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.