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.

Project Narrative To address the ongoing nationwide crisis of overdose deaths we propose to develop technology that encourages people who use drugs to protect themselves and the people around them, and that facilitates linkage to available harm reduction services. We will collaborate with a network of community members with whom we have developed strong relationships during prior research projects and will employ a highly participatory, iterative approach to developing intervention content in English and Spanish. Our proposed intervention is designed to be readily scalable for sustainable use in urban settings nationwide, future iterations can be developed for rural populations.