Shiner B, et al. - Researchers planned this study to ascertain the prevalence of diagnosed opioid use disorder and use of medications for opioid use disorder in a large cohort of patients with posttraumatic stress disorder (PTSD). Among patients with PTSD, opioid use disorder was an uncommon but increasing comorbidity. Patients entering Veterans Affairs (VA) treatment for PTSD had their opioid use disorder treated with opioid agonist treatments in large and increasing numbers. There was a demand for research both on the epidemiology of opioid use disorder among patients with PTSD and on screening for opioid use disorder.

• Administrative and pharmacy data for veterans who initiated PTSD treatment in the Department of Veterans Affairs (VA) between 2004 and 2013 (N = 731,520) was gathered.
• Those with a comorbid opioid use disorder diagnosis (2.7%; n = 19,998) were identified and whether they received a medication for opioid use disorder in the year following their initial clinical PTSD diagnosis (29.6%; n = 5,913) was determined.
• The predictors of receipt of opioid use disorder medications were determined using logistic regression.

• In this study, comorbid opioid use disorder diagnoses increased from 2.5% in 2004 to 3.4% in 2013.
• Compared to other patients with PTSD, patients with comorbid opioid use disorder used more health services and had more comorbidities.
• During the same time period, use of medications for opioid use disorder increased from 22.6% to 35.1% among patients with PTSD and comorbid opioid use disorder.
• Growth in the use of buprenorphine (2.0% to 22.7%) was accompanied by relative decline in use of methadone (19.3% to 12.7%).
• Patients who received buprenorphine were found to be younger with tendency towards being rural, White, and married.
• In contrast, patients were older, urban, unmarried, from racial and ethnic minorities, and more likely to see substance abuse specialists, who received methadone.
• Most (87%) patients who received naltrexone also had an alcohol use disorder, while the use of naltrexone increased (2.8% to 8.6%).
• The researchers found a substantial increase in the use of buprenorphine, a substantial decrease in the use of methadone, and no change in the use of naltrexone across years, after controlling for patient factors.