This proposal seeks to determine the feasibility, acceptability, and preliminary effectiveness of applying the Harnessing Online Peer Education (HOPE) intervention, or peer support social media community model, to reduce prescription drug abuse among chronic opioid non-cancer pain patients. Prescription drug abuse has reached epidemic proportions in recent years. Chronic opioid therapy, prescribed to treat patients experiencing chronic pain, is the most frequently abused of all prescription medications. Complications from chronic opioid misuse/abuse include respiratory suppression, infectious disease transmission, drug dependence/addiction, and fatal overdose. Chronic non-cancer pain patients with the following risk factors are at the highest risk for complications: 1) High dosage of opiods, 2) opioid use with concomitant use of sedatives (polysubstance use), and 3) aberrant medication-related behaviors (e.g. early refills requests). Although low cost, novel interventions are needed to reduce these risk behaviors before they lead to addiction and overdose, few studies have focused on this area. Community-based approaches, such as peer leader and peer support interventions, have been successful in creating health behavior change and could be applied to reduce opioid abuse. However, because peer support groups often require in-person visits and a great deal of time and financial resources, these groups have high drop-out rates. With the recent increase in social media/online communities, these technologies could be used as cost-effective platforms to deliver peer support interventions for opioid abuse and overdose. The HOPE intervention is an evidenced-based peer-led social media intervention provided over Facebook that has been successfully used to change health behaviors. However, no published research has studied whether the HOPE approach, or other social media-based peer social support interventions can be adapted to reduce prescription drug abuse, making this an important feasibility study. We propose the following specific aims to address this research:
Specific Aim 1 : Explore (qualitatively) how the HOPE social media-based intervention can be adapted for opioid abuse/overdose prevention among patients on chronic opioid therapy.
Specific Aim 2 : Assess the feasibility, acceptability, and preliminary effectiveness of applying th HOPE model to reduce opioid abuse/overdose risk among high-risk chronic non- cancer pain patients. Secondary aim: Explore the feasibility of using participants'publicly-viewable social media conversations to better understand prescription opioid abuse and to improve intervention implementation. The pilot data collected from this study will be used to develop an R01 proposal for a larger randomized trial designed to assess the effectiveness of using social media to scale peer-led prescription drug abuse interventions to reduce prescription opioid abuse and polysubstance use among chronic opioid users.
The ability to use low cost, novel technologies, such as social media, to deliver social support, community- based drug abuse interventions is critical to controlling drug addiction and the increasing number of overdoses. This project is particularly significant because it 1) attempts to address prescription drug abuse, the top cause of injury-related death in the United States, 2) seeks to adapt an evidenced-based, social media-delivered, peer support intervention to reduce risk factors for prescription opioid and polysubstance-related addiction and overdose, allowing the potential for these methods to be rapidly and cost-effectively scaled using social media, and 3) seeks to explore the use of new methods of using social media free-text group conversations to understand participant perspectives to provide additional observational data and improve future intervention delivery.