Post-traumatic stress disorder and risk of prescription opioid use, over-use, and misuse among World Trade Center Health Registry enrollees, 2015-2016

BACKGROUND: Among veterans, post-traumatic stress disorder (PTSD) has been shown to be associated with the use and misuse of prescription opioids. Less is known about PTSD among the general population and PTSD resulting from non-combat related trauma. We sought to determine if PTSD following exposure to the World Trade Center (WTC) disaster is associated with the recent use, over use, or misuse of prescription opioids. METHODS: This study, conducted in 2018, examined 26,840 individuals from the WTC Health Registry. PTSD symptoms were assessed on multiple surveys (2003-2016) using the PCL Checklist-17. Three categories of post-9/11 PTSD were derived: never, past, and current. Self-reported opioid use outcomes (past year, 2015-2016) were defined as (yes/no): recent use (use of a prescription opioid), over-use (use of a prescribed opioid in a manner other than prescribed) and misuse (use of a prescription opioid prescribed to someone else). RESULTS: Opioid use, over-use, and misuse prevalence was highest among those with current PTSD (prevalence: 12.2 %-46.1 %) compared to past PTSD (prevalence: 6.7 %-35.8 %) and never PTSD (prevalence: 3.6 %-22.9 %). In adjusted models, individuals with past and current PTSD had a greater risk of all opioid outcomes compared to never PTSD. CONCLUSIONS: Past and current 9/11-related PTSD is a risk factor for opioid use and misuse among the general population, findings which may assist in improving screening and surveillance measures.