National hotline provides effective virtual supervision for substance users: study

Emergency medical services are dispatched immediately if the user becomes unresponsive.

 Physician and addiction specialist S. Monty Ghosh led an evaluation study showing that the National Overdose Response Service telephone hotline can prevent overdoses and deaths among people using substances alone. (Photo: NORS)

Addiction specialist S. Monty Ghosh led an evaluation study showing that the National Overdose Response Service telephone hotline can prevent overdoses and deaths among people using substances alone. (Photo: NORS)

Drug overdoses can be prevented and lives saved by providing telephone supervision for people who are using substances alone, according to new research published in the Canadian Medical Association Journal.

Researchers reported no deaths during a pilot of the National Overdose Response Service telephone hotline from December 2020 to February 2022. Staff took 2,171 calls from 222 unique callers and monitored them over the phone while they used drugs such as opioids, cocaine and methamphetamine, either intravenously or by inhalation. During 53 of the calls, the clients became unresponsive and staff were concerned they might be in trouble, so emergency services or community-based responses were alerted. Followup contacts confirmed that all survived.

“Anywhere from 50 to 70 per cent of overdoses and drug poisonings nationally occur in people's own homes while they're using alone,” says principal investigator S. Monty Ghosh, assistant professor in the Faculty of Medicine & Dentistry at the University of Alberta, as well as at the University of Calgary. “That's a huge portion of the population that we don't seem to reach or be able to support with physical supervised consumption sites, which is the gold standard for supporting this population.”

“If you don't have supervised consumption or a friend who can monitor you, then we're here to support you so that you stay safe.”

Fighting stigma, building trust

People take the risk of using substances alone because they are afraid of stigma, explains Ghosh, who works as an internist at the University of Alberta Hospital in Edmonton and as an addiction specialist at the Foothills Medical Centre and the AHS Rapid Access Addiction Medicine program in Calgary. 

“They're afraid of being seen. They're afraid of being identified. They're afraid of being arrested, incarcerated and criminalized,” he says.

The researchers reported that 62 per cent of callers are women and 94 per cent are from urban areas in Ontario, Quebec and Alberta. Evenings are the peak time for calls. 

Callers are asked to provide only minimal personal information — their location, what drugs they are using — data that are either destroyed or anonymized after the call. Ninety per cent of the staff are people supported by Grenfell Ministries who have lived experience of substance use. These peer-based staff and the caller agree on a check-in schedule as the caller uses. Staff keep the line open until they’re confident the caller is safe. 

Sometimes the peers provide coaching for methamphetamine users who are experiencing “overamping” symptoms such as rapid heart rate, hallucinations and trouble breathing.

“By simple things such as telling them to go to a quiet place, turn off the TV or music, turn off the lights, try to get some rest, we basically can support and de-escalate them,” Ghosh says. 

Staff will connect callers with addiction counselling or mental health services if requested. 

Ghosh says the service has been advertised but the most common way callers hear about it is through word of mouth. He attributes that to the staff’s ability to quickly build judgment-free, positive relationships over the phone. 

“I think the peer piece is the secret sauce. They've walked the walk and they can talk the talk, so they are able to relate to individuals far more quickly than health-care providers can,” says Ghosh.

A blend of research and implementation

The National Overdose Response Service was founded in December 2020 by Ghosh in close partnership with Grenfell Ministries and Brave Technology Co-op. Ghosh pays tribute to co-founder Rebecca Morris Miller, who he says was integral to launching the service and who died in October.

The service and its evaluation are funded by Health Canada’s Substance Use and Addiction Program, Healthcare Excellence Canada and the Canadian Institutes of Health Research, with in-kind support from the University of Calgary and the University of Alberta. 

Ghosh hopes to continue offering the service while studying its impact. He is currently conducting a national survey of substance users. He’d like to understand why women use the service more than men or gender-diverse individuals, and he wants to shed light on how well mobile apps such as Brave, the Lifeguard Digital Health and the Digital Overdose Response Service — which allow users to set a timer that will automatically dispatch EMS if it is not refreshed in a timely manner — can support harm reduction. 

He also hopes to attract more rural users to the service, while acknowledging they face additional barriers including a lack of reliable internet and cell service and slower EMS response times. 

“This service can be an important additional option for harm reduction for people who are actively using substances,” Ghosh says. “We definitely want to be able to support rural individuals in their communities.”

Don’t use drugs alone. 

Call the National Overdose Response Service before you use drugs to connect with people who want to help you stay safe:

  • (Canada only): 1-888-688-NORS (6677)
  • Never Use Alone (U.S. only): 1-800-484-3731
  • Mobile app (Global): The Brave App