Psychiatric Comorbidities May Raise Risk for Sedative Use Disorder in Patients with Opioid Use Disorder

A prescription bottle of pills spilled over
A prescription bottle of pills spilled over
Over half of the sample attained opioids through their own prescription, and 47.2% of patients with co-occurring sedative use disorder attained sedatives by prescription.

Posttraumatic stress disorder (PTSD) and antisocial personality disorder may increase the risk for co-occurring sedative use disorder (SUD) in patients with opioid use disorder (OUD), according to study data published in the Journal of Substance Abuse Treatment. Depressive disorders and schizotypal personality disorder also predicted co-occurring SUD and OUD among women alone.

Investigators abstracted data on a representative sample of noninstitutionalized adults in the United States from the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III), which was administered between 2012 and 2013. NESARC-III participants who met criteria for past year OUD were eligible for the present analysis.

Patients reported frequency and duration of substance use, as well as prescription information, demographic characteristics, and psychiatric diagnoses. The investigators conducted logistic regression analyses to assess correlates of OUD and SUD, with all analyses were stratified by gender.

Of 36,309 individuals who participated in NESARC-III, 330 met criteria for past year OUD and were included in analyses. Among men (n=154), mean age was 40.5±14.3 years; among women (n=176), mean age was 44.5±16.3 years. The majority of participants were white (58.5%).

Overall, 16.4% of patients with OUD met criteria for co-occurring SUD. Over half (55.6%) of the full sample attained opioids through their own prescription, and 47.2% of patients with co-occurring SUD attained sedatives by prescription. A total of 37.7% of patients with co-occurring OUD and SUD had been prescribed both substances.

Patients with co-occurring SUD tended to begin opioid use at a younger age than patients with OUD alone (mean age, 24.6 vs 28.3 years; P =.039). However, the 2 groups did not differ significantly by age, race, income, frequency of opioid use during the past year, or length of heaviest opioid use period. In logistic regression analyses, patients with PTSD (odds ratio [OR], 2.72; 95% CI, 1.37-5.41) and patients with antisocial personality disorder (OR, 2.72; 95% CI, 1.37-5.41) were significantly more likely to have co-occurring SUD and OUD. Among women only, depressive disorders (OR, 2.12; 95% CI, 1.01-4.42) and schizotypal personality disorder (OR, 5.78; 95% CI, 2.48-13.49) were significantly associated with co-occurring SUD.

The results provide preliminary evidence that schizotypal personality disorder and depression may increase risk for sedative use disorder in women with OUD. As study limitations, the investigators noted that data on day-to-day substance use were unavailable as patients only reported broader use patterns.

“Results of the present study highlight the importance of prescription monitoring, further research into gender-informed treatments, and implementation of treatments for substance use and co-occurring symptoms,” the investigators wrote.


Ellis JD, Pittman BP, McKee SA. Co-occurring opioid and sedative use disorder: gender differences in use patterns and psychiatric co-morbidities in the United States [published online April 25, 2020]. J Subst Abuse Treat. doi:10.1016/j.jsat.2020.108012