Overview
The primary objective of the present pilot, sequential, multiple-assignment randomized trial (Pilot SMART) is to determine feasibility and acceptability of delivering (from the perspective of the treatment/intervention staff) and receiving (from the perspective of the patient) an adaptive intervention for reducing rates of opioid misuse and preventing development of opioid use disorder in individuals hospitalized for traumatic injury. A complimentary secondary objective is to ensure the feasibility of conducting a future, multi-site, full-scale SMART.
Approximately 107 participants will be enrolled and can expect to be on study for up to 6 months.
Description
The proposed project would be the first clinical trial to assess the feasibility of implementing a preventative treatment design that specifically targets the needs of individuals receiving opioid prescriptions following surgery for traumatic injury. The project will operationalize a standardized approach to screening, treating, and monitoring risk of opioid misuse following traumatic injury. If funded, the project would provide a personalized approach to post-injury monitoring and management through an adaptive intervention designed to target the needs of the individual, rather than implementing a rigid, one-size-fits-all intervention model to prevent opioid misuse.
Approximately 107 participants will be enrolled into the study (approximately 54 participants at UW and 53 participants at MCW). At or very shortly after (within 1-2 days) discharge, participants will be randomized using a 2x2 factorial design to initially receive any one of the following four interventions:
- standard Trauma Care Coordination (sTCC)
- sTCC + an abbreviated Pain Coping Skills Training (PCST-Lite)
- enhanced Trauma Care Coordination (eTCC)
- eTCC + PCST-Lite
Components of the adaptive intervention will be iteratively refined at various points before, during, and after the pilot SMART in order to maximize feasibility and acceptability.
Primary Objective: Determine the feasibility of delivering an adaptive intervention for reducing rates of opioid misuse and preventing development of opioid use disorder in individuals hospitalized for traumatic injury.
Secondary Objective: Obtain the preliminary data necessary for a successful NIH R01 Application.
Exploratory Objective 1: Identify associations between the interventions delivered and opioid use/misuse.
Exploratory Objective 2: Identify associations between the interventions delivered and the physical, social, and psychological antecedents of opioid misuse.
Eligibility
Inclusion Criteria:
- Able to speak, read, and write fluently in English.
- Admission to site hospital for a traumatic injury at time of screening. A traumatic injury is defined as a physical injury with sudden onset requiring immediate medical attention.
- Injury severity score of 9 or greater.
- Meets at least one of the following descriptions below:
- Received 40 mg morphine milligram equivalent (MME) within 48 hours of pre-screening; or
- Discharged with a prescription for an opioid medication.
- Expected to be in control of their own medications at the time of discharge from the
controlled environment of hospital or short-term rehabilitation.
Exclusion Criteria:
- Inability to provide written consent for any reason.
- Current self-reported diagnosis of cancer with life expectancy less than 12 months at time of screening.
- Current prescription for opioid use disorder (e.g., suboxone, buprenorphine, methadone, naltrexone), with a current diagnosis of opioid use disorder (OUD) (mild or greater) not in remission.
- History of dementing illnesses and other neurodegenerative diseases such as Alzheimer's disease, Parkinson's disease, or vascular dementia.
- Current significant traumatic brain injury (defined as the presence of any intracranial blood on Computed Tomography scan of the head or best Glasgow Coma Scale Score of less than 13 at the time of screening).
- Current spinal cord injury with persistent neurologic deficit at the time of screening.
- Acute stroke immediately prior to/upon admission, or emergent stroke as a new event during hospitalization.
- Any vision or hearing impairments resulting in an inability to complete study procedures.
- Current pregnancy, as indicated by chart review and self-report.
- Involved in any criminal justice proceedings related to illicit substance use at time of screening.
- Incarcerated or in police custody at time of study enrollment.
- Admitted to the hospital with a burn affecting >10% total body surface area, as indicated by chart review.
- Any medical, physical, cognitive, or psychiatric conditions that would limit the participant's ability to provide informed consent or complete study procedures, as determined by study staff and/or investigators.