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

Nonmedical prescription opioid use (NMPOU) is a significant public health problem impacting communities. NMPOU, defined as use of a prescribed opioid analgesic without a prescription or for reasons other than prescribed, is associated with a myriad of adverse consequences, including fatal overdose (NIDA, 2015), emergency department visits (Cottler, et al., 2017), dependence and addiction (Compton et al., 2006), and infectious diseases (Zibbell et al., 2015). The existing supply of opioid analgesics is high (Guy, 2017). Many of these opioid analgesics are leftover following treatment (Maughan, et al., 2015) and kept in homes rather than being disposed after ceasing use or expiration (Kennedy-Hendricks et al., 2016). Secure storage and disposal of unused opioid analgesics has been extensively promoted at the federal level and adopted by local communities as a strategy to combat NMPOU. Secure storage programs consist of provision of medication lock boxes and messages, typically provided by community organizations. Disposal programs include community-based take-back events, dropboxes and deactivation pouches which can be used at home. The premise underlying these two strategies is that (1) secure storage minimizes the likelihood of diversion while opioid analgesics are being used during treatment and (2) disposal programs provide opportunities for patients to remove unused or expired opioids outside the home, ultimately reducing availability for NMPOU. However, research is still in its infancy, and evidence is emerging that majority of individuals do not securely store opioids analgesics (Bicket, et al., 2017) and only a fraction of unused prescription opioids are disposed of through these take-back events and dropboxes (Egan, et al., 2016). This is likely due, in part, to a widespread failure of patients’ awareness of or ability to recall the need to- and appropriate mechanism of- storage during and disposal at the end of treatment. Studies suggest that increasing awareness of mechanisms of disposal is associated with disposal of unused medications (Egan et al., 2019; Yanovitzky, 2016). Mobile phone text message reminders, an emerging technology used in the promotion of multiple health behaviors (Armanasco, et al., 2017; Richman, et al., 2016), may address the need to provide guidance on secure storage and disposal of unused opioids by prompting patients about behavior modifications in the moment. Applying Fogg’s Behavior Theories on Persuasive Design (Fogg, 2009), a text message would serve as a ‘motivator’ or a trigger for a patient to securely store and dispose of unused opioid analgesics and including mechanisms of disposal within the text should result in an enhanced ‘ability’ to perform the task. Our long-term goal is to prevent NMPOU by decreasing the availability of unused prescription opioids in the home. The overall objective of the proposed study, which is the next step toward attainment of our long-term goal, is to conduct research to pilot test a novel prevention strategy that utilizes an informational text message reminder system to expand the impact of secure storage and disposal programs. Our central hypothesis is that implementation of a text message intervention will trigger individuals to securely store opioid analgesics during treatment and dispose of them following treatment. To address this need, we plan to pilot test our central hypothesis and thereby attain the objective of the proposed study by pursuing the following specific aims: Aim 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 by means of focus groups. Aim 2: Pilot test a text message intervention to facilitate secure storage and disposal of unused opioid analgesics using a randomized control trial. Our working hypothesis is that individuals who receive the text message intervention will be more likely to report secure storage and disposal compared to the control group.