Opioid Understanding Is Linked to Health Literacy in Orthopaedic Trauma

Abstract

Introduction: No current standard exists for assessing patients’ understanding about prescription opioid medication to curb related risks. This study evaluates the validity of a novel opioid literacy tool (OLT) to identify at-risk orthopaedic trauma patients in need of targeted education. Methods: In this on-going randomized controlled trial (NCT04154384) participants admitted to a level-1-trauma-center for an isolated orthopaedic injury completed the OLT, a 7-item self-administered survey, evaluating Knowledge (scored 0-10), Self-awareness (scored yes/no), and Attitude towards opioids and related risks (scored 0-10). Participants also completed the validated Opioid Risk Tool (ORT) and health literacy tool (SAHL-E) and were taking opioids during hospitalization. Demographics were collected from health records. Correlation coefficients (r) and multivariable regression analyses were performed to assess concurrent validity of the OLT with the SAHL-E. Results: Among 136 participants (66.2%=black, 50.7%=male, age=42.7±15.2 years) 38.2% were at high risk for opioid misuse (ORT≥3) and 26.5% had poor health literacy (SAHL-E≤14). All OLT-subcategories showed significant positive associations with SAHL-E scores (Knowledge: r=0.36, p < 0.001; Self-awareness: odds ratio=2.66, 95% confidence interval=1.14-6.23; Attitude: r=0.35, p = 0.024), demonstrating concurrent poor health literacy with poor opioid understanding. OLT scores were not associated with ORT scores, however, 35.6% of participants without opioid knowledge were at high risk for opioid misuse (ORT≥3). Conclusion: Findings confirm concurrent validity of our OLT with the SAHL-E in the orthopaedic trauma setting. This data demonstrates that poor opioid literacy is not associated with traditional opioid risk assessments (i.e., ORT) and ought to be considered as a separate, compounding entity in opioid-related risk stratification.