Interdisciplinary strategies to prevent long-term and detrimental opioid use following trauma: a stakeholder consensus study

Abstract

Objective Prolonged opioid use is common following traumatic injuries. Although preventive strategies have been recommended, the evidence supporting their use is low. The objectives of this study were to select interdisciplinary strategies to prevent long-term, detrimental opioid use in trauma patients for further evaluation and to identify implementation considerations. Design A consensus study using the nominal group technique. Setting Four trauma systems in Canada. Subjects Participants included expert clinicians and decision makers, and people with lived experience. Methods Participants had to discuss the relevance and implementation of 15 strategies and then rank them using a seven-point Likert scale. Implementation considerations were identified through a synthesis of discussions. Results A total of 41 expert stakeholders formed the nominal groups. Overall, eight strategies were favored: 1) using multimodal approach for pain management, 2) professional follow-up in physical health, 3) assessment of risk factors for opioid misuse, 4) physical stimulation, 5) downward adjustment of opioids based on patient recovery, 6) educational intervention for patients,7) training offered to professionals on how to prescribe opioids, and 8) optimizing communication between professionals working in different settings. Discussions with expert stakeholders revealed the rationale for the selected strategies and identified issues to consider when implementing them. Conclusion This stakeholder consensus study identified, for further scientific study, a set of interdisciplinary strategies to promote appropriate opioid use following traumatic injuries. These strategies could ultimately decrease the burden associated with long-term opioid use.

A qualitative longitudinal study of traumatic orthopaedic injury survivors’ experiences with pain and the long-term recovery trajectory

“… 61 64 Therefore, screening trauma patients’ preinjury mental health status, including substance use, is critical before prescribing opioids, particularly for long-term use. Moreover, as system-based strategies, including protocol and guidelines for opioid use, are promising in preventing long-term opioid use following injury, 24 65 trauma patients must be discharged from specialist health services with an individualised and tailored treatment plan for opioid therapy.…”