Tapering opioids for trauma patients to reduce long-term opioid use

INTERVENTION: Two groups will be studied in parallel and followed according to the study time points. In addition to usual care, the control group will receive a pamphlet, while the experimental group will receive a pamphlet and follow TOPP‐Trauma. Participants in the experimental group will receive TOPP‐Trauma as well as standard pain management interventions. The biopsychological model of pain, empirical data from previously tested opioid tapering interventions and clinical knowledge on the trauma patient population guided the development of TOPP‐Trauma; more specifically components, activities, dosages, and delivery modes. The TOPP‐Trauma combines a 20‐minute teaching session to be provided the week prior to hospital discharge and a maximum of six 15‐minute opioid tapering guidance sessions given every 2 weeks. An expert trauma nurse or the trauma service pharmacist will provide the teaching and guidance sessions. The teaching session will be based on the information included in the educational pamphlet that will also be distributed to the control group. Guidance sessions will be initiated one week after hospital discharge and will be stopped before the maximum planned sessions if patients cease opioid use. An Intervention Feasibility Evaluation Logbook (Appendix B) will be used to guide expert trauma nurse and the trauma pharmacist to provide the guidance sessions. The treating surgeon will be informed on the participant opioid tapering plan during their appointment at the outpatient clinic to ensure treatment consistency. The number and frequency of guidance sessions was determined based on the established timing for transitioning towards chronic consumption of opioids (i.e. 3 months). Considering that trauma patients admitted in the trauma center where the study will be conducted come from various regions, guidance sessions will be provided individually over the phone or face‐to‐face at the outpatient clinic at the time of follow‐up appointment with the treating surgeon. CONDITION: Opioid dependence in trauma patients ; Mental and Behavioural Disorders ; Opioid dependence PRIMARY OUTCOME: Morphine equivalent dose (MED) per day at 12 weeks after the beginning of TOPP‐Trauma. SECONDARY OUTCOME: 1. MED per day at 6 weeks after the beginning of TOPP‐Trauma, since some study findings indicated that a great proportion of trauma do not use opioids beyond this period of time ; 2. Pain intensity and pain interference with activities assessed using the Brief Pain Inventory at baseline and 6 and 12 weeks after the start of the intervention INCLUSION CRITERIA: 1. Aged 18 years and over 2. Able to read and speak French or English 3. =2 doses/day of opioids during the 3 previous days 4. At least one risk factor for chronic consumption. The risks factors for chronic consumption are: 4.1. Annual income =$40,000 4.2. Injury Severity Score (ISS) =12 4.3. Pre‐injury use of opioids or substance abuse (Alcohol, Smoking and Substance Involvement Screening Test–version 3.0 =11 for alcohol and =4 for other substance) 4.4. Anxiety or depression symptoms (scores =11 on the Hospital Anxiety and Depression Scale) 4.5. Pain catastrophizing score =20 on the Pain Catastrophizing Scale 4.6. Pain self‐efficacy score <17 on the Pain Self‐Efficacy Questionnaire 5. Discharged directly from hospital to home