Reducing Prescription Opioid Overdose: The Role of Health Communication in Guideline Adoption

Background:  Drug overdose deaths reached record levels in 2014, and at least half of those deaths involved prescription drugs. Opioids are the most common prescription drugs involved in these deaths. From 1999 to 2014, more than 165,000 people died from overdose related to prescription opioids. Prescription opioid sales have quadrupled in the United States since 1999, and so have the number of deaths from related overdose. In addition, many people become tolerant to opioids and require higher amounts of the drug, which can put them at risk of addiction and overdose. In 2014, nearly two million Americans, aged 12 or older, abused or were dependent on opioids.

Program background:  CDC developed the Guideline for Prescribing Opioids for Chronic Pain to help providers make informed prescribing decisions and improve communication between providers and patients about opioid risks and benefits. The guideline addresses initiating opioids; opioid selection, dosage, duration, and discontinuation; and assessing risk and addressing harms of opioid use. The impact of the guideline is dependent on provider adoption of the recommendations into clinical practice. Using the Diffusion of Innovations Theory, CDC developed a suite of communication products designed to translate the science of the guideline to practice.  Communication messages were developed to meet the following objectives:

• Increase awareness of the prescription opioid overdose epidemic.
• Promote the relative advantage of using the guideline to inform prescribing decisions.
• Reinforce compatibility with provider values and needs to improve patient safety and save lives.
• Reduce the complexity of guideline adoption by providing easy-to-understand messages.

Key messages were reinforced through a variety of communication materials to accommodate channel preferences of target audiences. Products include:

• Clinical decision tools (checklist and mobile app) to facilitate appropriate real-time prescribing decisions.
• Online training to increase provider knowledge of prescription opioid risks and pain treatment options.
• Infographics to convey complex data in digestible formats.
• Posters and fact sheets for provider and patient reference in the clinical setting.
• Social media content to increase awareness and influence social norms.
• Digital press kit to promote media coverage and help frame community dialogue.
• Exhibit and conference materials to engage partners as key influencers.
• Podcasts and videos to increase consumer awareness regarding the prescription opioid overdose epidemic.

Evaluation Methods and Results:  The impact of communication messages and products on provider knowledge, attitudes, and behaviors will be evaluated through online self-report quantitative surveys. Survey instruments will include measures regarding perceived opioid risk, awareness and perceptions regarding guideline recommendations, and guideline adoption. Analysis will consider differences between providers who report familiarity with the communication messages and those who do not.

Conclusions:  Health communication plays an integral role in guideline adoption among providers by increasing awareness, promoting relative advantage, emphasizing value compatibility, and reducing complexity.

Implications for research and/or practice:  Evidence regarding the role of health communication in adoption of clinical guidelines is lacking in the published literature. Evaluation of communication products designed to translate the CDC prescribing guideline to practice indicate the importance of health communication in enabling provider acceptance and corresponding implementation in medical practice. Adoption of other clinical innovations may be facilitated through a Diffusion of Innovations approach.