Past year non-medical opioid use and abuse and PTSD diagnosis: Interactions with sex and associations with symptom clusters

Abstract

Introduction Few studies have examined the associations between posttraumatic stress disorder (PTSD) and non-medical opioid use (NMOU), particularly in general U.S. samples. Methods We analyzed data from wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of non-institutionalized adults, to examine (1) the relationship between PTSD diagnosis with NMOU, Opioid Use Disorder diagnosis, and average monthly frequency of NMOU; and (2) the relationship between PTSD symptom clusters with NMOU, Opioid Use Disorder diagnosis, and average monthly frequency of NMOU. We also explored sex differences among these associations. Results In the adjusted model, a past year PTSD diagnosis was associated with higher odds of past year NMOU for women and men, but the association was stronger for women. In addition, a PTSD was associated with higher odds of an Opioid Use Disorder diagnosis for women, but not for men. With regards to the relationship between specific symptom clusters among those with a past year PTSD diagnosis, important sex differences emerged. For women, the avoidance symptom cluster was associated with higher odds of NMOU, an Opioid Use Disorder diagnosis, and average monthly frequency of NMOU, while for men the arousal/reactivity cluster was associated with higher odds of NMOU, an Opioid Use Disorder diagnosis, and average monthly frequency of NMOU. In addition, for men, the avoidance symptom cluster was associated with higher odds of an Opioid Use Disorder diagnosis, but a lower rate of average monthly frequency of NMOU. Conclusions Results add to the literature showing an association between PTSD and NMOU and suggest that PTSD is more strongly associated with substance use for women than men. Further, results based on individual symptom clusters suggest that men and women with PTSD may be motivated to use substances for different reasons.

Opioid medication misuse among unhealthy drinkers

“…Specifically, while depression (SAMHSA, 2014) and PTSD (Meier et al, 2014; Smith et al, 2016) have been found to have clear associations with opioid medication misuse in previous investigations, it appears for those engaged in unhealthy alcohol use there is a particular link between a positive screen for PTSD and opioid medication misuse. Previous research supports these results, which has shown heightened concurrence of PTSD and alcohol dependence among opioid dependent patients receiving substitution therapy (Peirce et al, 2008).…”

“…Individuals who misuse opioid medications have a number of attendant behavioral health conditions, such as depression, anxiety, posttraumatic stress disorder (PTSD), illicit drug use (Amari et al, 2011; Becker et al, 2008; Smith et al, 2016; Sullivan et al, 2010), severe pain (Amari et al, 2011; Hudson et al, 2008; Novak et al, 2009; Sullivan et al, 2010); and general poor health (Becker et al, 2008; Hudson et al, 2008). …”

Non-medical use of prescription drugs by young men: impact of potentially traumatic events and of social-environmental stressors

“…The link between traumatic stressors and NMUPD is particularly well established for a diagnosis of PTSD and the NMU of opioid medications (Smith et al, 2016). In the present study, the most malicious forms of interpersonal violence – physical or sexual assault – were not only associated with opioid medication but also to various degrees with all outcomes of NMUPD.…”

“…There is little research for specific effects of assaults on men. However, Smith et al (2016) showed that a diagnosis of PTSD is more strongly associated with NMU of opioid medication in women in comparison to men. Further, when comparing male with female samples that have been sexually assaulted during childhood and youth it was shown that odds ratios for abuse of alcohol or of illicit drugs was higher in females than in males (Dube et al, 2005).…”

“…A history of witnessing violence, experiencing a natural disaster, or a lifetime history of Post-Traumatic Stress Disorder (PTSD) were associated with an increased likelihood of NMUPD (Lowe, Sampson, Young, & Galea, 2017; McCauley et al, 2010; Quinn et al, 2016), particularly with the increased non-medical use (NMU) of opiates (Smith, Smith, Cercone, McKee, & Homish, 2016). …”