title: Morphine use after combat injury in Iraq and post-traumatic stress disorder.
abstract: BACKGROUND
  Post-traumatic stress disorder (PTSD) is a common adverse mental health outcome among seriously injured civilians and military personnel who are survivors of trauma. Pharmacotherapy in the aftermath of serious physical injury or exposure to traumatic events may be effective for the secondary prevention of PTSD.
  
  
  METHODS
  We identified 696 injured U.S. military personnel without serious traumatic brain injury from the Navy-Marine Corps Combat Trauma Registry Expeditionary Medical Encounter Database. Complete data on medications administered were available for all personnel selected. The diagnosis of PTSD was obtained from the Career History Archival Medical and Personnel System and verified in a review of medical records.
  
  
  RESULTS
  Among the 696 patients studied, 243 received a diagnosis of PTSD and 453 did not. The use of morphine during early resuscitation and trauma care was significantly associated with a lower risk of PTSD after injury. Among the patients in whom PTSD developed, 61% received morphine; among those in whom PTSD did not develop, 76% received morphine (odds ratio, 0.47; P<0.001). This association remained significant after adjustment for injury severity, age, mechanism of injury, status with respect to amputation, and selected injury-related clinical factors.
  
  
  CONCLUSIONS
  Our findings suggest that the use of morphine during trauma care may reduce the risk of subsequent development of PTSD after serious injury.
authors.affiliation: Naval Health Research Center, San Diego, CA 92106-3521, USA. troy@epi-soar.com
authors.forename: Troy Lisa
authors.initials: TL
authors.lastname: Holbrook
authors.forename: Michael R
authors.initials: MR
authors.lastname: Galarneau
authors.forename: Judy L
authors.initials: JL
authors.lastname: Dye
authors.forename: Kimberly
authors.initials: K
authors.lastname: Quinn
authors.forename: Amber L
authors.initials: AL
authors.lastname: Dougherty
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D004632:Emergency Medical Services; D004638:Emergency Treatment; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008887:Military Medicine; D008889:Military Personnel; D009020:Morphine / Q000627:therapeutic use*; D012306:Risk; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000517:prevention & control*; D017741:Survivors / Q000523:psychology*; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000523:psychology* / Q000628:therapy*; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine