As part of a growing effort to combat the spreading opioid crisis, Coastal Behavioral Healthcare this past fall invited Dr. Joe Smyser, CEO of The Public Good Projects (PGP), a nonprofit specializing in data-centric behavioral change campaigns, to Sarasota to discuss possible partnership with local institutions in affecting change here. A key strategist in some of the largest behavioral change campaigns in the history of the United States, Smyser and PGP’s latest campaign—The Opioid Prevention “End This Together” campaign—was developed for The National Academies of Sciences and Mental Health Services Administration, and aims to take big data and make a community-wide but still laser-focused approach to address opioid abuse with a brand new “tool kit.” Fresh off kickstarting a yearlong campaign in Syracuse, NY, Sarasota could be next to do so—and one of the first in the country.

Photo by Wyatt Kostygan.


SRQ: What is this new tool kit? Smyser:  The tool kit is half research and half a behavior change campaign in a box. National Academies of Sciences, Engineering and Medicine was our partner, with funding from SAMHSA—Substance Abuse Mental Health Services Administration under Health and Human Services. We worked for about a year to look at who is most at risk of beginning to use opioids? What do those people look like? What messages do they need to see and how do you get them those messages most effectively? That was a lot of traditional public health research. A lot of lit reviews and talking to subject matter experts. There was actually a panel of national subject matter experts that wrote that report.

What were some of the key findings?  If you’re going to do a prevention campaign to try to stop people from getting addicted or dependent, it’s really important to reach them before they are 25. That seems to be this really key age. And if you look at people who are under the age of 25, there are certain populations in that age group that are most at risk of the people who are already at risk. Then there’s a transition that unfortunately is happening more and more, where people switch to heroin. That’s usually late 20s to early 30s. 

What populations are particularly at risk?  Current and former athletes are at a really high risk. Because they are given a painkiller so they can keep going out of the field. There’s a culture in athletic organization where teammates give other teammates the opioids they are prescribed. It’s this mentality of, “I have to keep going and if I don’t get back out on the field, I’m letting my team down.” They’ll do whatever they need to do to keep going out on the field.  

What other groups have you identified as being at risk? Manual laborers. People who work with their hands. It makes a lot of sense. You’re going to be experiencing pain. You’re going to get injured. They need to keep working. People who have mental health conditions. There’s a risk there. Prescription opioids can be a temporary way to feel better. And people with a lot of recreational drug use are at a higher risk.

And each needs a tailor-made message? And that’s where we come in. Each one of these groups is actually really different from each other. The way that you’re going to give these people information is really distinct. What athletes see should be really specific to why an athlete would use opioids and the experience of being an athlete. That should be really different than somebody who is a manual laborer in a rural area. Those should almost be different campaigns altogether. That’s the other part of it. We were really interested in, is there a difference in rural populations versus urban populations and how they think about opioids. And there was a huge difference. One of the things you see with rural communities is they feel like they are being left behind and forgotten. There is also a tremendous sense of community resiliency and pride. We have the resources here in our community to do something. We want to do something. That’s a little bit different than urban communities where it’s a mishmash, a melting pot. There’s not a singular identity of an urban community.

Different campaigns? The facts might be the same—be cautious about using prescription opioids—but how that is framed should be really different. Data analysts use a combination of machine learning, natural language processing, and then some of it has to be hand-coded. We’re trying to figure out what the public is being exposed to. What do they see when they see something about the opioid crisis or opioids?   

Why is PGP interested in Sarasota? PGP actually only works in communities where there’s an existing network of partners already doing work. Our role here would be, where can we provide technical assistance? Where’s the gap that no one is covering? How can we plug in and complement the efforts that everyone’s already doing? This tool kit is a start. 

The start of what? When we partner with a community, it’s usually for a 15-month period at a minimum. We do a lot of grassroots organizing. There’s a model in community organizing called collective impact. That’s the model that we usually follow. That would be the next step. It’s sort of a rising tide lifts all boats.

What was your impression of Sarasota? It was really great. I can tell you a big part of my job is to fly around to communities all across the US. I am in meetings where there’s the community coalition that’s trying to deal with the opioid crisis, and there are three organizations around the table. This was 50 different organizations around the table that have been working together for years. Sarasota is really far ahead of a lot of other communities.

So Sarasota looks like a good candidate?  There is the motivation. And there are a lot of things already happening. And these are conversations that are going to have to continue to happen. The most common way that people hear about opioids in the US, and this is true also for this county, is as a policy debate. It has nothing to do with you at all. It’s policy makers arguing. We’re not giving them anything that makes them feel they have self-efficacy. That’s really disempowering. It really works against us.

All the messaging ideally would be that “this is what the community of Sarasota is doing for itself.” This is an empowering message, not a terrifying one.