Responding effectively to epidemics such as opioid addiction is challenging on many levels and can be very challenging from a public health communication point of view. “The tricky thing is to communicate lifesaving information to the public without overwhelming people or not fully addressing their information needs,” SC&I’s Associate Professor of Communication Itzhak Yanovitzky said, discussing his ongoing collaboration with the Partnership for a Drug Free New Jersey (PDFNJ), and their joint effort to develop and implement effective strategies for communicating about the dangers of opioid addiction and the link between opioid prescriptions and heroin addiction.

Information overload is a well-documented byproduct of intensive, high-volume public information campaigns. It happens when the public is continuously bombarded with information about a specific issue from multiple sources and about multiple angles, to the point that it is difficult for people to follow and fully process. As a result, the public becomes increasingly indifferent about the topic, or worse, process information in limited or biased ways. This, in turn, can cause people to ignore or misinterpret important information about a health risk they can avoid.

Yanovitzky and PDFNJ have been tracking public knowledge and attitudes regarding opioid addiction for over a decade in New Jersey in an effort to detect and address potential information overload and information gaps. They found that whereas an overwhelming majority of adults in New Jersey (about 85%) report regular exposure to information about the opioid epidemic in national, local, and social media, persistent knowledge gaps remain regarding a number of issues. For example, many were unaware of the link between pain killers prescribed for things like sports injuries and wisdom teeth removal and heroin abuse. In response, PDFNJ launched their Before They Prescribe - You Decide public communication campaign to educate parents about the link between opioid misuse and abuse and heroin addiction and urge them to ask physicians questions about the medical necessity, possible side-effects, and alternative treatments when their children are prescribed pain medications. Following the campaign, more than 70% of parents interviewed in a state-representative survey demonstrated knowledge of this fact with 64% also saying they learned about it from the campaign.            

“This is a great example of how researchers and community-serving organizations can partner together to routinely collect and use data that inform timely decisions regarding communication strategy while also advancing theory and research about effective communication campaigns in the long run,” said Yanovitzky. “In this way, the research we conduct collaboratively has direct and immediate impact on the lives of people in the community and beyond,” he added.     

The opioid addiction epidemic did not start as a problem with drugs manufactured and sold illegally. Many people suffering from heroin addiction can trace their addiction to the opioids legally prescribed to them by their doctors and dentists for pain. Without proper use and regulation of opioid medication, it can become highly addictive.

People’s brains become wired to need more and more of the opioid medication, but eventually doctors and dentists stop prescribing the drug because their patient’s conditions have improved. Once this happens, a way victims can feed the addiction is by taking heroin. Heroin acts in a similar way to opioids in the human brain. Thus, many heroin addicts aren’t making a conscious choice to take heroin, they are driven and controlled by their disease.

This explains why people of every age, race, background and education level are susceptible to developing a heroin addiction once they have been on opioids, and why so many New Jerseyans and other Americans are currently addicted and dying at alarming and ever-growing rates.

The research-based partnership between PDFNJ and Yanovitzky dates back to 2009 when PDFNJ were looking to assess and improve their efforts to decrease the misuse and abuse of prescription pain medicine in New Jersey by collecting expired, unused, or unwanted medicine stored in people’s homes. Together, they designed and implemented an evaluation of this initiative, the American Medicine Chest Challenge (AMCC), which was initially offered in New Jersey and later expanded to most other states. That study, which was the first to establish the efficacy of community-based drug take-back programs, earned PDFNJ a best-practice designation in the Office of National Drug Control Policy’s national strategy plan. Nationwide, AMCC currently has over 2,000 official collection sites set up by more than 1,000 community and law enforcement partners. The AMCC public campaign invites adults and families to participate in AMCC's 5-Step Challenge which includes: (1) taking inventory of the medicine stored at home; (2) locking their medicine cabinet; (3) safely disposing of EUU medicine in their home or at an authorized collection site; (4) taking their medicine(s) exactly as prescribed; and (5) talking to their children about the dangers posed by prescription drugs.     

Despite these many successes, significant challenges remain regarding effective communication about the opioid epidemic in New Jersey and nationally. One challenge Yanovitzky and PDFNJ were able to identify by continuously monitoring the information environment and engaging the public on this issue is that people are aware of the addiction risks posed by opioids, but are generally unsure about what to ask a physician or a dentist when they or their love ones are prescribed pain medicine. Recognizing this, PDFNJ moved to close this gap by compiling and sharing a list of questions that should be asked of prescribers. “We actually gave the task of designing these messages to students in my undergraduate Health Messages & Campaign Design class. The students appreciated the opportunity to work closely with PDFNJ as a client and to make direct and important contributions to the fight against an epidemic that devastate many of their home communities,” noted Yanovitzky. “I remain convinced that this type of engaged, real-world experience is excellent pedagogy,” he added.

More recently, Yanovitzky and PDFNJ noticed an alarming trend in the data they have been collecting about public knowledge and attitudes. Whereas virtually all members of the public recall information they received through the media and other sources about the opioid epidemic, there are persistent gaps in knowledge, attitudes, and propensity of taking preventive actions between those residing in communities with high versus low incidence of opioid and heroin addiction. That is, residents of low incidence communities are significantly less likely to perceive themselves or their family to be at risk for opioid addiction and more likely to hold misperceptions regarding the causes and victims of the epidemic. To address this problem, PDFNJ decided to test the efficacy and feasibility of employing an intensive and personalized campaign in these communities that combines direct mailing, tailored email communication, and door-to-door canvasing. Yanovitzky worked with them to design and execute a study that evaluated this effort, the results of which were summarized in a research report and a paper currently under review in a peer-reviewed journal. The findings of this study suggest that this type of campaign can have a measurable impact on increasing perceived risk and motivation to take preventive actions among residents of low incidence communities.    

The newest initiative that PDFNJ and Yanovitzky are collaborating on is a series of town hall meeting held in every county in New Jersey. The Town hall meetings gives an opportunity for local leaders, public health, law enforcement, and other stakeholders to engage directly with residents to share information and to learn about their concerns. The Q&A session at the end of each meeting generate important insights regarding remaining information gaps that exist in each community, which Yanovitzky is in the process of analyzing. For example, in many communities there appears to be gaps in knowledge regarding the community resources available to fight the opioid epidemic, and which are associated with low levels of collective efficacy or confidence that the community can respond effectively to the epidemic. Yanovitzky expects to complete this study by June of this year and then work with PDFNJ to share the findings with policymakers and other stakeholders in the state.

“To be successful in fighting public health epidemics, we must be able to engage local communities and help build their capacity to respond effectively to this type of challenges,” says Yanovitzky. “As researchers and educators, we have an important responsibility to support such efforts with sound research and evidence base, and partnering with community organizations such as PDFNJ is a crucial step in that direction,” he adds. Looking ahead, Yanovitzky believes that research partnerships can be an effective tool for Rutgers and other land grant universities to meet the responsibility of improving health and wellness in the communities they serve. “I see this as an effective mechanism for integrating teaching, research, and service in universities of the 21st Century,” he concluded.