Never Use Alone Hotline

Overview of Never Use Alone

Research indicates that individuals who use drugs alone are much more likely to die from a fatal overdose. In response to the growing number of opioid overdoses in the U.S. and Canada, a number of harm reduction services and resources have become available in recent years. Among them are overdose prevention hotlines like Never Use Alone. ^[2][3][4]

Never Use Alone is a nonprofit organization that launched a nationwide overdose prevention hotline in 2019. The hotline is free to call and is staffed by trained operators who aim to provide support around the clock, although availability may vary, particularly during overnight hours. An individual who is planning on using drugs alone can call the hotline and speak with an operator who will remain on the phone with them. ^[1]

Rather than try to convince the person to stop using, the operator will provide support and keep the person on the line while they use drugs and for a few minutes after. If the person becomes non-responsive, the operator will call EMS to have emergency medical care dispatched to the person’s location. Otherwise, all information obtained on the call is 100% confidential. ^[1][2]

The intention of Never Use Alone is to prevent overdose deaths by helping to ensure that high-risk populations receive timely emergency medical care in the event of an overdose. ^[1][2] One study has shown that as much as 69% of fatal overdoses involve people using drugs alone, and that using alone was associated with a 42% increased risk for overdose. Most of this risk involves the lack of timely administration of emergency medicines like naloxone, which can reverse a fatal opioid overdose if administered quickly. ^[3][4][5]

Step-by-step: How to use the hotline safely

People who use drugs alone can access the national hotline at any time of day or night by calling 800-484-3731 or 877-696-1996. When accessing this service, you will be requested to share basic information, including your first name, the exact address or location you’re calling from, and the type of drug you’re planning on using. ^[1]

After gathering this basic information, you will be able to use the drug, and the operator will remain on the phone with you for a few minutes. If you become unresponsive, the operator will call EMS on your behalf and have them dispatched to your location. If everything is fine and you are able to respond, the operator will end the call after a few minutes.

Here are guidelines on how to safely use the Never Use Alone hotline: ^[1]

1. Call 1-800-484-3731 or 1-877-696-1996 to be connected with an operator before you begin taking any illicit substance.
2. Provide the operator with your name, exact location, and the type of drug you are intending to use.
3. Use the drug and remain on the line with the operator until they recommend disconnecting or ending the call.
4. Understand that the operator will not provide information or support on recovery services unless you specifically request them.

Legality of Never Use Alone

Never Use Alone is a harm reduction resource, meaning its express intent is not to get people to stop using drugs, but instead to reduce the risks and harms associated with drug use. ^[1] While harm reduction programs are considered controversial, they are not illegal. The individuals calling the hotline do so voluntarily and are provided with information about the scope of the support provided on the call.

The hotline operators receive training on how to provide support to callers, and the website states that many are in recovery from an addiction as well. ^[1] Harm reduction helps to reduce the stigma associated with drug use and addiction by providing non-judgmental support to people in active addiction.

While some people may be concerned about the confidentiality of the hotline, the only time information is shared with outside agencies is in the case of a suspected overdose. If a caller becomes non-responsive, the operator will call EMS and provide them with the first name and location or address of the person. No records are kept after the calls to further ensure caller data remains private and protected. ^[1][2]

Limitations and considerations of Never Use Alone

The scope of support provided by a hotline like Never Use Alone is limited and specific to brief telephonic monitoring for signs of drug overdose. The hotline is not designed to provide in-depth counseling or support to individuals struggling with other mental health challenges. Instead, the service is intended to offer brief telephone support for individuals before, during, and directly after a person uses drugs. ^[1][2][4]

Providing basic information like your first name, exact address or location, and the type of drug you will be using is a condition of using the hotline. Without this information, the operator will not be able to dispatch EMS to your location in the event of an overdose, which is the primary mission of the hotline. To date, their website claims to have fielded 60,000 calls and dispatched EMS 250 times.^[1]

Because Never Use Alone is considered a harm reduction service, operators will not volunteer information about addiction recovery services, programs, or resources. This information can be provided upon the specific request of the caller.

Does it replace treatment?

Never Use Alone is not a replacement for professional addiction treatment. Most of the operators are trained volunteers or peers who are in recovery themselves, rather than licensed and trained counselors. While the hotline operators may be able to provide information about how and where to access treatment in your community, they are not able to provide addiction treatment or professional advice. ^[1]

Harm reduction resources like Never Use Alone are not intended or designed to help people who are trying to stop using drugs. Instead, they are intended to target active drug users and help to reduce the harms and risks associated with drug use. Professional addiction treatment, on the other hand, is specifically designed to help people who are ready to stop using drugs, establish their sobriety, and begin the road to recovery.

Other harm reduction services

Increased awareness and understanding of substance use issues in the U.S. over the past several decades has led to the wider implementation of harm reduction services across the nation. While legal, financial, and community restrictions still hinder access to some of these services, there are now more ways to safely use substances than ever before.

Examples of harm reduction strategies include: ^[6][7][8]

• Supervised consumption sites: Some states offer access to spaces for supervised substance use, reducing the risk of accidental overdose.
• Needle exchange programs: Offer clean needles while disposing of used ones, reducing the risk of blood-based diseases and other illnesses.
• O-T-C overdose prevention medications: Many states now offer overdose-reversing drugs like naloxone without a prescription, widening access.
• Affordable drug testing kits: Increased access to testing kits has reduced accidental overdose from contaminated drugs.
• Community education and support: By reducing the stigma associated with substance use disorders across communities, those who need help can reach out without fear.

When to call 911 immediately

Treatment and support