Table 1 Comparison of hotline and application-based services

Brief description of the service

Hotline-type services connect people who are using substances to live service operators. These service operators will stay on the line while someone uses their substances and will call either emergency medical services or designated community responders to intervene in the event of an overdose [8,9,10]

Timer-based services remain unmonitored and function in similar ways to an egg timer. An alarm begins quietly and increases in volume until a set time has passed. Once the time has passed, the application will connect with emergency medical services and have paramedics or other emergency services respond to the user's location [11, 12]

Technology requirements

Hotline services like the National Overdose Response Service (NORS) and Never Use Alone (NUA) hotline only require a phone and connection to cellular or landline services [8, 10]

Other services like Brave require a connection through the Internet or utilization of smart device data [9]

Of the timer-based services currently on the market in Canada, both Lifeguard and the Digital Overdose Response Service require an Internet connection or connection through cellular data which may limit access for certain populations [11, 12]

Availability

The Brave App is available globally

The National Overdose Response Service is available across Canada

The Never Use Alone hotline is available in most parts of the United States

Due to the linkage of these services with existing emergency medical dispatches, these services are only available province-wide

The Connect by Lifeguard app is only available in British Columbia and parts of Ontario, Canada

The Digital Overdose Response Services is only available in Alberta [11, 12].

Operation

To our knowledge, all of these services are run by people with lived and living experience of substance use sometimes referred to as peers [9, 13]

Of the services currently available, all timer-based services are government or private industry-run and operated [11, 12]

Additional services offered

Due to the nature of hotline services, many callers also utilize the service for peer support, mental health service calls and connection to resources [14, 15]

No additional live services offered within the app directly, but resource links are provided for users [9, 12].

Current research

To date, only two peer-reviewed publications are available describing NORS with no deaths reported [14, 16, 17]

To date, evidence released by both DORS and Lifeguard describes usage statistics but does not report on the number of deaths averted while using the service. [18, 19]

Costs:

All services are free of charge to users and customers

Both mobile applications are free of charge to users and customers