Project Summary/Abstract Adolescents (ages 12-18) are uniquely at risk for prescription opioid misuse for a variety of reasons, including inadequate knowledge about safety risks, easy access to opioids stored improperly in the home, and limited family communication about opioid safety in the home. Although adolescents identify parents as useful resources for opioid safety information, parents report they do not have the comfort or skills to talk to their children about opioid medication safety. Introducing an intervention at the point of care in emergency departments (EDs) (i.e., when an adult is prescribed an opioid prescription) is an accessible, low-cost, way to provide opioid education and facilitate communication about opioid medication safety among youth and their families. Although adolescents represent a public health priority population, no intervention has attempted to improve adolescent and parent knowledge, attitudes, and behaviors about opioid safety to prevent adolescent opioid misuse in EDs. Our transdisciplinary team, with experts in community engagement, dissemination and implementation science, emergency medicine and pediatrics, family medicine and community health, addiction medicine and substance use, adolescent and digital health, game design, biostatistics, health economics, and mixed-methods research, will collaborate with a health system: UW Health. The collaboration will lead to the adaptation and evaluation of a digital health intervention (MedSMA℞T Mobile) in health system EDs, to improve medication safety among adolescents and their parents, thus reducing prescription opioid misuse. The MedSMA℞T Mobile intervention incorporates the evidence-based serious game – MedSMA℞T: Adventures in PharmaCity – and a personalized family medication safety plan to promote opioid safety communication between youth and parents. We will use the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to ensure continual optimization of MedSMA℞T Mobile in ED settings. Three aims support the goal of reducing opioid misuse for adolescents and their parents. First, qualitative evaluation of adolescents, parents, and ED staff stakeholders will generate feedback used to iteratively adapt MedSMA℞T Mobile for its maximal availability in ED settings, while also informing an Implementation Package for more widespread ED adoption. Second, a randomized controlled trial will be used to evaluate effectiveness of MedSMA℞T Mobile to improve adolescent/parent opioid misuse knowledge, attitudes, and behaviors over 9 months. Finally, MedSMA℞T Mobile will be made available in more EDs, and interviews and a survey will be used to evaluate ED staff perceptions of sustainability and organizational preparedness for sustainability, while exploring health cost impact of increased opioid safety. Leadership from the health systems, as well as their front-line ED staff, are committed to promoting awareness of this innovative intervention for families r...