Complications of comorbid PTSD and opioid use disorder (research roundup)

The opioid pandemic has been dubbed the deadliest drug catastrophe in American history, with yearly fatality rates approaching 27,000 people.

12/21/20222 min read

Physicians have increased their opioid prescribing rates in the last 20 years, thanks to the availability of less priced pain medication. The comorbidity of opioid use disorders and other mental health concerns is a major source of worry. According to studies, between 20% and 50% of people seeking treatment for opioid use disorder also satisfy the criteria for PTSD (Ecker & Hundt, 2017). Individuals with opioid addiction and a comorbid diagnosis of PTSD, according to research, had worse treatment outcomes than those without a PTSD diagnosis (Hien et al., 2009; Read, Brown & Kahler, 2004).

The following studies look at how a person's symptomology, as well as their treatment strategy and success, can be complicated by a dual diagnosis of PTSD and opioid use disorder.

In addition to examining the research summaries below, psychologists are invited to dig deeper into the literature to see what might be beneficial in practice.

In the United States, about 15% of adults say they've used a non-medical opioid at some point in their lives. Between 1999 and 2009, opioids were linked to the highest increase in overdose deaths of any illicit substance. There has been a strong link shown between nonmedical opioid usage and psychiatric diagnoses, particularly PTSD. This study looked at the links between PTSD and nonmedical opioid usage, as well as the gender variations in those links.

The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV is used by the National Epidemiologic Survey on Alcohol and Related Conditions to collect information on alcohol and drug use disorders from a nationally representative sample of the noninstitutionalized adult population in the United States. Based on DSM-IV diagnostic criteria, PTSD diagnosis was a binary variable (yes/no). Intrusion, avoidance, negative cognition/mood, and arousal/reactivity were the four symptom clusters identified by DSM-IV. A questionnaire was used to collect data on nonmedical opioid usage and frequency.

A comparison study discovered a high link between non-medical opioid use and PTSD. A prior year's diagnosis of PTSD was linked to a two-fold rise in opioid use in women and a 52 percent increase in men. For both men and women, PTSD was linked to a higher frequency of use per month. Only women with PTSD were shown to have a favorable correlation with an opioid use disorder diagnosis. Women who scored high on avoidance were more likely to use opioids, had a higher average frequency of use, and were more likely to be diagnosed with opioid addiction. Men with high arousal/reactivity levels had similar results. These data show that distinct characteristics in men and women modulate the link between nonmedical opioid usage and PTSD. Women may be driven by a desire to avoid trauma-related stimuli and lessen negative affect, whereas men may be seeking to cope with arousal and reactivity changes that include impatience, aggression, and self-destructive actions.