Opioid-Related Public Health Communication Campaigns: An Environmental Scan

Introduction

The U.S. opioid overdose crisis has been ongoing for two decades and was declared a national emergency in 2017. ¹ Since then, drug overdose deaths continue to increase with recent data reporting a 28.5% increase from April 2020 to April 2021. ² Among the many important responses to the epidemic are public communication campaigns to increase the awareness of the opioid crisis and reduce stigma. Key features of successful communication campaigns include behavior change as an objective, formative research to inform campaign planning, focus on homogeneous population segments, and use of multiple channels to achieve a high frequency of exposure.^3-6

However, there is relatively little research to guide the design of campaigns for drug and alcohol use, opioid-related topics, and stigma. ⁷ One meta-analysis of mass media campaigns to prevent drug use noted inconsistent evidence for their effectiveness and could not identify any core features of either successful or unsuccessful campaigns. ⁸ Another review of mass media campaigns to reduce alcohol consumption and related harms found that while they can impact knowledge, attitudes, and beliefs about alcohol consumption, they do little to reduce consumption itself. ⁹ Furlan et al conducted a systematic review of the effectiveness of various strategies to reduce opioid use disorder and opioid overdose deaths and, based on limited evidence from five studies, found communication campaigns to be one of the most promising strategies. ¹⁰

Despite this lack of guidance or evidence, communication campaigns about the opioid crisis have proliferated. Most, if not all, campaigns have a web presence, regardless of the channels they use for message dissemination (i.e. televisions, radio, print) so that the audience can access additional information and resources. We report the results of an environmental scan of online-accessible campaigns to (1) understand the current state of the science and practice of opioid-related campaigns and (2) inform the development of future opioid-related campaigns.

Methods

The research team conducted a structured online search via Google on a quarterly basis from July 2019 to June 2020 (12 months), with the research team reviewing the first five pages of results filtered by the dates of each quarter. We included campaigns that were based in the United States and accessible online. Campaigns identified were not limited by their launch date or length of run. If a campaign was changed and adapted for a new location by a different organization with distinct audiences and creative assets, it was included more than once (e.g., the “Dose of Reality” campaign concept was repeated in multiple states, but materials, messages, and audiences varied widely).

“Campaign” or “initiative” were the first-level keywords used in the search strategy. These results were then searched with additional keywords for (1) types of opioids (“opioid” or “heroin” or “fentanyl” or “oxycodone” or “hydrocodone” or “codeine” or “morphine” or “pain relievers” or “prescription pain medication” or “painkillers”), (2) naloxone (“naloxone” or “Narcan” or “Evzio” or “opioid overdose”), (3) medications for opioid use disorder (“medication-assisted treatment” or “MAT” or “methadone” or “buprenorphine” or “naltrexone” or “medication for opioid use disorder” or “MOUD”), and (4) stigma (“opioid stigma").

For each search result that included an opioid-related health campaign, two research staff independently reviewed each campaign website and categorized campaigns by (1) the priority audience(s) for the campaign (people with lived experience, community leaders, providers, or other) and (2) the topic(s) covered (prevention, stigma, treatment with U.S. Food and Drug Administration-approved medications for opioid use disorder, treatment (general with no reference to medication), naloxone, or recovery). A coding guide was used to clearly define inclusion/exclusion criteria for each audience and topic category, and a third coder reviewed discrepancies to reach a consensus.

The use of pretesting or other formative research was determined by (1) reviewing campaign websites for such information or reports and (2) contacting listed campaign contacts via email to complete a survey about their campaign research activities. Campaign contacts were allowed 14 days to respond and received one email reminder on day 7.

Results

Of the 166 identified opioid-related campaigns, the most common organizations leading campaigns were health departments (n = 53), behavioral health departments (n = 38), cross-sector coalitions (n = 23), nonprofits (n = 20), criminal justice/law enforcement agencies (n = 18), human services agencies (n = 13), private businesses (n = 13), academic institutions (n = 11), elected officials’ offices (n = 10), associations (n = 10), and federal agencies (n = 9). Several campaigns were led by more than one type of organization.

The most frequent campaign topics were prevention (n = 91) and stigma (n = 91), followed by naloxone (n = 82) and treatment with medications for opioid use disorder (n = 49). Campaigns focused on prevention (e.g., “Know the Dangers, “Don’t Take the Risk,” “Take Meds Seriously”) were characterized by educating the public on the addictive nature of opioids. Stigma campaigns (e.g., “End the Stigma,” “Stop Opioid Silence,” “Anyone, Anytime”) aimed to destigmatize opioid use disorder and demonstrate that it can happen to anyone. Campaigns focused on naloxone (e.g., “Bring Naloxone Home,” “Be a Hero,”) and treatment with medications for opioid use disorder (eg “Bupe Works,” “Choose MAT”) aimed to share information about evidence-based options for treating opioid use disorder and preventing opioid overdoses.

The priority groups for these campaigns were most often the general public (n = 101), followed by people with lived experience (n = 97), providers (n = 39), and community leaders (n = 37). Many of the campaigns targeted more than one priority group or covered more than one topic. Prevention campaigns were most common for providers and community leaders, while stigma campaigns were often focused on people with lived experience and the general public.

Of the 166 campaign websites, 160 included contact information that was used to email a survey about the use of formative research in campaign planning and message design followed by a reminder email of day 7. Only 11% (n = 18) responded within the allotted 14-day timeframe. Most respondents (72%, n = 13) conducted formative research, which included analysis of existing data (n = 10), surveys (n = 9), peer-reviewed literature reviews (n = 7), focus groups (n = 6), interviews (n = 6), and environmental scans (n = 5). Objectives of their research included understanding the knowledge, attitudes, beliefs, and behaviors in the general population (n = 10); exploratory research (n = 10), concept testing (n = 7), and message testing (n = 9) among specific segments of the population (n = 7); and involving members of the population in the development of the campaign (n = 6). The five campaigns that did not conduct formative research noted barriers including lack of funding (n = 4), lack of time (n = 4), formative research not being a priority (n = 2), lack of methodological expertise (n = 1), lack of senior level support for formative research (n = 1), and lack of relevance to their mission/vision (n = 1).

Discussion

Although we identified 166 opioid campaigns through internet searching that had a website, there are likely more campaigns that were not discovered through our search process. However, this large sample allows us to draw conclusions about the evidence for the use of best practices in such campaigns.

A lack of segmentation was found among 63% of the campaigns where a general population was the focus. However, 58% of the campaigns did include a segment of people with lived experience. Few campaigns prioritize provider and community leader segments despite their important roles as facilitators and gatekeepers to prevention and treatment products and services, as well as their influence on public opinion and stigma.

There are few campaigns that address evidence-based treatment interventions compared with prevention. There is a great need for more campaigns to focus on increasing demand for naloxone and medications for opioid use disorder and to facilitate access and adherence to treatment and recovery.

The lack of evidence on websites, and a low response to the email survey, compromises the generalizations that can be drawn about the use of formative research in campaign design and development. Although the response window to our email was rather brief, but did involve a reminder, the low response rate from campaign contacts may be an indicator that they did not conduct research and do not have the information needed to respond to our questions. For full transparency to the public, elected officials, and colleagues contemplating similar efforts, campaigns should document their research and development efforts and make their results available for public or requested access. Access to these data would allow campaign developers with limited resources to learn from this research and create more effective campaigns and also contribute to collective knowledge within the field.

This research included only online English materials; therefore, some campaigns or elements of campaigns may have been excluded if they lacked a web presence, did not share all materials online, or targeted non-English speakers. Additionally, this scan captured only a cross-section of campaign materials available from July 2019 to June 2020 and may be an underestimate of the actual number of campaigns due to the rapidly evolving responses to the opioid epidemic across the United States.