Development and Pilot Randomized Control Trial of a Text Message Intervention to Facilitate Secure Storage and Disposal of Prescription Opioids to Prevent Diversion and Misuse

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Project Summary The existing supply of opioid analgesics is high; the prescribing rate equates to at least one opioid prescription per resident in the highest prescribing counties. Many of these opioid analgesics go unused and are kept in homes rather than disposed after ceasing use. The primary source of prescription opioids for nonmedical use is relatives or friends; which suggests that diversion of excess and retained prescription opioids contribute significantly to nonmedical use and associated consequences. Without effective strategies to facilitate their secure storage and disposal, prescription opioids will remain in communities, increasing the likelihood for nonmedical use-related morbidity and mortality. The long-term goal is to prevent nonmedical prescription opioid use by decreasing availability of unused medications in the home. The overall objective of this R34 application is to test the feasibility of a novel, evidence-informed strategy that utilizes a series of persuasive, informational text message reminders to expand the impact of secure storage and disposal programs. This research study will pursue two specific aims (1) use communications and health behavior theory to develop and refine a text message intervention to encourage secure storage and disposal of unused prescription opioids; and (2) pilot test the text message intervention, developed under Aim 1, to facilitate secure storage and disposal of unused opioid analgesics. For Aim 1, a systematic two-phase process will be used to develop and refine a text message intervention informed by the Message Impact Framework and the Health Belief Model. Phase 1 will consist of focus group discussions (n=6-8 FGDs, n=7-10 individuals per FGD) with the target population of individuals prescribed opioid medications for acute pain. Phase 2 consists of pretesting and refining the text message intervention using a nationally representative panel sample (n=1,500). For Aim 2, a randomized control trial will be conducted with 360 participants recruited from a local pharmacy when an opioid prescription is dispensed. This project is innovative in that it shifts the current paradigm by (1) adapting an evidence-based intervention strategy, SMS text messages on mobile phones, for a novel purpose – facilitation of secure storage and disposal of prescription opioids, (2) using theoretically driven messaging to deliver a text message intervention during a critical window of need following receipt of a prescription opioid medication, and (3) testing an intervention platform to address nonmedical prescription opioid use that is scalable across multiple systems of care. The proposed research is significant because it should reduce the accumulation of unused prescription opioids from patients’ homes and, subsequently, contribute to a decline in the prevalence of nonmedical prescription opioid use and associated consequences. The proposed study directly addresses NIDA’s priorities by developing and pretesting a theoretically-based, prevention intervention which can be implemented in healthcare settings to elicit population-level impacts to address the opioid crisis.