Project Summary For the 12 months ending in September 2022, more than 100,500 Americans died from an overdose, the majority of which involved opioids. Substantial national, state, and local resources have been invested in reducing the prevalence of overdose deaths in the United States. But rather than substantively declining, the annual overdose death count has remained over 100,000 for year-over-year reports since June 2021. There is no obvious, single solution to the overdose epidemic, which is a ‘wicked problem’ requiring a multifaceted prevention, treatment, and recovery system addressing a wide variety of risk factors. However, it is unequivocally clear that naloxone, an opioid antagonist that can reverse overdose, is a highly effective, rapid response tool that can save lives. What is perhaps less well understood is that naloxone is remarkably underutilized; in 2019, fewer than one quarter of fatal opioid-involved overdoses in the US had any evidence of naloxone administration prior to death. For naloxone to be an effective solution, it must be present at the scene (e.g., a dose must be within a radius of an overdose where it can be used) and someone within that radius also needs to be trained and willing to administer it. Overdose education and naloxone distribution (OEND) programming for laypersons (e.g., bystanders; other citizens who are not first responders or medical professionals) has been shown to be feasible and effective in reducing fatal overdose rates but does not presently have sufficient reach. As a solution, we propose a strategy to leverage the PulsePoint Respond app and network to facilitate OEND programming. The PulsePoint network is an existing, national network of more than 4,400 community first responder agencies who coordinate with 894,744 layperson CPR responders who already have indicated willingness to respond to unconscious and unresponsive persons in public. These layperson responders are notified through the app when a community first response agency deploys an emergency response team to an unconscious or unresponsive person in public who is within a certain radius of the layperson. This means that the infrastructure to deploy individuals to potential opioid overdoses already exists and is active, but the citizen responders have not necessarily been trained (overdose education and naloxone use) or carry naloxone. We will test the feasibility of recruiting PulsePoint agencies and layperson responders for OEND using a 3-arm, multi-stage randomized controlled trial that will assess (1) recruitment of community first responder agencies and (2) layperson engagement with OEND programming across (a) a standard recruitment condition, (b) an overdose/naloxone misinformation debunking condition, and (c) a control condition. We will also conduct qualitative follow-up analyses. Successful completion of this project will directly inform procedures for a follow- up R01 application to test this approach with an outcomes-focused randomized, controlled trial across a much larger (1,000+) community sample with a goal of meaningfully reducing community fatal overdose rates.

Project Narrative Despite substantial investment in treatment, prevention, and recovery, the United States continues to experience historically high rates of fatal overdoses, many of which involve opioids. Naloxone, an opioid antagonist, is a highly effective overdose reversal mechanism that can be easily used by laypersons – but it remains remarkably underutilized. This study will test how best to connect a large, existing CPR citizen responder network with opioid education and naloxone distribution programs, with the long-term goal of supporting a national-scale assessment of whether this approach can reduce the prevalence of fatal opioid- involved overdoses.