas when the European Monitoring Centre for Drugs and Drug Addiction published a scoping survey entitled: m-Health applications for responding to drug use and associated harms.

Here’s the introduction and the rationale for the scoping paper:

The fast developmental pace and widespread use of mobile technology and the internet mean that smartphone-based m-health (mobile health) applications (apps) have huge potential to further expand the reach of and access to drug-related health services towards a common goal of ensuring a healthier Europe. However, m-health for drug users and for health professionals in the field of drugs is still in its infancy and poorly documented at European Union (EU) level. The aim of this scoping study was therefore to carry out a first exploration of available smartphone applications in the drugs field within a European and global context. It explored the range of m-health applications available to users and professionals seeking information, support and advice in a wide range of EU languages.

Findings

The EMCDDA’s systematic search of drug-related smartphone applications identified a total of 67 applications across the three main app stores. The identified m-health applications apply various technologies ranging from simple text-based content display to more advanced interactive functions such as video transmission, geo-tagging functions and automated personalised feedback. Based on the main objectives, content and target end-users of the 67 identified apps, three main groups of drug-related m-health applications emerged: 

  1. apps that aim to disseminate drug-related information and advice, 
  2. apps that provide interventions and support for drug users and 
  3. apps for capacity building among health professionals. 

Most m-health apps address risk behaviour associated with drugs in general or drug use in specific settings (e.g. nightlife settings). Some drug-specific apps are available for more commonly used drugs such as cannabis and cocaine.

Potential

Smartphone-based m-health applications, in particular, provide new possibilities for health practices in the drugs field, such as the provision of location-based services via geo-tagging. Geotagging is the process of adding geographical identification metadata to media sources, including not only photographs and videos but also websites and apps. This feature allows app users to locate geo-tagged service points, often nearby peers or healthcare professionals and institutions in case of emergency. The Breaking Free online app alerts users to high risk locations which they have themselves identified. 

One novel feature of m-health is the just-in-time adaptive intervention. These mobile interventions seek to adapt to a user’s emotional, social and physical state to prevent negative health outcomes arising, for example, from high-risk drug use, and to promote healthy behaviours via users’ smartphones or smartwatches.

Researchers in Europe, for instance, are currently contemplating the development of low-cost electronic 
wristbands for drug users at high risk of overdose (e.g. heroin users). The wristbands can monitor heart rate and transmit an emergency signal to nearby health providers or relatives, alerting them to a potential drug overdose.

Geo-tagging and just-in-time adaptive interventions are just two examples revealing the potential of m-health technologies as a tool to support drug users and professionals in the field.

Screenshot from Breaking Free Online companion app

Challenges

The paper identifies a number of challenges for users, app developers and policymakers. The lack of scientific evaluations of drug-related m-health interventions is concerning considering the increasing interest in and availability of such apps. Additionally, the lack of quality control of the content of these apps available to EU citizens, with no age limits, remains to be addressed. Global differences in therapeutic approaches used in the identified apps were apparent, especially between the United States and Europe, and this raises questions about the cross-cultural relevance of m-health applications. At the same time, the impact of the new EU General Data Protection Regulation may be of particular relevance in a context of fast global development of drug-related m-health apps available to EU citizens.

I would add a couple of concerns of my own. Some apps are only available on one of the major platforms, disadvantaging users from the other camp and, in my experience, it’s not always possible for organisations to continue to maintain or update even high quality apps which have been well-received

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