Screening in Trauma for Opioid Misuse Prevention (STOMP): study protocol for the development of an opioid risk screening tool for victims of injury

Randall Brown, Brienna Deyo, Chelsea Riley, Andrew Quanbeck, Joseph E Glass, Rebecca Turpin, Scott Hetzel, Christopher Nicholas, Maireni Cruz, Suresh Agarwal, Randall Brown, Brienna Deyo, Chelsea Riley, Andrew Quanbeck, Joseph E Glass, Rebecca Turpin, Scott Hetzel, Christopher Nicholas, Maireni Cruz, Suresh Agarwal

Abstract

Background: Opioid addiction and overdose are epidemic in the U.S. Victims of traumatic injury are at greater than average risk for opioid misuse and related complications. Potential risk screens and preventive interventions in this clinical population remain under-investigated. The current project seeks to develop and pilot the implementation of a screening tool for opioid risk at American College of Surgeons (ACS) Level I and Level II trauma centers.

Methods: The project began with an online survey, which was sent to Wisconsin trauma center medical directors and trauma coordinators for the purpose of gathering information on current substance use screening practices. Next, a focus group of trauma center staff was convened to discuss barriers and facilitators to screening, resources available and needed to support trauma patients with opioid use disorders, and measurable clinical observations that could indicate a patient's potential risk for opioid misuse. Data from the surveys and focus group were combined to inform the data collection instruments that are currently being administered to patients recruited from the University of Wisconsin Hospital Trauma Inpatient and Orthopedic Surgery Services. Eligible and consenting patients complete standardized measures of socio-demographics, substance use history, opioid misuse risk, mental health, medical history, and injury and pain severity. Follow up visits at weeks 4, 12, and 24 after hospital discharge assess hypothesized risk factors for opioid addiction and opioid use disorder diagnosis. At the completion of patient data collection, a forward stepwise regression will identify factors of most significant risk of the development of opioid use disorder after traumatic injury. This modeling will inform the development of a novel opioid risk screening tool, which will undergo pilot implementation at 4 Wisconsin ACS Level I and Level II trauma centers, using an evidence-based implementation strategy with roots in systems engineering.

Discussion: Positive findings from the proposed work would lead to improved, standardized opioid risk screening practices among victims of traumatic injury. The ultimate goal of this and future work is to reduce the likelihood of opioid misuse, addiction, and related complications, such as overdose and death. Trial registration Clinicaltrials.gov registration number: NCT02861976. Date of registration: Feb 9, 2016.

Keywords: Injury; Opiates; Opioid abuse; Opioid addiction; Opioid misuse; Opioid use disorder; Opioids; Risk factors; Screening; Trauma.

References

    1. Results from the 2015 National survey on drug use and health: detailed tables. 1542. Center for Behavioral Health Statistics and Quality, US Dept Health and Human Services; 2016.
    1. Compton WM, Jones CM, Baldwin GT. Relationship between nonmedical prescription-opioid use and heroin use. N Engl J Med. 2016;374:154–163. doi: 10.1056/NEJMra1508490.
    1. CDC WONDER Online Database. Underlying cause of death 1999–2015. Centers for Disease Control and Prevention, National Center for Health Statistics; 2016. .
    1. Wisconsin Department of Health Services, Division of Public Health and Division of Mental Health and Substance Abuse Services. Wisconsin Epidemiological Profile on Alcohol and Other Drug Use, 2016. Wisconsin Department of Health Services; 2016.
    1. Beaudoin FL, Straube S, Lopez J, Mello MJ, Baird J. Prescription opioid misuse among ED patients discharged with opioids. Am J Emerg Med. 2014;32:580–585. doi: 10.1016/j.ajem.2014.02.030.
    1. Holman JE, Stoddard GJ, Higgins TF. Rates of prescription opiate use before and after injury in patients with orthopaedic trauma and the risk factors for prolonged opiate use. J Bone Jt Surg Am. 2013;95:1075–1080. doi: 10.2106/JBJS.L.00619.
    1. Field C, Cochran G, Caetano R, Foreman M, Brown C. Postdischarge nonmedical use of prescription opioids in at-risk drinkers admitted to urban Level I trauma centers. J Trauma Acute Care Surg. 2014;76:833–839. doi: 10.1097/TA.0000000000000100.
    1. Lankenau SE, Teti M, Silva K, Bloom JJ, Harocopos A, Treese M. Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012;23:37–44. doi: 10.1016/j.drugpo.2011.05.014.
    1. Ives TJ, Chelminski PR, Hammett-Stabler CA, Malone RM, Perhac JS, Potisek NM, et al. Predictors of opioid misuse in patients with chronic pain: a prospective cohort study. BMC Health Serv. Res. 2006;6:46. doi: 10.1186/1472-6963-6-46.
    1. Compton W, Cottler L, Dorsey K, Spitznagel E, Magera D. Comparing assessments of DSM-IV substance dependence disorders using CIDI-SAM and SCAN. Drug Alcohol Depend. 1996;41:179–187. doi: 10.1016/0376-8716(96)01249-5.
    1. Baker SP, O’Neill B, Haddon W, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–196. doi: 10.1097/00005373-197403000-00001.
    1. Cottler L, Robins L, Helzer J. The reliability of the CIDI-SAM: a comprehensive substance abuse interview. Br J Addict. 1989;84:801–814. doi: 10.1111/j.1360-0443.1989.tb03060.x.
    1. APA . Diagnostic and statistical manual of mental disorders. 4. Lake St. Louis: American Psychiatric Association; 2000.
    1. Butler S, Budman S, Fernandez K, Houle B, Benoit C, Katz N, Jamison R. Development and validation of the current opioid misuse measure. Pain. 2007;130:144–156. doi: 10.1016/j.pain.2007.01.014.
    1. Butler S, Budman S, Fanciullo G, Jamison R. Cross validation of the current opioid misuse measure (COMM) to monitor chronic pain patients on opioid therapy. Clin J Pain. 2010;26:770–776. doi: 10.1097/AJP.0b013e3181f195ba.
    1. Adams LL, Gatchel RJ, Robinson RC, Polatin P, Gajraj N, Deschner M, Noe C. Development of a self-report screening instrument for assessing potential opioid medication misuse in chronic pain pateints. J Pain Symptom Manag. 2004;27:440–459. doi: 10.1016/j.jpainsymman.2003.10.009.
    1. Dowling L, Gatchel R, Adams L, Stowell A, Bernstein D. An evaluation of the predictive validity of the Pain Medication Questionnaire with a heterogeneous group of patients with chronic pain. J. Opioid Manag. 2007;3:257–266.
    1. Osman A, Barrios FX, Kopper BA, Hauptmann W, Jones J, O’Neill E. Factor structure, reliability, and validity of the Pain Catastrophizing Scale. J Behav Med. 1997;20:589–605. doi: 10.1023/A:1025570508954.
    1. Osman A, Barrios FX, Gutierrez PM, Kopper BA, Merrifield T, Grittmann L. The pain catastrophizing scale: further psychometric evaluation with adult samples. J Behav Med. 2000;23:351–365. doi: 10.1023/A:1005548801037.
    1. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol use disorders identification test. Arch Intern Med. 1998;1998(158):1789–1795. doi: 10.1001/archinte.158.16.1789.
    1. Dube SR, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF. Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study. Pediatrics. 2013;111:564–572. doi: 10.1542/peds.111.3.564.
    1. McHugh RK, Fitzmaurice GM, Carroll KM, Griffin ML, Hill KP, Wasan AD, Weiss RD. Assessing craving and its relationship to subsequent prescription opioid use among treatment-seeking prescription opioid dependent patients. Drug Alcohol Depend. 2014;145:121–126. doi: 10.1016/j.drugalcdep.2014.10.002.
    1. Hays RD, Bjorner JB, Revicki DA, Spritzer KL, Cella D. Development of physical and mental health summary scores from the patient-reported outcomes measurement information system (PROMIS) global items. Qual Life Res Int J Qual Life Asp Treat Care Rehabil. 2009;18:873–880. doi: 10.1007/s11136-009-9496-9.
    1. Booth B, Kirchner J, Fortney J, Ross R, Rost K. Rural at-risk drinkers: correlates and one-year use of alcoholism treatment services. J Stud Alcohol. 2000;61:267–277. doi: 10.15288/jsa.2000.61.267.
    1. Carlson R, Sexton R, Wang J, Falck R, Leukefeld C, Booth B. Predictors of substance abuse treatment entry among rural illicit stimulant users in Ohio, Arkansas, and Kentucky. Subst. Abus. 2010;31:1–7. doi: 10.1080/08897070903442459.
    1. Siegal HA, Falck R, Carlson RG, Wang J, Rahman AM. Health services research among crack-cocaine users: a case study from the Midwest. Am Behav Sci. 1998;41:1063–1078. doi: 10.1177/0002764298041008004.
    1. Booth BM, Leukefeld C, Falck R, Wang J, Carlson R. Correlates of rural methamphetamine and cocaine users: results from a multistate community study. J Stud Alcohol. 2006;67:493–501. doi: 10.15288/jsa.2006.67.493.
    1. Gustafson D, Hundt A. Findings of innovation research applied to quality management principles for health care. Health Care Manag Rev. 1995;20:16–33. doi: 10.1097/00004010-199521000-00004.
    1. McCarty D, Gustafson DH, Wisdom JP, Ford J, Choi D, Molfenter T, Capoccia V, Cotter F. The network for the improvement of addiction treatment (NIATx): enhancing access and retention. Drug Alcohol Depend. 2007;88:138–145. doi: 10.1016/j.drugalcdep.2006.10.009.
    1. Gustafson DH, Quanbeck AR, Robinson JM, Ford JH, Pulvermacher A, French MT, McConnell KJ, Batalden PB, Hoffman KA, McCarty D. Which elements of improvement collaboratives are most effective? A cluster-randomized trial. Addict. Abingdon Engl. 2013;108:1145–1157. doi: 10.1111/add.12117.
    1. Quanbeck A, Brown RT, Zgierska A, Johnson R, Robinson JM, Jacobson N. Systems consultation: protocol for a novel implementation strategy designed to promote evidence-based practice in primary care. Health Res. Policy Syst. 2016;14:8. doi: 10.1186/s12961-016-0079-2.
    1. Vitesnikova J, Dinh M, Leonard E, Boufous S, Conigrave K. Use of AUDIT-C as a tool to identify hazardous alcohol consumption in admitted trauma patients. Injury. 2014;45:1440–1444. doi: 10.1016/j.injury.2014.01.004.
    1. Meneses-Gaya C, Zuardi AW, Loureiro SR, Hallak JEC, Trzesniak C, de Azevedo Marques JM, Machado-de-Sousa JP, Chagas MHN, Souza RM, Crippa JAS. Is the full version of the AUDIT really necessary? Study of the validity and internal construct of its abbreviated versions. Alcohol Clin Exp Res. 2010;34:1417–1424.
    1. Youden WJ. Index for rating diagnostic tests. Cancer. 1950;3:32–35. doi: 10.1002/1097-0142(1950)3:1<32::AID-CNCR2820030106>;2-3.
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health. 1999;89:1322–1327. doi: 10.2105/AJPH.89.9.1322.
    1. Berry PH, Chapman CR, Covington EC, Dahl JL, Katz JA, Miaskowski C, McLean MJ. Pain: current understanding of assessment, management, and treatments. National Pharmaceutical Council and the Joint Commission for the Accreditation of Healthcare Organizations, VA, USA; 2001.
    1. Liebschutz JM, Xuan Z, Shanahan CW, LaRochelle M, Keosaian J, Beers D, Guara G, O’Connor K, Alford DP, Parker V, et al. Improving adherence to long-term opioid therapy guidelines to reduce opioid misuse in primary care: a cluster-randomized clinical trial. JAMA Intern Med. 2017;177:1265–1272. doi: 10.1001/jamainternmed.2017.2468.

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