Disseminating and Implementing MedSMA℞T Families in Emergency Departments: A Randomized Control Trial to Assess Effectiveness of an Evidence-Based Gaming Intervention to Reduce Opioid Misuse

Pediatric opioid misuse has risen sharply, with adolescent deaths from opioids increasing by 94 percent between 2019 and 2021. A significant driver of this crisis is the easy access adolescents have to unused prescription opioids in their homes, coupled with a lack of awareness about the risks of misuse. Many adolescents perceive prescription opioids as safe because they are medications, while parents may inadvertently model unsafe practices. Research shows that adolescents and their families often lack the knowledge needed to safely manage opioids, and there are few interventions designed specifically for them. EDs, which frequently prescribe opioids for adults with adolescents living at home, are an untapped resource for delivering preventive education.

This research adapts MedSMA℞T Mobile, a digital health tool that combines an educational game with a personalized family medication safety plan, for use in the ED. By integrating this tool into ED workflows, the study aims to offer accessible, engaging, and cost-effective preventive education to address knowledge gaps and reduce opioid misuse in adolescents, a vulnerable population.

The specific aims of the research are as follows:

• Adapt MedSMA℞T Mobile based on ED and patient population characteristics.
• Evaluate effectiveness of MedSMA℞T Mobile to improve opioid misuse knowledge, attitudes, and behaviors in adolescents and parents.
• Evaluate continued dissemination of the finalized MedSMA℞T Mobile intervention and conduct pilot economic evaluations of MedSMA℞T Mobile from the ED and health system perspectives.

The researchers will hold stakeholder meetings with racially and ethnically diverse adolescent-parent pairs and ED staff to adapt MedSMA℞T Mobile for effective implementation and sustainability. They will observe how ED staff introduce MedSMA℞T Mobile to these pairs and use the insights to create an implementation package. A randomized controlled trial will evaluate the tool’s effectiveness by comparing outcomes for pairs using MedSMA℞T Mobile against a control group. Feedback from ED staff on scaling and sustaining the tool will inform broader implementation at the health system. Researchers will also look at the costs and benefits of MedSMA℞T Mobile to see how much money it could save in healthcare by improving health outcomes.

This study addresses the critical issue of opioid misuse, focusing on a vulnerable and often overlooked population—adolescents and their families—by introducing an engaging mobile game-based tool to deliver preventive education that promotes opioid safety at a crucial point of care: the ED. By involving ED staff and integrating MedSMA℞T Mobile into their workflows, the research fills a significant gap in opioid misuse prevention efforts, which typically center on adults. The anticipated impact includes raising awareness about opioid safety, enhancing family communication about medication use, and reducing opioid misuse among adolescents—a pressing public health issue contributing to rising opioid-related deaths—as well as the essential role ED staff play in preventing misuse. It will provide insights into the feasibility and scalability of using a game-based tool in diverse healthcare settings, with the potential for widespread adoption both in the United States and internationally. Results will be shared at national conferences, published in top journals, and communicated to professional and community groups, contributing to national efforts to curb the opioid epidemic.