2018 – 2020: CU College of Nursing Honors (Pre-PhD) Program

ABSTRACT: Comorbidity of Lifetime History of Trauma and Abuse with Opioid Use Disorder: Implications for Nursing Assessment and Care

Accepted for publication in JAPNA (Journal of the American Psychiatric Nurses Association), February 2022.

Purpose: The purpose of this study is to investigate history of lifetime sexual, physical, and/or emotional abuse among participants in a medication assisted treatment (MAT) program for opioid use disorder (OUD), and to investigate associations between abuse history and chronic pain among participants with OUD.

Background: Opioid use disorder (OUD) is a public health crisis that affects a wide range of demographics and is challenging to treat. OUD is highly stigmatized, both socially and among healthcare providers. Negative stereotypes are counter-therapeutic in healthcare settings, resulting in missed opportunities for non-pharmacological interventions. Informed by previous research showing correlations between OUD, lifetime history of abuse/trauma and chronic pain, we predicted that many participants in a MAT program for OUD would report a lifetime history of abuse.

Methods: This is a secondary analysis of intake data from SB-74, the Pilot Medication Assisted Treatment (MAT) Program, which was a 2-year, non-experimental cohort study coordinated by the University of Colorado College of Nursing. The Pilot MAT program was designed to increase access to MAT services in rural areas and expand the MAT workforce to treat OUD in Colorado. De-identified data was provided by 476 adult MAT patients between September 2018 and August 2019. Data were collected during the participants’ intake process using the Adult Addiction Severity Index (ASI-6) screening tool, administered by trained clinicians. The ASI-6 rates addiction severity in seven areas: medical status, employment/support status, drug/alcohol use, legal status, family history, family/social relationships, and psychiatric status. Data for this research was taken from the family history scale, which includes three yes/no questions about history of abuse, specific to emotional (harsh words), physical (physical harm), and sexual (forced sexual advances or sexual acts). Secondary data analysis included descriptive statistics, chi squares, and t-tests.

Results: Among participants, 23% reported lifetime sexual abuse, 43% reported lifetime physical abuse, and 58% reported lifetime emotional abuse. Results of chi-square showed that a history of physical abuse was significantly associated with having a chronic pain diagnosis, χ2  = 4.49, p = .03. Pain scores were higher for participants with a history of abuse than those without that history t(460) = 2.71, p = .007.

Implications: History of physical abuse is associated with OUD and chronic pain, yet standard pain assessments do not assess for these factors. Bedside nurses rarely assess for history of abuse/trauma in populations presenting with OUD (with or without co-morbid conditions). In healthcare settings, the implementation of standardized trauma-informed screening tools, prompt recognition of abuse/trauma-associated OUD, and provider-facilitated access to adjunct psychological interventions (education, psychotherapy, EMDR, etc.) may reduce stigma, reduce opioid use escalation, and/or help patients overcome OUD. In the second phase of the parent study, program intake data has been expanded to include a 20-item trauma- and resilience-informed screening tool designed to assess adverse childhood experiences (ACEs) along with resiliency factors among participants. Data will be used to improve treatment for abuse/trauma, OUD, and chronic pain, with special consideration of gender differences and resiliency factors that may contribute to strength-based treatment interventions.

POSTER: Considering the Impact of Trauma and Abuse in the Etiology of Opioid Use Disorder

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Honors Program Achievements:

2nd Place Poster Award at the CON’s Research & Scholarship Symposium (2019).

Poster winner at CU Medical School’s 34th Annual Student Research Forum (2020).

Awarded a podium presentation at the Western Institute of Nursing’s 2020 Conference, titled: “Exploring Associations between Abuse History, Opioid Use Disorder, and Chronic Pain.” (conference was cancelled due to COVID-19)