Screening in Trauma for Opioid Misuse Prevention (STOMP) aimed to address the opioid addiction and overdose epidemic in Wisconsin by developing and implementing a screening tool to identify risk factors for opioid misuse in individuals who experienced traumatic injuries. The study enrolled 295 patients who suffered traumatic injuries and were prescribed opioids upon discharge. About 59 percent of participants completed all required measures during the six-month follow-up period, and six individuals met criteria for opioid use disorder six months after receiving their prescription. A screening tool, developed using statistical modeling, was successfully pilot tested at four trauma centers across the state. This tool will contribute to efforts to prevent opioid addiction and related complications in this high-risk group.
The Challenge
Addiction to and overdose from opioids such as morphine, oxycodone and heroin have reached epidemic proportions in Wisconsin and across the United States. Over the past decade, opioid-related incidence of overdose and death in the state has increased more than 300 percent. Prescription opioids contribute to the vast majority of opioid-related complications, and victims of traumatic injury are at greater risk for misusing opioids than the general population. Therefore, there is a need for appropriate assessment, prevention, and intervention for this high-risk group.
Project Goals
STOMP’s long-term goal was to disseminate interventions that are effective in preventing opioid addiction and related complications, including overdose and death. The primary aims of this study were to engage the high-risk population of victims of traumatic injury to:
Measure baseline patient demographics and physical and mental factors, hypothesized risk factors for development of addiction post-injury and rates of new opioid use disorders in the six months following a traumatic injury.
Develop a model using the most strongly associated variables from the first aim to predict opioid addiction risk after traumatic injury and develop an implementable set of opioid misuse risk screening items.
Pilot test the implementation of an opioid misuse risk screening protocol making use of the instrument developed in aims 1 and 2 at Level I and II trauma centers in Wisconsin.
Results
This project developed and implemented a screening tool to identify potential opioid misuse. The study enrolled 295 traumatic injury patients from UW Hospital’s trauma and orthopedic surgery units who were discharged from with a prescription for an opioid medication. Overall, 59 percent of the enrolled participants completed all measures at study visits during the six month follow up period. Given the number of patients prescribed opioids, the research team expected 15 individuals to meet criteria for opioid use disorder, and they were able to identify six individuals who met this criteria six months following the receipt of the prescription.
To develop a screening tool, researchers analyzed the data using statistical modeling techniques to identify potential opioid misuse risk factors including past substance use, mental health issues and physical or emotional trauma. Once these variables were identified, a screening application was developed in partnership with University of Wisconsin’s DoIT, and it was pilot tested at four trauma centers across the state including UW Hospital, Gundersen Lutheran Medical Center, Marshfield Medical Center and Medical College of Wisconsin. All four trauma units were able to successfully implement a tablet-based screener into their trauma workflows. This data, which does not include protected health information, was retained by the study team and will be used to inform future validation work for this predictive model.
Looking to the Future
A new WPP-funded project awarded in 2023, Screening in Trauma for Opioid Misuse Prevention: Adaptive intervention (STOMP-AI), will build upon this work.
