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

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 Kate Egan, Ph.D., Principal Investigator, Wake Forest University (Lead) ABSTRACT 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.