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Introduction: Drug-related deaths involving an opioid are at all-time highs across the United Kingdom. Current overdose antidotes (naloxone) require events to be witnessed and recognised for reversal. Wearable technologies have potential for remote overdose detection or response but their acceptability among people who use opioids (PWUO) is not well understood. This study explored facilitators and barriers to wearable technology acceptability to PWUO., Methods: Twenty-four participants (79% male, average age 46 years) with current (n = 15) and past (n = 9) illicit heroin use and 54% (n = 13) who were engaged in opioid substitution therapy participated in semi-structured interviews (n = 7) and three focus groups (n = 17) in London and Nottingham from March to June 2022. Participants evaluated real devices, discussing characteristics, engagement factors, target populations, implementation strategies and preferences. Conversations were recorded, transcribed and thematically analysed., Results: Three themes emerged: device-, person- and environment-specific factors impacting acceptability. Facilitators included inconspicuousness under the device theme and targeting subpopulations of PWUO at the individual theme. Barriers included affordability of devices and limited technology access within the environment theme. Trust in device accuracy for high and overdose differentiation was a crucial facilitator, while trust between technology and PWUO was a significant environmental barrier., Discussion and Conclusions: Determinants of acceptability can be categorised into device, person and environmental factors. PWUO, on the whole, require devices that are inconspicuous, comfortable, accessible, easy to use, controlled by trustworthy organisations and highly accurate. Device developers must consider how the type of end-user and their environment moderate acceptability of the device., (© 2023 The Authors. Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Tobacco smoking prevalence in opioid addiction patients is approximately six times that of the general population, highlighting the need for novel interventions. A pilot/feasibility study was conducted to investigate whether a contingency management (CM) intervention could be added to UK standard smoking cessation treatment. The aim of this report is to describe the challenges experienced during the implementation of this CM intervention., Design and Methods: A two-armed, randomised, pilot/feasibility study of a 5-week escalating with reset CM intervention, conducted as an adjunct to smoking cessation treatment in an outpatient drug and alcohol treatment centre., Results: Forty participants were recruited, but only 19 attended the baseline session. Ten participants attended all treatment sessions (25% retention), with only one contactable at 6-month follow-up. While smoking cessation clinic engagement was higher than previously, implementation issues included limited operating hours of the smoking treatment clinic, ineffective biochemical verification of abstinence and overly restrictive inclusion criteria., Discussion and Conclusions: This study highlighted not only the difficulty of integrating CM interventions into standard smoking cessation treatment for this population, but also the potential of CM to engage this group with smoking cessation treatment. Future research in this area should consider increasing the availability and flexibility of smoking cessation treatment, and relaxing inclusion criteria to be more reflective of the opioid-treatment-seeking population. This study is registered on ClinicalTrials.gov (NCT03015597, https://clinicaltrials.gov/ct2/show/NCT03015597)., (© 2020 Australasian Professional Society on Alcohol and other Drugs.)

Introduction and Aims: Naloxone is an opioid antagonist used for emergency resuscitation following opioid overdose. Prisoners with a history of heroin use by injection have a high risk of drug-related death in the first weeks after prison-release. The N-ALIVE trial was planned as a large prison-based randomised controlled trial (RCT) to test the effectiveness of naloxone-on-release in the prevention of fatal opiate overdoses soon after release. The N-ALIVE pilot trial was conducted to test the main trial's assumptions on recruitment of prisons and prisoners, and the logistics for ensuring that participants received their N-ALIVE pack on release., Design and Methods: Adult prisoners who had ever injected heroin, were incarcerated for ≥7 days and were expected to be released within 3 months were eligible. Participants were randomised to receive, on liberation, a pack containing a single 'rescue' injection of naloxone or a control pack with no naloxone syringe. The trial was double-blind prior to prison-release., Results: We randomised 1685 prisoners (842 naloxone; 843 control) across 16 prisons in England. We stopped randomisation on 8 December 2014 because only one-third of administrations of naloxone-on-release were to the randomised ex-prisoner; two-thirds were to others whom we were not tracing., Discussion and Conclusions: Prevention RCTs are seldom conducted within prisons; we demonstrated the feasibility of conducting a multi-prison RCT to prevent fatality from opioid overdose in the outside community. We terminated the N-ALIVE trial due to the infeasibility of individualised randomisation to naloxone-on-release. Large RCTs are feasible within prisons., (© 2017 The Authors Drug and Alcohol Review published by John Wiley & Sons Australia, Ltd on behalf of Australasian Professional Society on Alcohol and other Drugs.)