Abstract

Objective: Post-traumatic stress disorder (PTSD) is a common risk factor for opioid use disorder (OUD). However, not all individuals with PTSD develop OUD when exposed to opioids. As the underlying moderators remain unexplored, this analysis aimed to determine if non-traumatic adverse experiences and stressors prior to the age of 18 moderate the relationship between PTSD and OUD. Methods: In a matched dataset (n = 830) of individuals with or without PTSD who reported lifetime use of opioids, the following non-traumatic adverse experiences and stressors were assessed: emotional abuse, emotional neglect and physical neglect, parents’ adverse experiences, and number of days jailed before the age of 18. Using the PROCESS macro in SAS for each factor, the conditional effects were estimated through simple slopes. Moderation was inferred through significant interaction effects. Results: The matched data were similar on age, gender, ethnicity, education, being born in the US, living with, or losing biological parents before age 18, and family history of depression, anxiety, and substance use disorder. Significantly more individuals in the preexisting PTSD group had preexisting psychiatric disorders, and preexisting substance use and schizotypal personality disorder. Childhood emotional abuse and neglect and physical neglect (effect: 0.03; 95%CI: 0.001−0.056; p = .039), and more than one event of adversity experienced by parents (effect: 0.34; 95%CI: 0.07−0.61; p = .013) significantly interacted with PTSD to lead to OUD. Conclusion: The conditional effect of PTSD on the development of OUD after exposure to opioids was dependent on the frequency and severity of childhood non-traumatic adverse experiences. To identify individuals with PTSD who are at a high risk of developing OUD, programs may focus on non-traumatic adverse childhood experiences that are not commonly explored. Future steps may include focusing on educational schemes to mitigate this higher risk of developing OUD in at-risk individuals, for example, by discussing the risks when prescribing opioids.

摘要

目的：创伤后应激障碍（PTSD）是阿片类药物使用障碍（OUD）的常见危险因素。然而，并非所有患有 PTSD 的人在接触阿片类药物时都会出现 OUD。由于潜在的调节因素仍未探索，该分析旨在确定 18 岁之前的非创伤性不良经历和压力源是否会调节 PTSD 和 OUD 之间的关系。方法：在匹配的数据集中（n = 830) 在报告终生使用阿片类药物的有或没有 PTSD 的个体中，评估了以下非创伤性不良经历和压力源：情感虐待、情感忽视和身体忽视、父母的不良经历以及在该年龄之前入狱的天数18。在SAS 中为每个因素使用PROCESS 宏，通过简单的斜率估计条件效应。通过显着的相互作用效应推断出适度。结果：匹配的数据在年龄、性别、种族、教育、出生在美国、在 18 岁之前与亲生父母同住或失去亲生父母以及抑郁、焦虑和物质使用障碍的家族史方面相似。在先前存在的 PTSD 组中，明显更多的人患有先前存在的精神疾病，以及先前存在的物质使用和分裂型人格障碍。儿童时期的情感虐待、忽视和身体忽视（影响：0.03；95%CI：0.001-0.056；p  = .039），以及父母经历过不止一次逆境事件（影响：0.34；95%CI：0.07-0.61；p  = .013) 与 PTSD 显着相互作用导致 OUD。结论：PTSD 对暴露于阿片类药物后 OUD 发展的条件影响取决于儿童非创伤性不良经历的频率和严重程度。为了识别具有发展 OUD 高风险的 PTSD 个体，项目可能会侧重于不经常探索的非创伤性不良童年经历。未来的步骤可能包括关注教育计划，以降低高危人群发生 OUD 的较高风险，例如，通过讨论开具阿片类药物时的风险。