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

项目摘要 阿片类镇痛剂的现有供应量很高；开药率相当于至少一张阿片类药物处方。 开处方最多的县的每个居民。这些阿片类止痛药中的许多都没有使用，而是保存在 房屋，而不是在停止使用后处置。非医疗用处方阿片类药物的主要来源 是亲戚或朋友；这表明过量和保留的处方阿片类药物的转移有助于 严重影响到非医疗用途和相关后果。如果没有有效的战略来促进他们的 安全储存和处置，处方阿片类药物将留在社区，增加了 非医疗用途相关的发病率和死亡率。长期目标是防止非医疗处方 通过减少家庭中未使用的药物的可获得性来使用阿片类药物。本R34的总体目标是 应用程序是测试一种新颖的、基于证据的策略的可行性，该策略利用一系列有说服力的、 信息性短信提醒，扩大安全存储和处置方案的影响。这 研究性学习将追求两个具体目标(1)利用传播学和健康行为理论来发展 并改进文本消息干预以鼓励安全存储和处置未使用的处方 阿片类药物；和(2)试点测试根据目标1开发的短信干预，以促进安全存储 以及处理未使用的阿片类镇痛剂。对于目标1，将使用系统的两阶段过程来开发 并细化由消息影响框架和健康信念通知的文本消息干预 模特。第一阶段将包括焦点小组讨论(n=6-8个FGD，n=7-10个人，每个FGD) 目标人群的个人处方阿片类药物治疗急性疼痛。第二阶段包括预试 以及使用具有全国代表性的小组样本(n=1,500)来提炼文本消息干预。为了达到目标 2，将进行随机对照试验，从当地一家药店招募360名参与者 配发阿片类药物处方。这个项目的创新之处在于，它通过(1)适应 一种基于证据的干预策略，手机短信，用于一个新的目的-- 促进处方阿片类药物的安全储存和处置，(2)使用理论上驱动的消息传递来 在收到处方阿片类药物后的关键需求窗口期间发送短信干预 药物，以及(3)测试干预平台以解决非医疗处方阿片类药物的使用，即 可跨多个医疗保健系统进行扩展。拟议的研究具有重要意义，因为它应该减少 从患者家中积聚未使用的处方阿片类药物，随后导致 非医疗处方阿片类药物使用的流行率及其相关后果。建议进行的研究 通过开发和预测以理论为基础的预防干预措施，直接解决NIDA的优先事项 它可以在医疗保健环境中实施，以引起人口层面的影响，以解决阿片类药物危机。

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.