Project Summary/Abstract
For more than 20 years, nationwide overdose death rates have set new records almost every year, and
increases continue. Current deaths are largely due to adulterants in the illicit drug supply, including fentanyl,
xylazine, and benzodiazepines. The unpredictable nature of adulterated drugs has created a new set of overdose
risks for people who use drugs. This includes people who have used heroin for many years as well as people
who use stimulants and previously faced little, if any, risk of opioid overdose. Although available drug checking
tools can help people determine the presence of dangerous adulterants prior to consumption, they may not be
used by those most at risk.
We, therefore, propose to build upon longstanding community partnerships and our team’s extensive
experience developing technology-based interventions for substance using populations in community settings,
to create new materials in English and Spanish designed to: increase behaviors that protect against overdose
(including drug checking), and facilitate linkage to harm reduction services available nearby. We also plan to
increase overdose related health literacy and to encourage initiation of medications for opioid use disorder.
Over the course of multiple NIH-funded studies our team has developed a highly iterative, participatory
methodology to understand barriers to enacting positive health behaviors among specific populations, and to
learn how these can be addressed using technology-based intervention content. The first step in our
methodology is to conduct a series of interviews to examine, in this case, why people who use drugs do not
engage in overdose protective behaviors, such as drug checking. We will then develop storyboards (paper
representations of onscreen content) to address identified barriers, and then elicit participant response. After
revising our content accordingly, we will then draft intervention content including short videos and still frame
images paired with text in the style of a graphic novel or comic book. We will then evaluate this content through
a third wave of interviews with a new set of participants. During this process, we will also empanel a stakeholder
advisory board of current substance users, care providers, and prospective payers who we consult at each step
of the design, development, and evaluation of our work.
After finalizing our intervention we will recruit a new sample of people who use drugs (n=800) via venue
based sampling and chain referral (waves of participants recruit others, who in turn recruit additional participants)
for a randomized controlled trial examining whether our intervention materials more effectively encourage
protective behaviors compared to a treatment as usual control condition. Exploratory analyses will examine
intervention effectiveness by participants’ behavioral characteristics (type of substances used, method of
administration) and demographics. If shown successful, our sustainable, low-threshold intervention design can
be readily scaled and adapted for substance using populations across the United States.
