Background: People who use alone are at high risk for fatal overdose. Restroom motion sensor systems can detect the loss of movement indicative of an overdose and rapidly alert nearby responders, who can administer naloxone and call emergency medical services. We assessed the feasibility and acceptability of sensor systems designed for public restrooms and pilot tested a system at three locations.

Methods: We surveyed 100 organizations in neighborhoods experiencing high rates of overdose in Rhode Island and conducted 8 focus groups with people who use drugs and service providers. In 2024, we began pilot testing the Brave Sensor system.
 
Results: Organizations surveyed included food service (27%), bars/clubs (7%), gas stations (11%), hotels/motels (10%), pharmacies/retail (16%), housing (7%), and medical/drop-in centers (7%). Most (73%) respondents expressed comfort with sensor implementation. Some (37%) organizations had a history of overdoses, but many did not keep naloxone onsite (59%) or had no staff trained in naloxone administration (42%). Perceived benefits of sensor systems, in addition to saving lives, included their low-threshold nature, potential reductions in overdose-related stress/anxiety/trauma. Concerns included data confidentiality, potential legal repercussions of being found onsite after overdosing (e.g., eviction), first-responder stigma, mistrust of surveillance-based technologies, burden of responding to alerts and false alarms, and resources required for system maintenance (e.g., electrician). To date, Brave Sensors have been implemented in 13 restrooms inside a research office, two drop-in centers, and a supportive housing program; 10 sensors are still active, 5 have been uninstalled. No overdose deaths have occurred to date.

Conclusions: Our findings demonstrated feasibility and high acceptability of sensors in the state of Rhode Island, but revealed several programmatic, technological, and policy considerations. Interventions are urgently needed in public restrooms and housing, where overdoses, when unnoticed, are likely to become fatal.