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

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 ( = 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. (PsycInfo Database Record (c) 2022 APA, all rights reserved).