Effectiveness of direct patient outreach with a narrative naloxone and overdose prevention video to patients prescribed long-term opioid therapy in the USA: the Naloxone Navigator randomised clinical trial.

Introduction: Public health efforts to reduce opioid overdose fatalities include educating people at risk and expanding access to naloxone, a medication that reverses opioid-induced respiratory depression. People receiving long-term opioid therapy (LTOT) are at increased risk for overdose, yet naloxone uptake in this population remains low. The objective of this study was to determine if a targeted, digital health intervention changed patient risk behavior, increased naloxone uptake, and increased knowledge about opioid overdose prevention and naloxone.

Methods: We conducted a pragmatic randomized clinical trial among patients prescribed LTOT in a health care delivery system in Colorado. Participants were randomly assigned to receive an animated overdose prevention and naloxone educational video (intervention arm) or usual care (control arm). The 6-minute video was designed to educate patients about opioid overdose and naloxone, increase overdose risk perception, and prompt them to purchase naloxone from the pharmacy. Over an 8-month follow-up, opioid risk behavior was assessed with the Opioid-Related Behaviors in Treatment survey instrument, and overdose and naloxone knowledge was measured with the Prescription Opioid Overdose Knowledge Scale after viewing the video at baseline. Naloxone dispensations were evaluated using pharmacy data over a 12-month period. Data were analyzed with generalized linear mixed effects and log-binomial regression models.

Results: There were 519 participants in the intervention arm and 485 participants in the usual care arm. Opioid risk behavior did not differ between the study arms over time (study arm by time interaction P=0.93). There was no difference in naloxone uptake between the arms (RR = 1.13, 95% CI: 0.77-1.66). Knowledge was significantly greater in the intervention arm compared to usual care (P<0.001).

Conclusions: A targeted, digital health intervention video effectively increased opioid overdose and naloxone knowledge, without increasing opioid risk behavior. Naloxone uptake did not differ between the intervention and usual care arms.

Trial Registration: ClinicalTrials.gov number NCT03337009.