The Opioid Safety Toolkit: An interactive prescription opioid safety toolkit to increase opioid safety literacy and behaviours among people prescribed opioids for pain—a randomised controlled trial

BACKGROUND AND AIMS: Prescription opioid-related harm remains a significant public health concern. This study aimed to evaluate the efficacy of the Opioid Safety Toolkit, a co-designed, interactive online resource, in increasing naloxone uptake and healthcare provider discussions among adults prescribed opioids for pain. DESIGN: Parallel-group, open-label, randomised controlled trial. SETTING: Community-based, online recruitment across Australia. PARTICIPANTS: Adults (n = 314) prescribed opioids for non-cancer pain. INTERVENTIONS: Participants were randomised to receive either the Opioid Safety Toolkit (intervention, n = 152), which included interactive and tailored educational content on opioid safety, or an active control website presenting evidence-based opioid safety information (n = 162). Both groups were followed for four weeks. MEASUREMENTS: The primary outcome was self-reported naloxone requests four weeks post-intervention. Other outcomes were intentions to access naloxone immediately post-intervention, and healthcare provider discussions about opioid safety at four weeks, opioid safety knowledge (immediately after the intervention and at four weeks), satisfaction with resources and naloxone possession at four weeks. FINDINGS: Participants in the intervention group were more likely to have requested naloxone at four weeks compared with controls [21.7% vs 9.9%, odds ratio (OR) = 2.5, 95% confidence interval (CI) = 1.3, 4.8; P = 0.005], and more likely to report intentions to access naloxone immediately post-intervention compared with controls (41.4% vs 15.4%, OR = 3.9, 95% CI = 2.3, 6.6; P < 0.001). Participants in the intervention group were not more likely to have healthcare provider discussions at four weeks compared with controls (OR = 1.1, 95% CI = 0.7, 1.8; P = 0.620). Post-intervention opioid overdose knowledge was statistically significantly higher in the intervention group compared with control group (Mean score 16.6, 95% CI = 15.5, 17.7 vs control mean score 13.3, 95% CI = 12.3, 14.3). Satisfaction with the resource was higher in the intervention group compared with control group (Mean = 20.0, 95% CI = 18.7, 21.3 vs Mean = 18.0, 95% CI = 16.7, 19.3, P = 0.035). CONCLUSIONS: We found good evidence that, compared with a gold-standard opioid information website, the Opioid Safety Toolkit increased naloxone requests among Australian adults prescribed opioids for non-cancer pain. We also observed consistent effects across secondary outcomes, with the Toolkit increasing intentions to access naloxone, enhancing opioid overdose knowledge and yielding higher satisfaction ratings, although it did not increase healthcare provider discussions at four weeks.