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Leading with solutions to prevent opioid misuse

How do you know if you’re making a difference? Bring research into all aspects of a campaign.

HCA launched Starts with One with a 30-second scene-setting video that ran throughout the state. The campaign now has dozens of videos assets, including those for Spanish-speaking and tribal communities.

The challenge

By 2016, opioid misuse had become a leading cause of injury-related deaths in Washington and elsewhere. But public education about the problem often relied on ineffective scare tactics.

Our state’s public health leaders had a simple but novel idea — talking about real, everyday ways that any resident could prevent opioid misuse. Four years later, Starts with One has grown into one of Washington’s largest public health-education efforts and one of the largest opioid prevention campaigns in the country. 

The Washington State Health Care Authority and DH both believed a positive prevention message would help stem the crisis. Scare tactics had been proven by 20 years of research to be ineffective. The opioid crisis already scared people, but they still didn’t know the steps they could take to make our communities safer and healthier.

We knew that positive norming — using media to show healthy, supportive behaviors as a normal part of life — was far more effective as a health communications tool. But how to apply that principle to the opioid crisis, and show that it works?


The Starts with One campaign and website makes it easy to find practical information about talking to a loved one about opioids, safely storing and disposing of medications, and how to respond to an opioid overdose.

The Starts with One website makes it easy to find practical information about talking to a loved one about opioids, safely storing and disposing of medications, and how to respond to an opioid overdose.

The strategy

Back in 2016, we had few “best practices” to turn to, few state opioid campaigns to learn from. Given the chance to invent something new to help address this life-or-death problem, we had a lot of research and thinking to do. What messages would resonate with residents — providing the knowledge, motivation and tools they need to become part of the solution?

We started by interviewing 50 subject-matter experts working in opioid misuse prevention throughout the state. We wanted to know what they knew about prevention: the behaviors that can protect against addiction and strategies to prevent misuse in the first place. We also wanted to know what kind of messaging and campaign the experts would find most useful.

While opioid use was affecting many in Washington, it was disproportionately affecting tribal communities. Overdose rates in Indian Country were nearly triple of rate of any other community in Washington. As we grew Starts with One, we also needed to think about how to adapt the campaign for this community.

Our team also interviewed 17 tribal representatives across Washington working to address opioid misuse in their communities. We talked about each of their communities’ distinct experiences with opioids and how a campaign could best support their work.  These perspectives contributed to the overall strategy and helped ensure the approach would continue to be culturally appropriate and address the most important needs.

Our research found that everyday people could take specific steps, such as starting a conversation with a loved one, to interrupt the patterns leading to opioid misuse.

What we did

We learned what opioid misuse looked like in real lives, families and communities — and that the patterns that lead to addiction could be interrupted. 

What if everyone knew how to lock up their prescribed opioids, so nobody else could access them? What if they knew how and when to safely dispose of unused medication? What if every person knew how to start a conversation about opioids with their loved ones? These, we learned, were among the simple but powerful steps that anyone could take to prevent misuse of opioids. If we could educate people about what those steps were and give them the tools to enact them, we could start to dismantle the problem.

The campaign is called Starts with One — because opioid-misuse prevention starts with one person taking one small action. Our campaign would take on an overwhelming problem by breaking it down into parts that anyone — everyone — could do to make a difference.

And, over several years, we have continued to use research to understand how behaviors and attitudes can change. Before launching our first ad campaign, we conducted a statewide survey to understand awareness of the issue, residents’ likelihood to take preventive steps, as well as people’s motivations and barriers for behaviors certain. Our team continues to pose these questions to audiences each year.

DH has used a number of research strategies to understand the impact of different campaign efforts:

  • Message testing for all new creative via online and offline focus groups.
  • Statewide phone and online surveys on residents’ likelihood to adopt specific behaviors, before and after media campaigns.
  • Partnering with agency partners through IPREX to collect national data on social norms around opioid prevention.
  • Interviewing coalition leaders about using partner materials.
  • Implementing a full research pilot program with pharmacists.
  • Mutually reporting data with HCA, which tracks our media data alongside all prevention activities in the state.

As part of the evaluation process for the tribal campaign each year, we hold in-depth interviews with tribal representatives to inform the next year’s strategy and goals. As we evaluate campaigns each year, we refocus attention to connecting to motivations and removing barriers to promote positive change for everyone in our state. Together, we can make a difference.


Starts with One campaign assets including toolkits of materials that our partners throughout the state could use to help educate their own communities. The toolkits included print materials such as these rack cards.

Outdoor media reached targeted demographics with campaign messages and public service announcements.

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