The opioid crisis has left an estimated 2.5 million people 18 and older in the U.S. with opioid use disorder, or OUD. Despite increased attention to the heavy toll taken by OUD, key risk factors such as intimate partner violence (IPV) and post-traumatic stress disorder (PTSD) are often overlooked. Both increase the risk of OUD and complicate recovery efforts.
A team of MUSC researchers led by clinical psychologists Amber Jarnecke, Ph.D., and Tanya Saraiya, Ph.D., both of the Department of Psychiatry and Behavioral Sciences, secured critical funding of up to $5 million expected over six years from the National Institute on Drug Abuse to address the overlooked link between IPV, PTSD and OUD, which is known to contribute to higher treatment dropout rates and poorer outcomes for OUD treatment.
People who experience PTSD may use substances like opioids to cope, and similarly, people who experience IPV may numb the pain with opioids. In some cases, partners use opioids together, and one may encourage – or even force – the other to participate. This dynamic can quickly create a complex and overwhelming storm of IPV, opioid use and PTSD."
Tanya Saraiya, Ph.D., Department of Psychiatry and Behavioral Sciences, MUSC
Jarnecke and Saraiya are developing and implementing a digital toolkit to screen patients being treated for OUD for IPV and PTSD and point them to the necessary resources and support for long-lasting recovery.
Such a toolkit is badly needed in South Carolina, which has a very high rate of IPV.
"The state has consistently ranked in the top 10 states for intimate partner violence for the past 20 years," noted Saraiya.
In 2021, there were 68 IPV-related homicides in South Carolina, 69% of which were committed using a firearm, according to the Bloomberg School of Public Health at Johns Hopkins University.
As the researchers develop the toolkit, they are assembling a community advisory board of IPV survivors, family members and clinicians from across South Carolina to guide them and ensure that they meet the needs of all stakeholders. The toolkit will prioritize patient safety, providing clinicians guidance on creating a safety plan for patients, when needed, which identifies their personal safety network and connects them with local domestic violence centers and shelters. As part of the plan, patients are asked to identify "safe spaces" away from where firearms are stored and are advised to move to those safe areas before violence escalates. Patients are also encouraged to lock away knives and guns if at all possible. In addition to protecting patients, the toolkit must also be simple enough to fit into regular screenings without overwhelming clinicians.
When finished, the digital toolkit will include a series of questionnaires to identify co-occurring PTSD and other mental health conditions as well as IPV risk and its severity. It will also provide clinicians with recommended ways to follow up with their patients based on their screening results, including providing suggestions for evidence-based treatments. Finally, it will provide a list of local resources to facilitate referrals. Before being rolled out, the toolkit will be beta-tested by clinicians and patients.
After beta testing, the toolkit will be tested in a large randomized clinical trial in three substance use treatment centers across South Carolina, including the Center for Drug and Alcohol Programs at MUSC in Charleston, Behavioral Health Services of Pickens County and Shoreline Behavioral Health Services in Conway.
Patients receiving treatment for OUD will be asked to enroll in the study and will be screened for IPV, PTSD and other mental health conditions through measures in the digital toolkit. Clinicians will discuss which treatment options are best for patients based on their screening results and available local resources. After the initial screening, enrolled patients will complete toolkit questionnaires regularly to track whether they have followed up on the treatment recommendations for PTSD and IPV and if doing so has made them more likely to stick to their OUD treatments.
Once the trial is completed, Jarnecke and Saraiya plan to make the toolkit available to other states and to tailor it to address other substance use disorders. They also intend to adapt it for use in other countries and raise awareness about IPV to promote advocacy and policy reform.
"We're hoping that the sheer number of positive screens for IPV and PTSD in patients with OUD detected through our toolkit might help to inform more policy and advocacy work," said Jarnecke. "If we want to make headway against the opioid crisis, it is important that we provide adequate resources for family and relationship health."
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