A dedicated OSF page was set up [50], which made all the exercise components publicly available. This page included draft components such as the methodology; current scenario; an ideal desirable 2030 scenario unbounded by circumstances, limitations, barriers, values, challenges, and facilitators; and a series of mini scenarios to introduce the following 5 distinct key areas aligning with relevant areas identified by the Inter·GLAM group as priorities: (1) web-based advertising, marketing, and health promotion; (2) availability, implementation, and sustainability of digital services; (3) innovations in digital tools; (4) data privacy, data sharing, and digital rights; and (5) web-based outreach with hidden populations.

The first part of the in-person session was used to explain the objectives, methodology, and expected outcomes of the exercise in the plenary setting. A description of the current scenario and a future ideal desirable 2030 scenario were presented to the participants, and time was allocated for questions and amendments.

Participants were allocated to one of the 5 small multidisciplinary working groups, each focusing on one of the 5 key areas (identified in Step 1). Participants were allocated to the groups according to their area of interest or expertise. Participants included people who use drugs, service providers, nongovernmental organization advocacy groups members, and policy makers, with 5-6 people forming each group with 1 group for each of identified mini scenario. Stakeholders were provided with 3 printed lists of items relevant to optimizing digital tools to address substance use in 3 domains: values, challenges, and facilitators (Table 1 for definitions). The lists included definitions of each concept. Participants could also propose new items or suggest revisions for the provided definitions, if deemed necessary. Each working group was instructed to choose by consensus the 5 most relevant concepts from each list for each domain and record them on a flipboard. These concepts were then reported and discussed in plenary settings. Subsequently, the lead facilitators consisting of the working group leads (FS and MAT) and Inter·GLAM project coordinators (EC and HL-P) developed consensus in a plenary discussion to identify 5 values, challenges, and facilitators but not hierarchically ordered in terms of importance. Discussions were held until all the voiced opinions by the participants were adequately addressed. The participants could then further refine the concept definitions on the OSF page.

Each group focused on a specific key area of the bigger desirable future scenario (see Step 1) by means of a mini scenario associated with their specific key area. The participants were asked to deconstruct the route starting from the end point in 2030 and moving backwards toward the present by using a predesigned canvas to facilitate the exercise. At the end of the exercise, the results were briefly discussed with the other members of the workshop.

Based on reflections during the exercise and the professional and personal background of the participants, a discussion was held within each working group regarding the milestones necessary for reaching the 2030 goals. Key terms and definitions were collated on OSF by using open Google documents to enable further definitions. These documents were circulated among those interested in further revision and discussion through the use of comments leading to a series of iterative revisions and definitions.

Five key values regarding digital tools to address substance use were identified by the group: (1) digital rights, (2) evidence-based tools, (3) user-friendliness, (4) access or availability, and (5) person-centeredness. More detailed definitions can be found in Table 2.

Participants stressed the importance of promoting and protecting digital rights in the context of ongoing debates around content moderation in social media. Harm reduction organizations, for instance, experience difficulties because of content blocking while delivering services and providing information online. Innovations related to artificial intelligence–led identification of people who may be susceptible to intervention offers to treatment were also mentioned, along with the potential use of digital technologies to identify people who use drugs by governments that are compliant with nonhuman rights. Participants developed a consensus that the main goal of promoting and protecting digital rights was that digital tools are used in a way that will benefit people in a way that is ethical, safe, and secure.

Participants emphasized the importance of founding approaches in the field of substance use on available, reliable, and high-quality evidence. However, questions were raised on the use of the current scientific methods (eg, the gold standard randomized clinical trial), which may not be suitable to develop the evidence base for rapidly evolving digital innovations, and new paradigms such as the Sequential Multiple Assignment Randomized Trial [51] or other trial methods were suggested as potential alternative methods to be considered [52,53]. A discussion also emerged on how to address and manage the wide availability of misinformation and disinformation related to substance use online.

According to participants, the user-friendliness of digital tools can impact their uptake, long-term use, and effectiveness, and thus this factor should be considered. The key requirements identified included being able to cater to the diverse needs of heterogeneous groups of people who use drugs with varying needs, language, and cultural context requirements.

The workshop participants highlighted that digital divide (understood as unequal access to digital technology) and low digital literacy (understood as a person’s ability to collect and assess information and engage with digital tools) continue to be significant barriers for a major portion of the global population. According to the participants, people in some regions of the world (most notably, low- and middle-income countries) continue to lack access to the internet, mobile phones, tablets and laptops, and new technologies that require advanced equipment (eg, virtual reality devices), which will likely pose new barriers to delivering and accessing digital interventions. Moreover, disadvantaged subpopulations in high- and middle-income countries experience similar barriers.

The high heterogeneity in the needs of people who use drugs and of individuals living with drug dependency was another issue recognized by the working group. These diverse needs can include those related to particular substances, polysubstance use, routes of administration, specific populations, or environments. They may involve the parallel treatment of other (mental) health issues or chronic conditions, require addressing social determinants of health and economic disadvantages (eg, homelessness, poverty), and require responsiveness to local situations (eg, treatment availability, customs, norms, laws). In this context, experts argued that a person-centered approach should be adopted to the greatest possible extent.

Five key challenges regarding the adoption of digital tools for addressing substance use were identified: (1) ethical funding, (2) regulations, (3) commercialization, (4) best practice models, and (5) digital literacy and access or reach. More detailed definitions can be found in Table 3.

The sustainable funding of programs and projects and the development of digital tools were identified as a key challenge across working groups, with precarity and instability of funding seen as a critical factor affecting long-term sustainability. The necessity of identifying sustainable sources of funding was discussed, while the importance of this funding being ethical was stressed, particularly in the context of possible industry involvement. Significant skepticism was expressed concerning the motives of for-profit entities, but it was also argued that there can be shared value or mutual interests around projects where public health and profit outcomes coalesce around shared objectives. Participants also noted that the current grant application processes for most funders do not adequately allow for business practices like market research (customer discovery, etc) and rather, the focus is on defining the population and features before the project begins. This means, unlike start-ups, it is difficult to pivot during a project to better address the need through a change in features or to switch to a different population that has the need for the features originally specified. Public funders may also be hesitant or resistant to fund certain types of technologies that are politically contentious. Participants argued that public entities are reluctant to fund the development of web-based harm reduction initiatives, as they are frequently seen as controversial.

Session participants highlighted several cases where harm reduction content was removed from social media platforms, for example, a recent case between SIN (Students Drug Policy Initiative) Poland and Facebook [38]. Concerns were also raised about predictive algorithms currently being developed to identify people with substance use disorders as treatment ready [54]. Experts encouraged more extensive work with stakeholders (such as social media companies) in the field of content moderation as well as advocacy efforts against current policies and laws, which may restrict the access to evidence-based information or advice.

Being cognizant of alcohol and gambling, participants expressed concerns that commercial interest companies are likely to advertise and market substances online once they become legal and may focus their marketing to those with an increased risk of substance use–related problems. The likely emergence of new licit industries (eg, Big Cannabis, Big Psychedelics) and their potential involvement in aggressive marketing was deemed worth monitoring and proactively responding to. It was also discussed whether the development and commercialization of digital tools in this field should be done exclusively by health or governmental institutions or also by private companies. Ethical issues are likely to arise from the involvement of big companies with economic interests, but it was also recognized that such actors may also offer bigger funding opportunities.

The group discussed the lack of availability of best practices for both developing and using digital tools, although attention was brought to emerging practices in the field of harm reduction such as Eurasian Harm Reduction Association's recommendations for setting up web-based harm reduction services [22] and Peer-to-Peer Counsellor Manual for Online Counselling [23] and the guide “Recommendations Web—outreach for people who use drugs” developed by the United Nations Office on Drugs and Crime [21]. Digital tools are equally being implemented in the substance use prevention and early intervention field by, for instance, the BePrepared team in Germany for young refugees with hazardous substance use [33]. The lack of available best practice was seen to negatively impact the quality assurance of service and highlighted the need for increased quality management. In this context, issues around the well-being of health care workers working in the web-based space using digital tools and the need for new management protocols to work with such potentially remote workers were discussed [23].

The multidimensional nature of digital inequalities and the digital divide were stressed, including the importance of focusing on dimensions for any given scenario and the development of an understanding of boundary settings and challenges. It was also highlighted that we must remain cognizant of the potential role of hybrid approaches and the use of digital environments as a medium or setting as well as a tool. Digital literacy was highlighted as a key challenge, which may particularly affect nondigital natives (eg, older people), disadvantaged populations, as well as health sector representatives. In this context, disparity in terms of technology development, investment, and accessibility between high income and low- and middle-income countries was emphasized. The likely impact identified by participants was primarily concerned with people’s access to services and their ability to critically analyze available information. In addition to low digital literacy, the digital divide was also identified as an obstacle for some people to engage in web-based services due to poor internet access, lack of computer devices, or due to the lack of access to modern newly emerging technologies (eg, virtual reality headsets).

Five key facilitators of adopting digital tools for addressing substance use were identified: (1) scientific research, interoperable infrastructure, and a culture of innovation; (2) expertise; (3) ethical funding; (4) user-friendly design; and (5) digital rights and regulations. More detailed definitions can be found in Table 4.

Participants highlighted that there was a need for further collaboration among researchers, people who use drugs, clinicians, and advocacy groups in the conduct of research, development of infrastructure, and the promotion of innovation in this field. It was acknowledged that multidisciplinary research needs to be conducted at all stages from planning to execution to monitoring and evaluation. A need to ensure that technologies and infrastructure were interoperable was also identified. The importance of multistakeholder involvement in innovations in this field was also stressed. It was suggested that a culture of innovation would include lean or agile start-up methods used in business.

The working group highlighted the need to build capacity and expertise of developers and end users for digital tool development and use. This includes the development of expert advisory groups composed of all key stakeholders, including people who use drugs that would help monitor and oversee efforts such as the cocreation of best practices and guidelines around cybersecurity, data sharing, content moderation, and ethical use of artificial intelligence.

A long discussion took place on the need for sources of ethical funding and the potential role of industry in the development of digital tools. Some experts indicated significant skepticism toward the involvement of for-profit entities’ and advocated for no industry involvement. Others argued for the involvement of industry where there was a shared value (mutual interests) around well-being and health. A consensus was achieved that all funding procedures should always consider ethical questions explicitly.

All experts emphasized the importance of user-friendly designs of digital tools for substance use to enhance uptake, engagement or adherence, efficacy, and efficiency. It was noted that the term “user-friendly” is rather generic, and its specific features will vary significantly depending on the characteristics of specific target groups (eg, different age groups). However, some general and universal features of user-friendliness mentioned by the experts included easiness of use, availability in local languages, the use of simple language and terms, lack of excessively lengthy text descriptions, and accessibility for people with reading difficulties or cognitive difficulties. In terms of content, it was also advised to avoid scientific jargon and use common expressions or colloquialisms instead of scientific language to enhance clarity and understandability of information.

For the optimal use of digital tools, working groups stressed the importance of digital rights ensured by the existence of appropriate regulations and laws that are rooted in equity and human rights principles. It was considered extremely important to protect people who use drugs, service providers, and other key actors’ data privacy, confidentiality, right to transparent information, and health care provision while also protecting them from harassment from automated technologies engaging in predictive risk prediction and actions of state or nonstate malicious actors.

Participants proposed that an integrative and levelled ethical framework should inform substance use–related work in the digital space. This framework could guide social media operators on how to moderate content related to substance use, governments in creating appropriate regulations focused on the protection of individuals, as well as developers (either public or private entities) in the creation of digital tools.

Participants proposed that a range of focused and coordinated efforts should be undertaken to increase access to digital tools and reduce the digital divide. This includes efforts aiming to widen the geographical coverage of the internet network to improve internet access, enhance digital literacy among those less familiar with new technologies, and address accessibility issues related to physical and mental disabilities and different cognitive abilities, dependent on local and regional contexts.

Participants proposed that interventions, policies, and infrastructures should be subject to continuous monitoring and evaluation. Data sharing infrastructures could be regularly reviewed in terms of security and conformance with digital rights. Monitoring of digital tools would allow for assessment of their effectiveness and adequacy and for adjusting them accordingly to the dynamic changes in substance use. Services should be adaptive to changes in substance use patterns.