Name of Intervention/ Program
Prevent Overdose WA

Background and Situation Analysis
The U.S. is experiencing an overdose epidemic driven by the proliferation of highly potent synthetic opioids containing fentanyl. Drug overdose deaths in Washington involving synthetic opioids increased more than 160% between 2018 and 2022. Each day about two people in Washington die of an opioid-related overdose, and thousands more struggle with opioid use disorder. C+C and the Washington State Department of Health created a campaign with a goal to reduce overdose deaths caused by opioids in the state of Washington by building awareness and driving harm reduction strategies. To accomplish this goal, the team developed a strategy to raise awareness and urgency among the general public about the opioid crisis and motivate people who use substances and the people who support them to take steps that reduce the likelihood of overdose death (harm reduction). The team used both secondary and primary research and social marketing planning principles to arrive at the final Prevent Overdose WA/No más sobredosis WA campaign. The campaign development process included six research phases. One of the key challenges to the research approach was recruiting people who use opioids (PWUO) into the research to ensure we had their perspective. This was solved by supplementing our usual recruiting methods to work with community organizations that serve people with Opioid Use Disorder. Phase 1 – Secondary Research: Review of recent opioid harm reduction and anti-stigma campaigns to identify information, best practices, and knowledge gaps. Phase 2 – Stakeholder Interviews: Gathered feedback from key opioid stakeholders to inform campaign focus, audience barriers, messaging and strategies. Phase 3 – Message Testing: Conducted qualitative testing to understand awareness, barriers and motivators related to harm reduction strategies among PWUO and friends and family of PWUO (care networks). Phase 4 – Concept Testing: Tested campaign concepts with priority audiences to gain overall feedback on campaign message understanding, relevance, believability and tonality. The first four research phases reinforced that stigma regarding opioid use exists within the general public and among PWUO (self-stigma). An additional phase of research was conducted to learn more about the influence of stigma: Phase 5 – Baseline Survey on Stigma and Behaviors: Statewide quantitative survey to identify stigma levels among priority audience groups as well as awareness of harm reduction behaviors. The Phase 5 survey confirmed high levels of stigma surrounding opioid use in Washington. Stigma exists with the general public judging people who use opioids as well self-stigma with PWUO feeling shame and low self-worth. The last research phase was a statewide quantitative survey to help measure campaign impact: Phase 6 – Evaluation: Evaluated ad recall and post campaign harm reduction behavior awareness.

Priority Audiences(s)
People Who Use Opioids (PWUO): This population is diverse in terms of demographics, geography and socioeconomics. We emphasized populations disproportionately affected by opioid overdose, including males, young adults, Hispanics, African Americans, American Indian/Alaska Natives, and people in 13 counties with higher overdose death rates. Care Networks: This audience had higher awareness of the dangers of opioids and of naloxone than the general public. They had a close relationship with someone who uses opioids. Many did not see themselves as bystanders who can intervene — while they were aware of naloxone and understood its benefits, few had it on hand.

Behavioral Objectives
The research helped the team narrow the campaign focus to the most immediate behavior intervention that can help save lives – getting more people in the community to have and know how to use naloxone (an easy to use, safe nasal spray that can reverse an opioid overdose). Other behaviors such as avoiding using alone and going low and slow with drug use were considered, however the research showed higher barriers for these behaviors and therefore less likelihood of impact to prevent overdose deaths. The key motivator to carry naloxone for both audiences was the potential to save a life. Barriers for both audiences included not having naloxone and not knowing how to get it. Care networks also didn’t know how to use it (PWUO did). The following campaign objectives were defined: 1)  Increase the number of people who are aware of, carry and know how to use naloxone 2)  Drive orders for free naloxone in 13 Washington counties with the highest overdose rates 3)  Increase number of people who feel confident intervening if they encounter someone experiencing an overdose 4)  Address stigma through a compassionate and non-judgmental approach

Description of Strategy/Intervention
Audience research insights and data guided every aspect of this campaign, from strategy development to implementation to evaluation: Insight: The most direct way to save lives was to focus on harm reduction behaviors among PWUO and their care networks. How applied: These two audiences were prioritized for further research. Insight: Overdose deaths in WA were higher among males, young adults, Hispanic/Latinos, Black/African Americans, and American Indians/Alaska Natives. In addition, 13 WA counties had higher overdose death rates. How applied: These demographics were applied to the priority audience strategy for the campaign. Additional research was also conducted in Spanish to dig deeper into the Hispanic/Latino audience. Insight: Possible harm reduction behaviors with the most potential to save lives included: 1) not using alone, 2) carrying naloxone, 3) starting slow with usage, and 4) testing before use. How applied: Tested barriers and receptivity to these harm reduction behaviors in the next research phase. Carrying naloxone rose to the top as the behavior focus due to lower barriers and high motivators. Insight: There were high levels of stigma associated with opioids among the general public and PWOU (self-stigma). How applied: The campaign focused on a compassionate and non-judgmental approach to start addressing this stigma. Insight: The barriers to carrying naloxone for both audiences included not having naloxone and lacking the confidence to intervene. For care networks, they also didn’t know how to use it (PWUO did). How applied: The campaign website focused on how to recognize the signs of an overdose and how to intervene with naloxone. Based on these insights, the campaign, Prevent Overdose WA/No más sobredosis WA, was created in English and Spanish and was designed to give people information to effectively identify an overdose and how to stop it. Being mindful of stigma, all information was non- judgmental, honest, and compassionate. Campaign messaging inspired audiences to: Think: I can help save the life of someone I care about if they experience an overdose Feel: Confident, empowered, and prepared Do: Carry naloxone and intervene in the event of an overdose The campaign deployment had three pillars: 1. Use media to raise awareness of naloxone as a tool that can reverse an opioid overdose while also addressing stigma 2. Drive people to a website to learn about how to recognize the signs of overdose and how to intervene 3. Promote easy access to naloxone through free mail order in priority counties and easy steps to obtain in other counties

The cornerstone of the campaign was a video that told the story of someone using naloxone to save a friend’s life. This video ran on TV and digital video and social media channels. You can view the video in English and Spanish, as uploaded to the campaign artwork. Media communications were deployed statewide with the following channels used to reach key audience segments: – PWUO and Care Networks: Digital video, TV, digital audio, Snapchat, TikTok, Facebook/Instagram – Young Adults 16-24: Snapchat and TikTok – Focus Counties: Billboards and Facebook/Instagram – Black/African American: Digital video and digital audio – American Indian/Alaska Native: Digital video – Hispanic/Latino: Digital video, TV, digital audio, Snapchat, TikTok, and Facebook/Instagram Websites, ( and (, were created to educate audiences about how to recognize the signs of an overdose and how to use naloxone. Incentives were provided through social media promotion of free mail order naloxone in 13 Washington counties that have the highest overdose rates.

Evaluation Methods and Results
All four campaign objectives were achieved: Objective: Increase the number of people who are aware of, carry and know how to use naloxone. Result: The post campaign survey showed a 14% increase in statewide naloxone awareness among English-speakers and a 11% increase among Spanish-speakers. Objective: Drive orders for free naloxone in 13 counties in Washington with the highest overdose rates. Result: A 98% increase in naloxone orders occurred in the 13 targeted counties during the campaign period as compared to average monthly orders in the six months before the campaign. Objective: Increase number of people who feel confident intervening when they encounter someone experiencing an overdose. Result: The campaign engaged audiences with the content about how to intervene to help reverse and overdose. – The campaign drove more than 188K unique visitors to the website with a very low bounce rate of 5%. was #1 driver of traffic to (a linked partner site). – The campaign garnered more than 500K social media engagements – Campaign priority audience groups had statistically significant higher campaign recall (as compared to the general pop at 29%) showing that the campaign impacted its priority audience groups: –People who use opioids (PWUO): 62% recall –Care networks: 47% recall –BIPOC individuals: 40% recall Objective: Address stigma through a compassionate and non-judgmental approach Result: While addressing both public and self-stigma requires a long-term approach, the campaign creative was able to begin this journey through the use of compassionate and non-judgmental messaging and tonality. The concept testing and stakeholder outreach showed the campaign was well received by priority audiences across the state as a model of how you can promote harm reduction behaviors while also addressing stigma.

Entry Letter: PP

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