HIV-positive people with a high level of posttraumatic stress disorder (PTSD) symptoms were 54% more likely to show signs of opioid use disorder during pain management, according to a study published in the journal AIDS Care.

People with HIV have been found to have higher rates of both chronic pain and PTSD.

This observational cohort study recruited 166 people with HIV receiving pain management services from HIV clinics in Atlanta and Boston in 2015 and 2016. Participants were all on HIV treatment, mainly Black (72%), heterosexual-identifying (67%) and men (65%). One participant identified as nonbinary or another gender, and 9% were Latino. The median age was 55.

Participants overall had relatively high levels of stressors: Fifteen percent were unstably housed, 41% met criteria for depression and 72% were disabled, either permanently or temporarily. All had chronic pain requiring pain management, and just under one in four participants (23%) were working or in school. Fifteen percent met criteria for risky alcohol use, 19% met criteria for a nonalcohol substance use disorder and 22% met criteria for “aberrant” opioid use.

But when researchers broke down the results by likelihood of PTSD, a new picture emerged: Those with a greater level of PTSD—that is, a score of 38 or higher on a commonly used PTSD checklist—were more likely to be women (47% versus 31%), unstably housed (29% versus 11%) and nearly two and a half times as likely to have depressive symptoms (82% versus 29%). 

And while 23% of participants met criteria for a high likelihood of PTSD, those participants were 54% more likely to engage in behaviors typical of opioid use disorder. Plus, those same people were 28% more likely to engage in risky alcohol use.

“The findings from this study underscore the need to be attentive to trauma history,” wrote lead study author Elenore Bhatraju, MD, MPH, and colleagues. “The findings raise the possibility that reducing PTSD symptom severity could reduce opioid misuse and risky alcohol use, although this would require further research, as our work shows an association but not causality.”

Click here to read the full abstract.