PROJECT ABSTRACT Young people using counterfeit pills and opioids from the unregulated market today are faced with little information and even less control over a drug’s content. Experimentation or infrequent use can be harmful if not lethal for youth and young adults who lack opioid tolerance, knowledge and awareness of protective behaviors, and are neither aware of nor carry lifesaving tools like naloxone and fentanyl test strips. The rate of fatal overdose in adolescents and young adults continues to rise and there is an urgent need for evidence- based interventions to reduce overdose risk. Effective, evidence-based overdose prevention interventions have primarily been developed and implemented for adults and there is a significant gap in our understanding of how youth understand overdose risk and effective strategies to reduce their risk. To date, the United States lacks a robust national public health response for overdose in adolescents and young adults. The goals of this study are to engage adolescents and young adults, parents, youth providers, pharmacists, and people who use drugs to generate timely knowledge to guide future intervention development and co-create adaptations to reduce youth overdose risk. We proposed the following specific aims: 1) Explore perceptions of overdose risk, the drug supply, and safety precautions among adolescents (ages 13-17 years) and young adults (ages 18-25 years) through a series of focus groups (3 each, 6 total). We will then invite a subset of the young people to take part in a photovoice component, to help visualize and further articulate these formative concepts. 2) Investigate family (n=10), youth providers (e.g., nurses, physicians, social workers) (5-7), pharmacists (n=5), and people who use drugs’ perspectives (n=10) about overdose risk and how best to educate young people and provide them with the knowledge and skills to reduce their own overdose risk to respond to an overdose. 3) Adapt existing educational materials and overdose prevention interventions through an evidence-based co- design approach with young people and content experts. Building from earlier aims, the co-design teams will revise educational materials, placement, and messaging for extant overdose prevention tools (i.e., fentanyl test strips, community drug checking services, naloxone kits including OTC naloxone products) and then test their validity and feasibility through two final sets each of adolescent and young adult focus groups (n=4) in a different location. Conceptually, our approach leverages cutting-edge methods and theories of empowerment, youth identity, and the well-established information, behavior and management (IMB) framework from HIV that we extend for the first time to gain insights into adolescent and young adult overdose prevention. Practically, the knowledge gained in the proposed research is critical to developing effective responses, tailoring to the unique needs of young people, and will shape how we implement and test future intervention studies of overdose prevention for these critical demographics.

PROJECT NARRATIVE Youth overdose deaths have continued to climb in recent years. Effective, evidence-based overdose prevention interventions have primarily been developed and implemented for adults and there is a significant gap in our understanding of how youth understand overdose risk and effective strategies to reduce their risk. We will engage adolescents and young adults, parents, youth providers, pharmacists, and people who use drugs to generate timely knowledge to guide future intervention development and adaptation to reduce youth overdose risk.