UnityPhilly Response App for Overdose Reversal: Assessing Citywide Effectiveness and Sustainability

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PROJECT SUMMARY/ABSTRACT Reducing overdose mortality immediately and long-term is a top public health priority as the overdose epidemic in the U.S. continues to worsen. The COVID-19 pandemic, which began hitting the U.S. in early 2020, has exacerbated the overdose crisis - particularly among African Americans and Latinxs. Opioid overdose deaths, which accounted for the most overdose deaths in 2020, continue to drive the epidemic. Overdose deaths linked to synthetic opioids, such as illicitly manufactured fentanyl, have increased significantly and comprised most of the opioid-related deaths in 2020. Despite increasing availability and acceptability of naloxone among laypersons, opioid overdose deaths remain catastrophically high in communities across the U.S. The UnityPhilly smartphone app was developed in 2018-19 alongside several community-based organizations as a public health intervention in response to the opioid overdose crisis in Philadelphia, which has the most acute overdose epidemic among large cities in the U.S. UnityPhilly automatically connects bystanders and victims of opioid overdose with nearby community members who can respond immediately with naloxone. The objective of this proposal, following a successful feasibility study (R34) and clear evidence of overdose reversal supported by UnityPhilly, is to create an easy-to-use, effective, sustainable, and scalable smartphone app to be deployed across the city of Philadelphia. This objective will be achieved by studying subgroups of people equipped with naloxone and UnityPhilly (n=450) and disseminating UnityPhilly to 3,000 citizen volunteers for everyday use to respond to opioid overdose emergencies. The long-term goal of this research is to create a scalable app that can be disseminated to communities across the U.S. experiencing high levels of opioid overdose death. The rationale for this study is that expanding the availability of the UnityPhilly app to laypersons citywide will increase the speed and delivery of naloxone to opioid overdose events across Philadelphia while laying the groundwork for scalability and broader national uptake. Our goals will be achieved with three specific aims: 1) Redevelop UnityPhilly to ensure ease of use; 2) Assess differences in the effectiveness of UnityPhilly across varied urban environments and participant profiles; and 3) Build and study a sustainable environment for UnityPhilly to expand city-wide. This 5-year study will have significant impact by providing actionable evidence regarding the effectiveness of an app-based naloxone intervention to scale up for nationwide use. The study will be conducted in partnership with long-standing community-based organizations to ensure usability and acceptability. This intervention is highly significant since it directly addresses one of the most significant public health problems in the U.S. – the opioid overdose epidemic – which is worsening due to the effects of COVID-19. This intervention is highly innovative as it improves upon a previous developed successful mobile phone app and expands its use to a broader population of users in a large city most impacted by the opioid crisis.