ABSTRACT
Naloxone is a life-saving drug capable of reversing a fatal opioid overdose. Although this drug has existed for over 50 years, opioid overdose-related deaths have consistently risen and surpassed 120,000 globally in 2021. Opioids induce respiratory depression by activating μ-opioid receptors at specific sites in the central nervous system. This results in overdose deaths caused by slow and shallow breathing, also known as opioid-induced respiratory depression. 1.6 million individuals suffer from opioid use disorder annually, making them at high risk of overdose, primarily due to the increasing prevalence of Fentanyl. Over 52% of these deaths occur when the individual is alone. Immediate response to an overdose by delivering naloxone can save the individual's life. To solve this problem, we developed a closed-loop sensor-driven auto-injector that can determine a fatal overdose and inject naloxone. 76% of this population is willing to wear such a device on the shoulder, a canonical injection site. This paper presents the DOVE, a shoulder-based opioid overdose detection and reversal device. It noninvasively measures the subject's motion state and changes in blood oxygen levels (SpO2) along with the respiration state. These biomarkers are measured from the shoulder using an optical sensor and accelerometer to determine if a fatal overdose occurred. We evaluated our DOVE device against an FDA-cleared commercial pulse oximeter by inducing apneic events as they have very similar SpO2 trends to an overdose. Results show that SpO2 can be measured on the shoulder across different skin tones with an accuracy of 96.8% and a high Pearson correlation of 0.766 (p < 0.0001).
- 3M Double Coated Polyester Nonwoven Medical Tape. 2020. url: https://www.3m.com/3M/en_US/p/d/v000176405/.Google Scholar
- John Allen. "Photoplethysmography and its application in clinical physiological measurement". In: Physiological measurement 28.3 (2007), R1.Google ScholarCross Ref
- Richard Beasley et al. "Thoracic Society of Australia and New Zealand oxygen guidelines for acute oxygen use in adults:'Swimming between the flags'". In: Respirology 20.8 (2015), pp. 1182--1191.Google ScholarCross Ref
- Richard B Berry et al. "Rules for scoring respiratory events in sleep: update of the 2007 AASM manual for the scoring of sleep and associated events: deliberations of the sleep apnea definitions task force of the American Academy of Sleep Medicine". In: Journal of clinical sleep medicine 8.5 (2012).Google ScholarCross Ref
- Edward W Boyer. "Management of opioid analgesic overdose". In: New England Journal of Medicine 367.2 (2012).Google ScholarCross Ref
- U.S. Opioid Dispensing Rate Maps. 2021. url: https://www.cdc.gov/drugoverdose/rxrate-maps/index.html.Google Scholar
- Understanding the Opioid Overdose Epidemic. 2022. url: https://www.cdc.gov/opioids/basics/epidemic.html.Google Scholar
- Justin Chan et al. "Closed-loop wearable naloxone injector system". In: Scientific reports 11.1 (2021), pp. 1--13.Google Scholar
- Hsien-Yen Chang et al. "Healthcare costs and utilization associated with high-risk prescription opioid use: a retrospective cohort study". In: BMC medicine 16.1 (2018), pp. 1--11.Google ScholarCross Ref
- Keerthi Kumar Chintha et al. "Wearable biosensors to evaluate recurrent opioid toxicity after naloxone administration: a Hilbert transform approach". In: Annual Hawaii International Conference on System Sciences. Vol. 2018. 2018.Google Scholar
- ACM Dassel et al. "Reflectance pulse oximetry at the forehead improves by pressure on the probe". In: Journal of clinical monitoring 11.4 (1995), pp. 237--244.Google ScholarCross Ref
- JP De Kock et al. "The effect of varying LED intensity on pulse oximeter accuracy". In: Journal of medical engineering & technology 15.3 (1991), pp. 111--115.Google ScholarCross Ref
- Bahar Dhowan et al. "Simple minimally-invasive automatic antidote delivery device (A2D2) towards closed-loop reversal of opioid overdose". In: Journal of Controlled Release 306 (2019), pp. 130--137.Google ScholarCross Ref
- Paul Dietze et al. "Effect of intranasal vs intramuscular nalox-one on opioid overdose: a randomized clinical trial". In: JAMA network open 2.11 (2019), e1914977--e1914977.Google ScholarCross Ref
- LED Emitters- Infrared, UV, Visible. 2022. url: https://www.digikey.com/en/products/filter/led-emitters-infrared-uvvisible/94.Google Scholar
- Jonathonm Dowling et al. "Population pharmacokinetics of intravenous, intramuscular, and intranasal naloxone in human volunteers". In: Therapeutic drug monitoring 30.4 (2008), pp. 490--496.Google ScholarCross Ref
- Amber N Edinoff et al. "Pharmacologic and Clinical Considerations of Nalmefene, a Long Duration Opioid Antagonist, in Opioid Overdose". In: Psychiatry International 2.4 (2021).Google Scholar
- Michael Estephan, Carly Loner, and Nicole M Acquisto. "Effect of Extreme Temperature on Naloxone Nasal Spray Dispensing Device Performance". In: Prehospital and Disaster Medicine 35.3 (2020), pp. 272--275.Google ScholarCross Ref
- Andri Feldmann, Roger W Schmitz, and Daniel Erlacher. "Near-infrared spectroscopy-derived muscle oxygen saturation on a 0% to 100% scale: reliability and validity of the Moxy Monitor". In: Journal of biomedical optics 24.11 (2019).Google ScholarCross Ref
- Curtis Florence, Feijun Luo, and Ketra Rice. "The economic burden of opioid use disorder and fatal opioid overdose in the United States, 2017". In: Drug and alcohol dependence 218 (2021), p. 108350.Google Scholar
- Food and DrugAdministration. Pulse Oximeters---Premarket Notification Submissions [510(k)s]: Guidance for Industry and Food and Drug Administration. Mar. 2013.Google Scholar
- Andrew Franco, Jonathan Meldrum, and Christine Ngaruiya. "Identifying homeless population needs in the emergency department using community-based participatory research". In: BMC Health Services Research 21.1 (2021), pp. 1--11.Google ScholarCross Ref
- Peter SA Glass, Rajiv M Jhaveri, and L Richard Smith. "Comparison of potency and duration of action of nalmefene and naloxone". In: Anesthesia & Analgesia 78.3 (1994).Google Scholar
- Is Your Medication Making You Sweat? 10 Drugs That Cause Excessive Sweating as a Side Effect. 2020. url: https://www.goodrx.com/drugs/side-effects/medications-cause-excessive-sweating-side-effect.Google Scholar
- Robin Kingsley Harris. "Nuclear magnetic resonance spectroscopy". In: (1986).Google Scholar
- Mohammad S Imtiaz, Charles V Bandoian, and Thomas J Santoro. "Hypoxia driven opioid targeted automated device for overdose rescue". In: Scientific Reports 11.1 (2021).Google Scholar
- Amal Jubran. "Pulse oximetry". In: Critical Care 19.1 (Dec. 2015), p. 272. issn: 1364-8535.Google ScholarCross Ref
- Katie Kanter et al. "Willingness to use a wearable device capable of detecting and reversing overdose among people who use opioids in Philadelphia". In: Harm reduction journal 18.1 (2021), pp. 1--14.Google Scholar
- Anne-Maree Kelly et al. "Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose". In: Medical Journal of Australia 182.1 (2005), pp. 24--27.Google ScholarCross Ref
- Richard P Kingsborough et al. "Chemical sensing via a low SWaP wearable spectrometer". In: Chemical, Biological, Radiological, Nuclear, and Explosives Sensing XXI. Vol. 11416. SPIE. 2020, pp. 192--197.Google ScholarCross Ref
- Marcus Kramer et al. "Wearable pulse oximetry measurements on the torso, arms, and legs: A proof of concept". In: Military medicine 182.suppl_1 (2017), pp. 92--98.Google Scholar
- Jeffrey T Lai et al. "Nobody wants to Be Narcan'd: A pilot qualitative analysis of drug users' perspectives on naloxone". In: Western journal of emergency medicine 22.2 (2021), p. 339.Google ScholarCross Ref
- V Lakshminarayanan and N Sriraam. "The effect of temperature on the reliability of electronic components". In: 2014 IEEE international conference on electronics, computing and communication technologies (CONECCT). IEEE. 2014, pp. 1--6.Google ScholarCross Ref
- Yongbo Liang et al. "An optimal filter for short photoplethysmogram signals". In: Scientific data 5.1 (2018), pp. 1--12.Google Scholar
- Sally K Longmore et al. "A comparison of reflective photoplethysmography for detection of heart rate, blood oxygen saturation, and respiration rate at various anatomical locations". In: Sensors 19.8 (2019), p. 1874.Google ScholarCross Ref
- Paul D Mannheimer. "The light-tissue interaction of pulse oximetry". In: Anesthesia & Analgesia 105.6 (2007), S10--S17.Google ScholarCross Ref
- Chris J McManus, Jay Collison, and Chris E Cooper. "Performance comparison of the MOXY and PortaMon near-infrared spectroscopy muscle oximeters at rest and during exercise". In: Journal of biomedical optics 23.1 (2018), p. 015007.Google ScholarCross Ref
- Yitzhak Mendelson, R James Duckworth, and Gary Comtois. "A wearable reflectance pulse oximeter for remote physiological monitoring". In: 2006 International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE. 2006.Google ScholarCross Ref
- Rajalakshmi Nandakumar, Shyamnath Gollakota, and Jacob E Sunshine. "Opioid overdose detection using smartphones". In: Science translational medicine 11.474 (2019), eaau8914.Google ScholarCross Ref
- Lena Nilsson et al. "Combined photoplethysmographic monitoring of respiration rate and pulse: a comparison between different measurement sites in spontaneously breathing subjects". In: Acta Anaesthesiologica Scandinavica 51.9 (2007).Google Scholar
- Meir Nitzan, Ayal Romem, and Robert Koppel. "Pulse oximetry: fundamentals and technology update". In: Medical Devices (Auckland, NZ) 7 (2014), p. 231.Google ScholarCross Ref
- Meir Nitzan, Ayal Romem, and Robert Koppel. "Pulse oximetry: fundamentals and technology update". In: Medical Devices (Auckland, NZ) 7 (2014), p. 231.Google ScholarCross Ref
- BR O'driscoll et al. "BTS guideline for oxygen use in adults in healthcare and emergency settings". In: Thorax 72. Suppl 1 (2017), pp. ii1--ii90.Google Scholar
- Rowan P Ogeil et al. "Pharmaceutical opioid overdose deaths and the presence of witnesses". In: International Journal of Drug Policy 55 (2018), pp. 8--13.Google ScholarCross Ref
- Amparo de la Peña et al. "Subcutaneous injection depth does not affect the pharmacokinetics or glucodynamics of insulin lispro in normal weight or healthy obese subjects". In: Journal of Diabetes Science and Technology 9.4 (2015).Google ScholarCross Ref
- Tania Pereira et al. "Photoplethysmography based atrial fibrillation detection: a review". In: NPJ digital medicine 3.1 (2020), pp. 1--12.Google Scholar
- Colin Raymond, Tom Matthews, and Radley M Horton. "The emergence of heat and humidity too severe for human tolerance". In: Science Advances 6.19 (2020), eaaw1838.Google ScholarCross Ref
- Alexis M Roth et al. "Wearable biosensors have the potential to monitor physiological changes associated with opioid overdose among people who use drugs: A proof-of-concept study in a real-world setting". In: Drug and alcohol dependence 229 (2021), p. 109138.Google ScholarCross Ref
- Opioid Overdose. 2022. url: https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/opioid-overdose.Google Scholar
- Elizabeth Y Schiller, Amandeep Goyal, and Oren J Mechanic. "Opioid overdose". In: (2017).Google Scholar
- Collin Schreiner et al. "Blood oxygen level measurement with a chest-based pulse oximetry prototype system". In: 2010 Computing in Cardiology. IEEE. 2010, pp. 537--540.Google Scholar
- Abhishek B Sharma, Leana Golubchik, and Ramesh Govindan. "Sensor faults: Detection methods and prevalence in real-world datasets". In: ACM Transactions on Sensor Networks (TOSN) 6.3 (2010), pp. 1--39.Google ScholarDigital Library
- Jennifer L Sherr et al. "Safety and performance of the Omnipod hybrid closed-loop system in adults, adolescents, and children with type 1 diabetes over 5 days under free-living conditions". In: Diabetes technology & therapeutics 22.3 (2020).Google ScholarCross Ref
- iNEMO inertial module: always-on 3D accelerometer and 3D gyroscope. 2017. url: https://www.mouser.com/datasheet/2/389/dm00133076-1798402.pdf.Google Scholar
- Toshiyo Tamura. "Current progress of photoplethysmography and SPO2 for health monitoring". In: Biomedical engineering letters 9.1 (2019), pp. 21--36.Google ScholarCross Ref
- Toshiyo Tamura et al. "Wearable photoplethysmographic sensors---past and present". In: Electronics 3.2 (2014).Google Scholar
- Peter Veng-Pedersen et al. "Duration of opioid antagonism by nalmefene and naloxone in the dog: an integrated pharmacokinetic/pharmacodynamic comparison". In: Journal of pharmaceutical sciences 84.9 (1995), pp. 1101--1106.Google ScholarCross Ref
- Karen Wanger et al. "Intravenous vs subcutaneous naloxone for out-of-hospital management of presumed opioid overdose". In: Academic Emergency Medicine 5.4 (1998).Google Scholar
- Nana Wilson et al. "Drug and opioid-involved overdose deaths---United States, 2017--2018". In: Morbidity and Mortality Weekly Report 69.11 (2020), p. 290.Google ScholarCross Ref
- Jyoti Yadav et al. "Prospects and limitations of non-invasive blood glucose monitoring using near-infrared spectroscopy". In: Biomedical signal processing and control 18 (2015).Google Scholar
- LDS Yadav. "Ultraviolet (UV) and visible spectroscopy". In: Organic Spectroscopy. Springer, 2005, pp. 7--51.Google ScholarCross Ref
- Ayae Yamamoto et al. "Association between homelessness and opioid overdose and opioid-related hospital admissions and emergency department visits". In: Social science & medicine 242 (2019).Google ScholarCross Ref
- Li Yang et al. "Wearable pressure sensors based on mxene/tissue papers for wireless human health monitoring". In: ACS Applied Materials & Interfaces 13.50 (2021).Google Scholar
Index Terms
- DOVE: Shoulder-based Opioid Overdose Detection and Reversal Device
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