A Universal Primary Care Based Intervention to Reduce Youth Overdose Risk

PROJECT SUMMARY/ABSTRACT
Between 2015 and 2019, overdose deaths translated to 1.25 million years of life lost among adolescents and
young adults (“youth”), and the percent change in fatal overdose death rates among adolescents was higher
than adults between 2019 and 2020. Similar to adults, illicitly manufactured fentanyl (IMF) is the major driver of
drug overdose deaths in youth. Unlike adults, youth are more commonly exposed to IMF through counterfeit
pills, and some youth are unaware that they are using a pill that is counterfeit and thus unintentionally exposed
to IMF. Unfortunately, any youth who uses a counterfeit pill or other drug is at risk for an overdose, even after
first use. There is an urgent need for evidence-based overdose prevention interventions for youth. Within the
healthcare setting, youth primary care providers routinely provide injury prevention anticipatory guidance as
part of annual comprehensive physical exams and are well positioned to provide anticipatory guidance for
overdose prevention. Through this R61/R33 mechanism we propose to develop and evaluate the efficacy of an
universal overdose prevention intervention that will increase: (1) awareness of the risks of fentanyl and other
emerging drugs in the drug supply, (2) knowledge of strategies to reduce overdose risk, and (3) recognition
and response to overdose. In the R61, in collaboration with our existing Youth Community Advisory Board, we
proposed to use the Informational-Motivational-Behavioral Skills Model to develop an overdose prevention
intervention to be delivered in primary care setting. We will pilot the intervention in two primary care settings at
Boston Medical Center, Pediatric Primary Care and Family Medicine, to assess acceptability and feasibility for
providers and youth ages 13 to 26 years who are being seen for an annual comprehensive physical exam. We
will do this through a pilot two-arm cluster randomized controlled trial (RCT) that is randomized at the provider
level. During the pilot trial, we will share preliminary data with the Community Advisory Board to inform any
needed adaptations to the intervention. If the intervention is acceptable and feasible to providers we will
transition to evaluating the intervention’s efficacy in a larger RCT during the R33. In the R33, we will again
conduct a two-arm cluster RCT randomized at the provider level using the same inclusion/exclusion criteria,
procedures, and study measures as the R61. Youth outcomes will be evaluated at one-year follow up and the
primary outcome will be youth knowledge of the risk associated with fentanyl and other emerging drugs in the
drug supply. Secondary outcomes will include youth knowledge of strategies to reduce overdose risk,
recognize and respond to an overdose. If the universal youth overdose prevention intervention is effective this
will benefit youth and public health generally as youth will be better prepared to decrease their risk for
overdose, and recognize and respond to others who have an overdose.

Grant Number: 1R61DA062217-01
NIH Institute/Center: NIH
Principal Investigator: Sarah Bagley