Trauma and principles of trauma-informed care in the U.S. federal legislative response to the opioid epidemic: A policy mapping analysis.

Abstract

Objective: The U.S. declared the opioid epidemic as a national public health emergency in 2017. Given the strong and bidirectional relationship between trauma and substance misuse, policy responses to this crisis that reflect principles of trauma-informed care are especially salient. This study is the first to use trauma-informed policy analysis to systematically assess the U.S. Congressional response to the opioid epidemic. Method: We used policy mapping methods to build and analyze a dataset of all opioid-related bills and resolutions proposed in Congress between 2009 and 2017 (N ϭ 188). Following an established trauma-informed policy analysis framework, 2 researchers reviewed these policies and coded their incorporation of trauma-specific language and the principles of safety; choice; trust and transparency; collaboration and peer support; empowerment; and intersectionality. We calculated coding frequencies in these categories and rates of intercoder agreement. Results: A minority of policies (10.6%) directly mentioned trauma and 55% of policies incorporated at least 1 trauma-informed principle. Safety was the most commonly coded principle (38.3%), while intersectionality was the least (6.9%). Conclusions: Our analysis found limited attention to trauma in opioid-related federal legislation. Based on these findings and following the example of coalitions such as the Campaign for Trauma-Informed Policy and Practice, advocates can mobilize for better inclusion of trauma-informed principles in opioid policy. Further, this study demonstrates the feasibility of applying the trauma-informed policy analysis framework to code Congressional policies using publicly available data, a replicable methodology with potential application at federal and state levels. Clinical Impact StatementGiven that psychological trauma is often linked with substance misuse, this study investigated the extent to which U.S. federal legislation responding to the recent opioid crisis was trauma-informed. Approximately 11% of opioid-related bills or resolutions introduced in Congress between 2009 and 2017 mentioned the term "trauma" and 55% were aligned with at least one principle of trauma-informed care, such as safety, choice, or empowerment. Stakeholders can use these findings as a basis for advocating for continued inclusion and expansion of trauma-informed principles in opioid policy in particular contexts, such as addressing pathways between incarceration, trauma, and opioid misuse.

Key features of a trauma-informed public health emergency approach: A rapid review

“…An associated concept within safety was Human Rights (69). When designing policy/emergency responses it is important to consider whose safety is being prioritized, such as in drug policy (58,99), or whether there are adverse, unintended or inequitable impacts for vulnerable sub-groups, such as increasing the risk of one threat to address another (e.g., domestic violence during stay-at-home orders) (60,69,74,77,79,82,103). In Argentina, 20 women were killed in the first month of COVID-19 stay-athome orders and police responses to reports of gender-based violence and missing women were considered negligent (77).…”

“…As such, public health emergency responses and policies must prioritize restoring social supports, systems, communications and rituals; and promote supportive relationships including creating opportunities for connection for isolated people (58,61,65,67,73,76,87,94,99,101,103). It may be possible to facilitate this through the use of media and technology, including supportive broadcasts, mobile phone use and social media, but for some may contribute to phone addiction (78,97).…”

“…Participation from the target population (including disaster victims, eco-dependent communities, and clients), in the planning and response, including in the design of communications and messages and of policies is important for addressing power imbalances, utilizes local knowledges; increases efficiency of resources; promotes community efficacy, resilience and capacity building; and provides mental health benefits including increasing empowerment reducing helplessness (57, 58,61,66,68,71,72,74,80,81,84,85,88,91,95,99,103,104). This included the importance of local leadership and control (61,65,85,103).…”

“…Twenty-four studies included content relevant to empowerment (58, 59, 61, 63-66, 68, 69, 71-74, 77, 79-81, 84-86, 88, 95, 96, 104). This included individual, family, and community level empowerment (61,65,86,95,99,103). Key to empowerment was the sub-concept of efficacy.…”

Developing a trauma-informed workforce for the opioid crisis in a rural community in the United States: a case study

“…The idea of addressing physical, psychiatric and addiction related conditions of the same client simultaneously under a single roof is not yet widely accepted. Additionally, even after a vast array of literature establishing the correlation of ACE and adult trauma to OUD, trauma screening is usually not a routine practice during intake (Bowen and Irish, 2020). The situation is even more acute in rural areas, as a single primary care center may be the only service provider with other care centers unavailable for miles around (Keyes et al, 2014;Lawson et al, 2013).…”