Association between posttraumatic stress disorder and nonfatal drug overdose.

Abstract

Objective: North America is in the midst of a growing drug overdose crisis. While prescription opioid misuse and synthetic opioids such as fentanyl have been implicated in the overdose crisis, less attention has been given to the role that posttraumatic stress disorder (PTSD) may play in this crisis. As such, this study sought to examine the relationship between PTSD and risk of nonfatal overdose among people who use drugs (PWUD). Method: Data were derived from three prospective cohorts of PWUD in Vancouver, Canada. For each participant, PTSD was assessed using the PTSD Checklist for the DSM-5. Multivariate logistic regression analysis was used to estimate the relationship between PTSD and nonfatal overdose, adjusting for potential confounders. Results: Between 2016 and 2018 among 1,059 PWUD, including 363 (34%) nonmale participants, 171 (16%) experienced a nonfatal drug overdose in the past 6 months, and 414 (39%) met criteria for a provisional PTSD diagnosis. In multivariate analysis, PTSD (adjusted odds ratio = 1.98, 95% confidence interval [1.4, 2.79]) remained independently associated with nonfatal overdose after adjustment for a range of confounders. Conclusions: Among participants in these community-recruited cohorts of PWUD, having a provisional PTSD diagnosis nearly doubled the risk of nonfatal overdose. The findings from this study support the need to incorporate a trauma-informed approach within the current overdose prevention framework. Education and training relating to trauma and PTSD should be prioritized for health care professionals who work with and treat PWUD.

The impact of PSTD on service access among people who use drugs in Vancouver, Canada

“…One explanation for such findings is that PTSD can impair cognition, negatively affecting the ability to obtain services [ 17 ]. Therefore, impaired goal-oriented thinking coupled with the need for relief from emotional pain [ 7 , 17 ] can prompt PWUD to seek immediate self-soothing resources (e.g., use of opioids), rather than pursuing supportive services and staying connected in services, which often require long wait lists and specific criteria [ 4 ]. Similar to the current study, Beaulieu et al [ 3 ] found that amongst VIDUS and ACCESS participants, major depressive disorder (MDD) diagnosis among PWUD was positively and independently associated with reported barriers to accessing health care.…”

“…After reviewing the literature [ 3 , 17 , 19 ], other characteristics considered as potential confounders included age (≥median vs. <median), sex (male vs. non-male), ethnicity (white vs. Black Indigenous or other People of Colour [BIPOC]), and within the last 6 months prior to data collection interviews: homelessness (yes vs. no), incarceration (yes vs. no), sex work (yes vs. no), overdose (yes vs. no), employment (yes vs. no), alcohol binge (yes vs. no), daily use of prescription opioids (yes vs. no), heroin (yes vs. no), crack (yes vs. no), cocaine (yes vs. no), and methamphetamine use (yes vs. no).…”

“…While the lifetime prevalence of PTSD in the general Canadian population is approximately 9.2% [ 24 ], the lifetime prevalence of PTSD among those with a substance use disorder is estimated to be between 26 and 52% [ 20 ]. PTSD is characterized by intrusions, avoidance behaviour, changes in mood and hypervigilance [ 8 ], all of which can impair goal-oriented thinking and behaviour, like pursuing supportive services and staying connected to services [ 17 ]. Additionally, recent data has indicated that a PTSD diagnosis almost doubles the overdose risk among people who use opioids [ 17 ].…”

“…PTSD is characterized by intrusions, avoidance behaviour, changes in mood and hypervigilance [ 8 ], all of which can impair goal-oriented thinking and behaviour, like pursuing supportive services and staying connected to services [ 17 ]. Additionally, recent data has indicated that a PTSD diagnosis almost doubles the overdose risk among people who use opioids [ 17 ]. Furthermore, many providers are untrained in trauma informed care (TIC), especially caring for PWUD [ 3 ], and can administer inappropriate care and perpetuate substance use related stigma, deterring PWUD from approaching services.…”

Variation in US Drug Overdose Mortality Within and Between Hispanic/Latine Subgroups: A Disaggregation of National Data

“…The Puerto Rican population experiences the highest unemployment rate of all the Latine subgroups that were included in the present study, as well as the second-lowest median household income and lower rates of home ownership than Mexican, Cuban, or South American groups [19]. When considering exposure to trauma, which has been identified as a risk factor for overdose among individuals who use drugs [45][46], the Puerto Rican group has the highest percentage of veterans across all Latine heritage groups [19], and evidence from select US cities suggests that Adverse Childhood Experiences may also disproportionately impact Puerto Rican populations [47]. Moreover, rates of incarceration in the male US population ages 18-39 are higher in individuals of Puerto Rican heritage than any other Latine group [48].…”