Overdose Lifeline is a nonprofit that distributes free fentanyl test strips to Indiana residents, but research shows that utilization of fentanyl test strips can be quite low. Overdose Lifeline, design studio GRIDDL, and independent creative consultants developed non-stigmatizing, health-focused messaging around the use of fentanyl test strips in our community to prevent overdoses.

The campaign was designed based on Indianapolis survey results that utilized the Health Belief Model (HBM) to map community understanding of the issue as well as the type of marketing that may work best. Survey response analysis indicated that messaging should focus on HBM constructs of (1) Perceived Severity and (2) Perceived Susceptibility of the issue. We also placed a focus on stigma reduction and normalization to make sure that all people understood that this message is for them.

The creative idea "Best Test Ever" focuses on the test and testing behavior itself, rather than the overused 'fentanyl can kill you' messaging. The insight behind the work is that no one likes taking tests, but this is one test we can get behind because it helps save lives. We placed 60 billboards, 6 bus shelters, wrapped 2 buses, and digital ads targeting Indianapolis residents as well as a website to support the campaign where individuals can anonymously request free fentanyl test strips to be shipped directly to them. The campaign ran for 3 months with over 47 million estimated impressions and 7,712 distributed in the county through this website alone, with a 68% increase in strips distributed by Overdose Lifeline (not including campaign specific distribution) that is attributed to the campaign exposure. We received additional unplanned campaign exposure via radio and newspapers that carried out pro-harm reduction discourse to even more Indianapolis residents.

Background: Substance use remains high, especially among young people and racial/ethnic minority groups. While studies have shown relationships between exposure to substance-related advertising and use, studies have not examined perceived targeting to specific groups. This study examined perceived targeting of popular e-cigarette, cannabis, and alcohol images, and how such perceptions differed across age and racial/ethnic groups.

Methods: National, cross-sectional survey of N=6,098 participants 13-40 years old (X_age = 22.6; SD=7.0) who were exposed to popular social media posts for e-cigarettes, cannabis, and alcohol. After viewing an image for each type of substance, participants were asked “Which age group(s) do you think the advertisement is trying to reach?” [13-17, 18-20, 21-24, 25-40]. For cannabis and alcohol, participants were also asked the same question for “racial/ethnic group(s)” [American Indian/Alaska Native, Asian, Black/African American, Hispanic/Latino, Middle Eastern, Native Hawaiian/Pacific Islander, North African, White, Other]. Descriptive statistics were conducted in R.

Results: Participants identified as 51.5% Non-Hispanic White, 17.3% Non-Hispanic Black, and 22.1% Hispanic. Across all three substances, participants perceived that the image they saw was targeting their own age group, especially those ages 18-20, versus older or younger. Participants also perceived that the cannabis and alcohol advertisements mostly targeted Black/African American (32.5-84.8% for cannabis; 17.9-82.8% for alcohol) and Hispanic/Latino groups (14.8-53.1% for cannabis; 22.5-83% for alcohol).

Discussion: Depictions of substance use in social media and advertising should be regulated and limited, as images containing use are perceived to target specific demographic groups. Such efforts may help reduce disparities in use.

Background: Safety First is an innovative comprehensive drug intervention curriculum for middle and high school students. Safety First is one of a few curricula that focuses on harm reduction principles, acknowledging the wide spectrum of drug use, from abstinence as an important, and primary, strategy in reducing drug harms to encouraging youth who use to take steps to reduce the potential harms of drugs. This study describes the development, dissemination, reach, and preliminary impact of Safety First.

Methods: We conducted Google analytics and implemented a novel data dashboard whereby we administer surveys immediately before and after the administration of the curriculum. Adolescents were asked questions about the safest path for drug use; perceptions of harms associated with cannabis use (daily and occasional use); and other variables. We used SPSS to conduct descriptive and independent sample t-tests analysis.

Results: We have reached over 95,873 youth, conducted over 19 trainings, and trained over 625 educators on Safety First. Preliminary data indicate that adolescents were significantly more likely to report better understanding of the safest path for drug use (avoidance of all drugs; p<.001) and that occasional cannabis use is harmful to their health (p<.003).

Conclusions: A harm reduction-based curriculum such as Safety First offers a holistic approach in teaching middle and high school students about drug use in an engaging and nonjudgmental way. Safety First provides youth with scientifically accurate information to empower them to quit and/or reduce harm should they choose to continue to use.

Issue: The illegal sale of controlled substances over the internet poses significant health risks to consumers of all ages. Continued availability of controlled substances – such as opioids, benzodiazepines, and stimulants – through social media, websites, and other online platforms exacerbates public health concerns due to heightened risks associated with the combined use of these products, as well as lack of assurance that these products are safe and effective.

Description: The U.S. Food and Drug Administration (FDA) has partnered with the Reagan-Udall Foundation for the FDA to explore the intersection of misinformation and consumer behavior, with a focus on prescription controlled substances that are available online. This project began with preliminary research through a literature search, social media evaluation, and interviews with thought leaders. Next, consumer input was solicited through online polls to explore consumer perceptions and knowledge and listening sessions on consumer motivations and behaviors. Findings will inform the development of FDA’s fifth Online Controlled Substances Summit in July 2024, which will explore ways to reduce the availability of illicit controlled substances online. These activities fall under FDA’s Overdose Prevention Framework priority of protecting the public from unapproved, diverted, or counterfeit drugs presenting overdose risks.

Lessons learned: Addressing misinformation in the controlled substances space requires collaboration among public and private stakeholders, ranging from social media and technology experts to government entities, academic researchers, and advocacy groups. Activities to better understand consumer behavior may help inform tailored messaging, with the goal of targeting misinformation that is influencing consumers to make risky choices and exacerbating the overdose crisis.

Recommendations: Proactive engagement, coordination, and collaboration involving the public and private sectors and informed by diverse consumer input is an effective strategy for mitigating the risks associated with the online availability of prescription controlled substances.