Table 3

A sampler of possible demonstration projects

1. Deliver substance-focused prevention or treatment services in unconventional settings.  A randomized controlled trial that found a hypertension intervention delivered in barbershops increased uptake of blood pressure checks, with effects still evident a year later. Barbershops may also be a good setting for substance-focused programs in some communities, while others may have better results in bowling alleys, dental offices, chat rooms, gaming clubs, or faith communities.
2. Interfere with online drug sales using inexpensive tricks developed by hackers. For example, IP “spoofing” (using a false IP address to impersonate a trusted computing system), can be automated and scaled to overwhelm a website in a denial of service attack. A potential way to collapse online drug transaction websites offline would be to create many impersonation IP addresses to access the site until it crashes. 
3. Automate naloxone administration. Opioid users who overdose when alone cannot benefit from naloxone. A possible solution is a wearable device that automatically triggers a naloxone injection based on respiration rate, much as an insulin pump administers medication in the event of acute need. At the users’ option, the device could also be set to contact emergency medical services in the event of overdose.
4. Mount creative and accurate public messaging campaigns to reduce drug-related risks, e.g., Promoting the role of designated rescuer akin to designated driver; or campaigns informing people who use stimulants or pressed pills that fentanyl is not just an issue with heroin.
5. Use technology to limit diversion. Smart pill bottles have not been shown to be particularly helpful for improving adherence in HIV treatment, but they may be repurposed to reduce medicine-cabinet diversion of prescription opioids.
6. Monitor places where people who use drugs publicly discuss drugs to learn of emerging risks. Novel drugs like brorphine have shown up on r/opiates on Reddit months before their existence was widely reported. Screen-scraping these and similar fora, including on the dark web, can provide behavioral data to complement toxicology.
7. Remove technical and legal barriers to providing telehealth care across state and provincial lines and across international borders as well. For example, crisis counseling could be more available during relevant periods – i.e., dawn to dusk – if counselors working in other countries could take these shifts during their daytime hours.
8. Develop machine learning algorithms that predict response to pain, risk of addiction and overdose in patients for whom opioids are being considered to inform decisions about medication choice, dosing, and co-prescription of naloxone if an opioid is prescribed.
9. Develop and test assessments of the incidence and prevalence of opioid use, addiction, and overdose that do not involve surveying individuals. These could include a combination of wastewater analysis, scraping of social media and Internet search engine data, medical examiner data, and natural language processing of journalistic reports and chat room dialogue from around the world.