ATTC Messenger December 2015: Developing and Testing an Opioid Risk Screening Tool for Trauma Centers

December 2015

Opioid Use Disorder Prevention and Intervention: Developing an Opioid Risk Screening Tool for Trauma Centers

Maureen Fitzgerald
ATTC Network Coordinating Office

A new research project based at the University of Wisconsin School of Medicine and Public Health (UW SMPH) will focus on reducing opioid addiction and overdose death in Wisconsin. With funding from a Wisconsin Partnership Project Collaborative Health Sciences Grant, the three-year project will develop and test an opioid risk screening tool in Wisconsin trauma centers.

Principal Investigator Dr. Randall T. Brown is an Associate Professor in the University of Wisconsin School of Medicine and Public Health, the Founding Director of the UW Addiction Medicine Fellowship Program, the Director of the UW SMPH fourth year Clinical Addiction Elective, and the Medical Director of the Overdose Prevention Program of the AIDS Resource Center of Wisconsin. He is also a certified buprenorphine prescriber.

The project is unique in its focus on screening for opioid risk in trauma settings, and also in building a research team that brings together family medicine, addiction medicine, surgery, social work, population health sciences, and industrial and systems engineering.

Says Brown, “In addiction medicine, we have some knowledge about risk factors for developing an opioid use disorder after traumatic injury, but that needs to be complemented by the viewpoint of trauma surgeons. From the social work perspective, Dr. Joseph Glass will bring quantitative expertise along with a background in substance use disorder treatment and how stigma might interfere with patients’ decisions to seek treatment.”

Andrew Quanbeck, Associate Scientist at the Center for Health Enhancement Systems Studies, has been an investigator on several NIATx projects. Quanbeck will bring the industrial and systems engineering perspective by looking at the best ways to integrate the tool, once it’s developed, into existing workflows for busy clinicians in trauma centers.

The team will focus on developing an effective screening tool with predictive value for the development of opioid use disorders in traumatic injury victims.

“Existing tools were developed mainly for chronic pain management in primary care settings and have been validated in prediction of patients’ requests for an early refill, but not for whether or not they might develop an addiction to a prescription opioid,” explains Brown. “In this study, we will refine a tool with predictive value as to the likelihood that a clinical diagnosis of addiction might evolve over time. We’ll also look at building in safeguards to prevent addiction down the road.”

The project will first convene clinical staff from Wisconsin trauma centers to get feedback on what the tool should include, as well as on barriers to implementing the tool in existing workflows.
Says Quanbeck, “We’ll start out by testing the screening tool on trauma surgery services and observing the implementation process. Active implementation will follow in the third year of the project.”

Once developed, the opioid risk screening tool could guide a framework for prevention and early intervention for opioid misuse (or “recreational use”) and opioid use disorders. The tool will not be technology-based, but it could eventually be integrated into an electronic health record.

“An important part of addressing substance use disorders and their complications is that entities other than addiction treatment need to be involved,” says Brown. “Substance use disorders affect about 30 percent of patients in primary care settings and even more patients in hospitalized populations. Health care professionals frequently describe having a low degree of comfort and training in dealing with SUDs. We’re hoping that the tool developed in this project will expand that level of comfort and also lead to follow-up multi-site trial in other states.”

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