In our recent pilot study in an urban ED, 25% of adults reported recent extramedical opioid use (more than prescribed or for purposes other than pain care) and 3.5% had had a non-fatal overdose on prescription opioids. Currently, little is known about strategies to reduce unintentional prescription opioid overdoses.
An important strategy for drug use reduction (but that has not been yet adapted for overdose prevention) is brief motivational enhancement, a counseling style in which a therapist uses a non-judgmental approach to empower client to enact behavior change. Prior studies on heroin users suggest that witness-based prevention interventions (i.e., interventions that train substance users to take helpful actions when witnessing an overdose) are also a promising prevention strategy. Additionally, interventions with a peer outreach focus (i.e., interventions that train participants to discuss reducing risk behaviors with peers) may be more effective than interventions focusing on the individual. However, to date, there have been no randomized controlled trials of interventions to reduce prescription opioid overdose risk.
The proposed study will test a tailored ~45 minute for adults at high risk of unintentional prescription opioid overdose delivered in an urban ED, with the primary goal of reducing overdose risk behavior via motivational enhancement techniques. Participants who report using opioids with others will receive additional intervention content on responding to others’ overdoses that they witness, and conducting peer outreach. The proposed study will screen for individuals who report a lifetime history of a non-fatal overdose and past three month extramedical use of prescription opioids or a prior prescription opioid overdose. In total, 250 individuals at risk for future prescription opioid overdose will be randomized to either the intervention or an enhanced usual care control condition and reassessed six months later.
The primary specific aims will focus on changes in precursors of overdose risk behavior (e.g., self-efficacy, readiness to change, behavioral intentions, and knowledge of overdose risk behaviors) immediately post-intervention and overdose risk behavior (e.g., use of high dose/quantity of opioids, use of opioids in combinations with certain psychoactive substances, taking multiple types of opioids, type of opioid used, and route of administration) six months post-intervention. Secondary analyses will examine gender and the presence of a substance use disorder as effect modifiers. Additionally, exploratory data will be collected via a pilot study in which we interview a subsample (n = 20) of participants who endorse opioid use with others to explore ways to reach the social network of participants at high risk. Knowledge generated in the proposed study is likely to have broad implications for prescription opioid overdose prevention efforts.