Why is it Important to Be Aware of Trauma and PTSD in MOUD Treatment Settings?

There are several reasons why it is important for MOUD providers to assess patients for a history of traumatic experiences and PTSD.

1. Buprenorphine and methadone treatment providers may be the first or only point of contact with the healthcare system for individuals with co-occurring OUD and PTSD. Most individuals with co-occurring OUD and PTSD do not receive treatment for their trauma/PTSD symptoms.¹ MOUD providers can be an important first point of access to mental healthcare. Empirically supported brief screening measures for PTSD, such as the PTSD Checklist for DSM-5 (see below in Measures), may be a worthwhile addition to assessment in MOUD treatment settings as it has demonstrated utility for identifying a potential PTSD diagnosis, provides information on trauma-related symptoms, and takes only a few moments to complete.
2. Traumatic experiences and PTSD are common among individuals with OUD. Ninety percent of adults with OUD have experienced at least one trauma in their lifetime. The most commonly experienced traumas include sexual assault, physical assault, and witnessing the injury or death of someone else (e.g., opioid overdose). Further, 18.1% of individuals with OUD currently meet the criteria for PTSD, compared to only 1.2% in the general population.²
3. PTSD affects health and healthcare utilization. The co-occurrence of PTSD and OUD is associated with more severe substance dependence, higher rates of depression, attempted suicide, and psychosocial problems.³ PTSD is also comorbid with a range of physical health conditions (e.g., arterial, musculoskeletal, gastrointestinal, dermatologic, autoimmune, and cerebrovascular).⁴ These psychiatric, psychosocial, and physical health burdens are likely to impact MOUD treatment retention and outcomes. Furthermore, given these greater health burdens, individuals with PTSD are more likely to utilize healthcare services.⁵
4. PTSD is underrecognized in healthcare settings. Most patients with PTSD are not properly evaluated and are not offered education, counseling or referrals for mental health evaluation or treatment.⁶ Additionally, many patients avoid talking about their trauma due to uncomfortable emotions associated with this discussion or feelings of guilt or shame, making it even less likely that patients will spontaneously share their trauma experiences or related symptoms with providers unless they are specifically asked about it. Screening measures for traumatic experiences or PTSD can be completed in as little as 5-10 minutes and may provide a valuable opportunity for intervention.