Severity of post-traumatic stress and non-medical, concomitant opioid and benzodiazepine use in a sample of women at high risk of overdose.

Women who exchange sex and use opioids experience substantial post-traumatic stress disorder (PTSD) symptoms. Among veterans, PTSD increases the risk of concomitant opioid-benzodiazepine use, increasing overdose risk, but this relationship is underexplored in other at-risk populations. We examined correlates of non-medical benzodiazepine use among a cohort of women who exchange sex and use opioids daily (N=270) in Baltimore Maryland. PTSD symptom severity was measured by the full PCL-5 (possible range: 0-80, categorized by tertile as low, medium, high) and four symptom-specific subscales. The prevalence of benzodiazepine use was 27% and the median PCL-5 score was 34. In adjusted models, women with high PCL-5 scores were more likely to use benzodiazepines than those with low scores, overall and across subscales. Severe PTSD symptoms conferred elevated risk of concomitant opioid-benzodiazepine use, calling attention to the importance of addressing trauma in combating the opioid and overdose crises.