Influence of Posttraumatic Stress Disorder on Daily-Level Trajectories of Opioid Use Among Trauma-Exposed Individuals in the Community Who Use Opioids

<b>Objective:</b> Individuals who use opioids are at elevated risk of posttraumatic stress disorder (PTSD). The objective of this study was to examine the influence of PTSD diagnosis on opioid use outcomes over a 60-day period. <b>Methods:</b> Participants were individuals with a history of trauma and recent opioid use who were recruited from the community (<i>M_age</i> = 43.45 years; 54.8% white). Participants were administered a structured diagnostic assessment for PTSD during a baseline session, and reported 30-day opioid use, opioid treatment engagement, impaired control around using opioids, and opioid overdose using a Timeline Follow-back during baseline (<i>N =</i> 84) and follow-up (<i>N =</i> 56) sessions. Multilevel models were used to examine the influence of PTSD on change in opioid use, treatment, and impaired control over the course of the 60-day observation period among the 56 individuals that completed follow-up interviews. <b>Results:</b> Two-thirds of the sample had a diagnosis of PTSD (66.7%). Compared to those without PTSD, individuals with PTSD were less likely to decrease opioid use (<i>OR</i> = 1.04, 95% CI [1.02, 1.06], <i>p</i> < .001), but were not more likely to report episode of impaired control (<i>OR</i> = 1.02, 95% CI [0.98, 1.06], <i>p</i> = .268), over the 60-day period. Although individuals with PTSD were less likely to increase their engagement with opioid treatment (<i>OR</i> = 0.96, 95% CI [0.95, 0.97], <i>p</i> < .001), these individuals engaged in treatment at much higher levels compared to individuals without PTSD. <b>Conclusions:</b> Findings underscore the high prevalence and impact of PTSD on opioid use outcomes among trauma-exposed community individuals who use opioids.