Canadian questionnaire captures attitudes toward overdose prevention services across four stakeholder groups
Canadian researchers have developed the Canadian National Questionnaire on Overdose Monitoring (CNQOM), a new online instrument designed to measure perspectives on two major overdose prevention approaches: supervised consumption sites and overdose response hotlines and applications. The work matters because policy debates around these services often move faster than the evidence base for public attitudes, especially when views differ between people who use substances, clinicians, emergency responders, and the general public.
The survey was built to serve as a national tool for capturing those views in a structured way. It was administered in English and French to adults drawn from four key informant groups, and it was designed to examine attitudes toward specific elements of overdose prevention services rather than broad abstract opinions. In a country where overdose mortality continues to drive urgent harm reduction discussions, the need for a reliable instrument is practical and immediate.
Survey development centered on human validation and harm reduction expertise
Item development followed a standard questionnaire design process, with face validity checked by representatives from each of the four informant groups. Experts in harm reduction and addiction medicine also contributed to content and face validity, strengthening the instrument before field use. The result was not a generic public opinion poll, but a targeted tool intended to measure how different stakeholders perceive the role, accessibility, and acceptability of services meant to prevent overdose deaths.
The questionnaire addressed supervised consumption sites and overdose response hotlines and applications, abbreviated as ORHAs. These interventions occupy different points in the overdose response continuum. Supervised consumption sites operate in person, reducing the risk of fatal overdose in real time through direct supervision and rapid intervention. Hotlines and applications extend overdose response into the digital space, aiming to connect people to help or guidance when in-person support may be farther away. A questionnaire that distinguishes between those models can reveal whether stakeholders see them as complementary, interchangeable, or unequal in legitimacy.
Response validation was treated as a major methodological step. Investigators used a rigorous process to confirm that respondents were human and located in Canada, an increasingly important safeguard in online research. Without that filter, public health surveys can be distorted by automated responses, duplicate submissions, or geographically irrelevant entries. The final analytic sample included 4,445 valid responses after cleaning and validation.
Four groups, one national sample, and wide geographic reach
The valid respondents came from all provinces and territories and reflected a range of sociodemographic backgrounds and housing situations. The breadth of that sample gives the CNQOM a national footprint that many attitude studies lack. It also allows the questionnaire to be used across stakeholder categories that may not share the same exposure to overdose services or the same reasons for supporting them.
This is especially important in overdose policy. People who use substances may evaluate these services through the lens of personal safety, stigma, and access. Emergency responders may focus on operational feasibility and the interface with acute care. Health professionals may judge clinical utility and linkage to treatment. The general public may weigh safety, community concerns, or misconceptions about harm reduction. A single validated instrument that can be used across those groups offers a way to compare perspectives without flattening them into one undifferentiated opinion pool.
Reliability testing showed variable stability across items
Test-retest reliability was examined in a subsample of 142 participants, primarily from the general public. Questionnaire items showed slight to substantial stability depending on the item, with Cohen’s kappa values ranging from 0.15 to 0.58 and Spearman’s rank correlations from 0.08 to 0.66. Those figures indicate that some questions were answered consistently over time, while others were more variable.
One sentence captures the central psychometric tension in this study: several items were stable, but not uniformly so.
In questionnaire science, such variation is not unusual when the subject matter is socially charged, unfamiliar, or abstract for some respondents. Lower test-retest reliability may reflect limited familiarity with supervised consumption sites, and especially with ORHAs, among some respondents. It may also reflect the impersonal nature of certain items, which can leave room for shifting interpretation depending on context, media exposure, or the respondent’s own experience between survey administrations.
What the reliability numbers mean for overdose policy research
The questionnaire’s performance suggests it can function as a large-scale tool for describing attitudes, but it also shows where future refinement may be needed. Instruments that ask about harm reduction services have to balance clarity with nuance. If an item is too vague, responses may drift. If it is too specific, the question may stop being broadly applicable across very different respondent groups. The CNQOM sits in that middle ground, and the variability in retest reliability provides useful feedback for later revisions.
A second punchy finding stands out: familiarity with the services appears to shape measurement stability.
That has practical implications for interpretation. A respondent who has never encountered an overdose hotline app may answer based on general impressions rather than direct knowledge. Someone with experience using or working around supervised consumption sites may provide more anchored responses. The questionnaire therefore measures both attitude and exposure, even when exposure is not the explicit endpoint. For policy researchers, that means the CNQOM may identify where public education or service outreach is needed before community attitudes can be meaningfully assessed.
A national baseline for future harm reduction work
The CNQOM is presented as the first online questionnaire in Canada built specifically to capture perspectives on these overdose prevention services across multiple key informant groups. Its main value lies in that combination of scope and specificity. It was fielded to a large, geographically diverse sample, validated against obvious online-response threats, and structured to compare opinions across groups that often enter overdose policy from very different angles.
The work also leaves clear room for further refinement. The reliability data were mixed rather than uniformly strong, and the small retest sample was drawn mainly from the general public. Future studies will need to examine whether the same item structure performs similarly in people who use substances, health professionals, and emergency responders. The next step is not simply larger deployment, but sharper calibration of the questions themselves so that attitude measurement can keep pace with the complexity of overdose prevention in Canada.