Understanding the Relationship Between PTSD and Opioid Use Disorder

veteran with ptsd and opioid use disorder

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Post-traumatic stress disorder (PTSD) is a mental health problem people can develop after witnessing or experiencing a life-threatening event. PTSD can affect anyone, but certain factors increase your risk. Veterans, for example, are more likely to develop PTSD than the general population. Unfortunately, PTSD can co-exist with various substance use disorders, including opioid use disorder. 

Symptoms of PTSD

Before elaborating on the relationship between PTSD and opioid use disorder, it may be helpful to understand a few of the indications associated with PTSD. 

According to Mayo Clinic, there are four main groups of PTSD symptoms:

  • Intrusive memories
  • Adverse changes in thinking and mood
  • Changes in physical and emotional reactions
  • Avoidance 

The elevated response associated with the symptoms of PTSD, including hypervigilance and exaggerated startle, can be unbearable. As a result, those with PTSD are often desperate to alleviate their suffering. 

They may use licit and illicit substances to do so.

PTSD and Substance Use Disorder

There is a strong relationship between substance use disorder and PTSD.

According to the VA, nearly one out of every three veterans seeking treatment for substance use disorder also has PTSD; and one out of every four veterans with PTSD also has substance use disorder. 

Alcohol use disorder is the most common, taking up 42% of co-occurrences. Nicotine accounts for about 38%, while other substance use disorders, including opioids, stimulants, sedatives, etc., make up about 22%. 

PTSD and Opioid Use Disorder

Because opioids are often categorized with other substance use disorders, it is difficult to know precisely how many co-occurrences exist with PTSD. What we do know is that the prevalence of opioid use disorder is higher among those with PTSD than for those without PTSD.

The VA reported a 37% relative increase in the number of patients in the VA treated with opioid use disorder in addition to a new PTSD diagnosis from 2004 to 2013.

The Relationship Between Opioid Pretreatment and PTSD

In some instances, opioids can be an effective method to treat trauma, but it also has drawbacks. Aside from being addictive, opioid use, whether prescribed or obtained illegally, can lead to PTSD down the road. 

One study, Chronic opioid pretreatment potentiates the sensitization of fear learning by trauma, looked at the relationship between opioids and fear learning by trauma, which is associated with PTSD. Researchers treated mice with morphine for a week. Then, they gave the mice relatively strong foot shocks. After the morphine wore off, the researchers gave the mice mild foot shocks. 

The mice given morphine had a more extended freeze response than the control group, which did not receive an opioid. A freeze response occurs when the mice recognize fear, and the longer the freeze, the more significant the perceived threat. The result suggests that opioids may affect fear response and increase the risk of developing PTSD-like symptoms.

It’s important to note this particular study only shows a relationship between taking opioids before the traumatic experience and not after. 

The Importance of Understanding PTSD and Opioid Use Disorder 

PTSD and opioid use disorder are devastating conditions that affect many veterans. By understanding the relationship between the two, health care professions can identify risk factors and take steps to treat or prevent them from occurring in the first place.


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