Spotlight on… e-health interventions

What is e-health and m-health?

e-Health involves the use of digital technologies to improve health in a variety of ways including:

• providing drug-related information with harm reduction advice (e.g. safer use) with or without personalised feedback from professionals and linked with specialised drug services if needed;
• treating patients with substance use disorders, including comorbidity, via e-health interventions; educating treatment professionals using e-learning modules on therapeutic techniques; and
• using digital diaries to monitor substance use in persons being treated for substance use disorders.

Digital technologies have also been used, more so during the COVID-19 pandemic, to initiate and maintain contacts with clients, diagnose health conditions and treatment needs, provide or renew prescriptions, and monitor the provision of health interventions to specific clients. 

m-Health is a type of e-health involving the delivery of e-health interventions using mobile phones and similar devices.

What is happening in Europe?

Delivering screening and brief interventions via e-health and m-health applications is a promising innovation for responding to a wide range of substance use problems, in particular, interventions targeted at vulnerable young people.

An EU-funded project established the Click for Support network, which has developed guidelines for the development of e-health interventions. e-Health applications available in Europe use a variety of technologies ranging from simple text-based content display to more advanced interactive functions such as video transmission, geo-tagging and automated personalised feedback.

Three main groups of m-health apps based on primary objectives

Three main groups of m-health applications related to illicit substance use have been identified:

• apps disseminating drug-related information and advice;
• apps providing interventions and support for people who use drugs (including prevention of opioid overdose deaths); and
• apps for capacity building among health professionals.

Most m-health apps address risk behaviour associated with drugs in general or drug use in specific settings (e.g. nightlife settings). Some drug-specific apps are available for more commonly used drugs such as cannabis.

Examples include:

• Quit the Shit (QTS) is a German online cannabis withdrawal programme developed for adolescents, aged 15–17 years, who want to reduce or quit their cannabis use. An interactive diary helps them monitor their drug use and a counselling team provides them with tips and personalised feedback to support them in achieving their personal goals.
• Mobile apps have been developed to provide information and harm reduction advice to young people in nightlife settings. Examples are Psychoactif and Techno+ apps available in French, and the RedAlert app in Dutch.
• The Dutch substance misuse treatment centre, Jellinek, has developed a ‘blended’ programme called MijnJellinek (MyJellinek) for people who meet the criteria for a substance use disorder diagnosis, which combines an e-health intervention with face-to-face contact with a therapist.
• The EU-funded Overdose Risk Information Tool (ORION) is an e-health decision support tool for individuals who are at high risk of experiencing a drug overdose. Using a number of questions, the tool calculates an estimate of overdose risk from 0 (lowest) to 100 (highest). The app presents the risk estimate in a visually attractive way, with the aim of facilitating discussion on overdose risk management between people who use drugs and their doctors.

Implications for the future

This is a rapidly developing field, further expanded by the advancement of many existing initiatives and the development of new ones during the COVID-19 pandemic. While the use of digital and mobile platforms for the delivery of appropriate and timely health interventions appears to have great potential, a number of challenges for users, app developers and policymakers exist. The lack of scientific evaluations of drug-related m-health interventions is concerning considering the increasing interest in and availability of such apps. Research into the effectiveness of these interventions is needed, especially among hard-to-reach target populations, such as high-risk youth. Consideration should also be given to how to deliver such interventions in a safe and appropriate manner to those from marginalised communities, like those experiencing homelessness, who may lack reliable access to internet or a smart phone.

Quality management and data security are also important issues. The lack of quality control of the content of these apps available to EU citizens, with no age limits, remains to be addressed. Questions have also been raised about the cross-cultural relevance of m-health applications, especially between the United States and Europe. At the same time, the impact of the EU General Data Protection Regulation, applicable since 2018, may be of particular relevance in a context of fast global development of drug-related m-health apps available to EU citizens.

Advances in technology have also opened up possibilities for continuous, real-time data collection and feedback from smartphones, social media, sensors and self-report. In this context data protection becomes increasingly important, and European-level policy and good practice on data security needs to be further developed and applied to all e-health interventions for people who use drugs.