Prevention of Opioid Use Disorders for Veterans with Chronic non Cancer Pain and PTSD

Psychological trauma is a major predictor of opioid dependence, with the risk of intravenous drug use being increased nine-fold in individuals with a history of early trauma [1] and a co-morbid rate of 33% in adults with post traumatic stress disorder (PTSD) [2]. The comorbidity of PTSD and opioid dependence complicates treatment of both conditions. Thus, most clinical trials for the treatment of opioid dependence have excluded participants with co-occurring psychiatric disorders, including PTSD. The few treatment studies in patients with PTSD and opioid dependence have reported poor outcomes for both conditions. PTSD patients report a reduction in intrusive and hyperarousal symptoms of PTSD with acute opioid use [3] and studies in children with burn injuries have shown that acute morphine administration protects against the development of PTSD in children who are burn victims [4-6]. Therefore, patients with PTSD have high risk of developing opioid addiction.