Early Evidence of an Opioid Education Campaign: A Case Study of Rhode Island.

CONTEXT: The opioid crisis poses a significant burden at a national level, and certain states have seen particularly high rates of misuse, addiction, and overdose. In 2017, Rhode Island reported opioid-related deaths nearly twice the national average. OBJECTIVE: To test message efficacy and evaluate the effectiveness of campaign messaging to shift attitudes/beliefs related to opioid misuse in Rhode Island. DESIGN: In phase 1, near-final versions of 6 advertisements were shown to a sample of the target audience via an online survey portal to assess responses to the messages (N = 1210). Phase 2 of the study employed a pre/posttest design whereby 2 cross-sectional surveys were conducted, first prior to the campaign launch (N = 456) and another survey 6 months later in Rhode Island (N = 433). SETTING: Phase 1 was conducted online using a nationally representative panel, and phase 2 included a convenience sample of participants in Rhode Island recruited to undergo an online survey. PARTICIPANTS: Eighteen- to 29-year-old members of a nationally representative online panel (phase 1) and 15- to 34-year-olds living in the state of Rhode Island during data collection periods. MAIN OUTCOME MEASURE(S): Empathy and destigmatization ("someone like me could become addicted..." and "those who are dependent on prescription opioids are victims") and perceived risk of developing dependence on opioids. RESULTS: In both phases, there was an increase in empathy ("someone") (phase 1: pretest [31%], posttest [42%; z = 5.5, P < .0001] and phase 2 [34% baseline vs 41% follow-up; z = 2.0, P = .04]) and destigmatization ("victims") (phase 1: pretest [54%], posttest [58%; z = 2.2, P = .01] and phase 2 [46% baseline vs 54% follow-up; z = 2.2, P = .03]). There was also an increase in perceived risk: phase 1 (pretest [65%], posttest [75%; z = 5.4, P < .0001]) and phase 2 (66% baseline vs 74% follow-up; z = 2.5, P = .01). CONCLUSIONS: This study demonstrated the potential efficacy of a media campaign to shift young adults' opioid-related attitudes.

Defining a recovery-oriented cascade of care for opioid use disorder: A community-driven, statewide cross-sectional assessment.

BACKGROUND: In light of the accelerating and rapidly evolving overdose crisis in the United States (US), new strategies are needed to address the epidemic and to efficiently engage and retain individuals in care for opioid use disorder (OUD). Moreover, there is an increasing need for novel approaches to using health data to identify gaps in the cascade of care for persons with OUD. METHODS AND FINDINGS: Between June 2018 and May 2019, we engaged a diverse stakeholder group (including directors of statewide health and social service agencies) to develop a statewide, patient-centered cascade of care for OUD for Rhode Island, a small state in New England, a region highly impacted by the opioid crisis. Through an iterative process, we modified the cascade of care defined by Williams et al. for use in Rhode Island using key national survey data and statewide health claims datasets to create a cross-sectional summary of 5 stages in the cascade. Approximately 47,000 Rhode Islanders (5.2%) were estimated to be at risk for OUD (stage 0) in 2016. At the same time, 26,000 Rhode Islanders had a medical claim related to an OUD diagnosis, accounting for 55% of the population at risk (stage 1); 27% of the stage 0 population, 12,700 people, showed evidence of initiation of medication for OUD (MOUD, stage 2), and 18%, or 8,300 people, had evidence of retention on MOUD (stage 3). Imputation from a national survey estimated that 4,200 Rhode Islanders were in recovery from OUD as of 2016, representing 9% of the total population at risk. Limitations included use of self-report data to arrive at estimates of the number of individuals at risk for OUD and using a national estimate to identify the number of individuals in recovery due to a lack of available state data sources. CONCLUSIONS: Our findings indicate that cross-sectional summaries of the cascade of care for OUD can be used as a health policy tool to identify gaps in care, inform data-driven policy decisions, set benchmarks for quality, and improve health outcomes for persons with OUD. There exists a significant opportunity to increase engagement prior to the initiation of OUD treatment (i.e., identification of OUD symptoms via routine screening or acute presentation) and improve retention and remission from OUD symptoms through improved community-supported processes of recovery. To do this more precisely, states should work to systematically collect data to populate their own cascade of care as a health policy tool to enhance system-level interventions and maximize engagement in care.