The Impact of Military Sexual Trauma on Opioid Use Disorder and Related Outcomes in Men and Women Veterans

Abstract

This dissertation research included three primary aims related to military sexual trauma (MST) and opioid use disorder (OUD) among U.S. Veterans enrolled in Veterans Health Administration (VA) care. Specifically, aims were to (1) assess the relationship between MST and OUD, (2) assess the relationship between MST and treatment for OUD among Veterans who have an OUD diagnosis, and (3) evaluate the potential role of chronic pain as a mediator in the relationship between MST and OUD, as chronic pain is a common diagnosis in sexual trauma survivors and is a major cause of opioid use. Because gender plays a critical role in how a Veteran reacts to and copes with MST, the differential role of gender was assessed in all three aims. Data were derived from VA administrative data from fiscal years 2009-2017. Analyses included multivariable logistic regression in Aims 1 and 3, and multi-level logistic regression models to account for the facility-level factors that impact opioid prescribing and OUD treatment access in Aim 2. This research can be used to inform care planning and recommendations for Veterans who are survivors of MST that is sensitive to gender-related concerns, chronic pain diagnoses, and OUD risk. It also informs barriers to receipt of effective OUD treatment and care coordination at VA facilities for these high-risk patients.