In the context of opioid use, research has shown that the prevalence of OUD is significantly higher among individuals who have been diagnosed with post-traumatic stress disorder66 and that those who have been diagnosed with concurrent post-traumatic stress disorder and OUD experience a greater severity of OUD compared to those who have been diagnosed only with OUD.67 Consistent and universal adherence to trauma- and violence-informed approaches in all aspects of clinical practice help create a supportive setting for all patients and families, whether or not they have experienced trauma or violence in their lives.68 It should also be acknowledged that navigating the healthcare system can be a source of trauma for individuals with substance use disorders. Accordingly, it is important that all clinicians and care teams be familiar with and follow the principles of trauma-informed practice when working with patients and families affected by OUD.

The goal of trauma- and violence-informed practice is to create a safe and respectful environment that minimizes the potential for harm and re-traumatization of patients.69 The key principles of trauma- and violence-informed practice are trauma awareness; safety and trustworthiness; choice, collaboration, and connection; and strengths-based approaches and skill building.69 

While a universal approach to trauma- and violence-informed practice is recommended, it is recognized that some patient populations are more likely to have experienced trauma and violence than others. For example, Indigenous people, women, and/or 2S/LGBTQQIA+ populations are more likely to have experienced trauma and violence as a result of racism, discrimination, and social inequity compared to other patient populations.70,71 

The Centre of Excellence in Women’s Health’s Trauma-Informed Practice (TIP) Guide69 and New Terrain toolkit71 and the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Trauma-Informed Care in Behavioral Health Services72 may be useful resources for clinicians seeking to adopt trauma- and violence-informed care in their practice. The Canadian Institutes for Health Research (CIHR)-funded EQUIP Health Care research team has also published a Trauma- and Violence-Informed Care Tool73 for organizations and care providers in BC, and has several webinars on incorporating trauma- and violence-informed approaches in primary and emergency care settings available on their website.

It is important to note that disclosure of violence and trauma is not a requirement for trauma- and violence-informed practice; health care providers do not need to know an individual’s past experiences to provide appropriate support. Additionally, trauma- and violence-informed care is not intended to treat trauma. However, it is recommended to screen patients for trauma when appropriate and assess its impact on the patient’s life.74  Clinicians should be familiar with specialized treatment options, support services, and crisis services for individuals who have experienced trauma, and provide information and referrals to patients, should the need arise.