Morphine use after combat injury in Iraq and post-traumatic stress disorder

N Engl J Med. 2010 Jan 14;362(2):110-7. doi: 10.1056/NEJMoa0903326.


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.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Analgesics, Opioid / therapeutic use*
  • Drug Utilization / statistics & numerical data
  • Emergency Medical Services
  • Emergency Treatment*
  • Female
  • Humans
  • Iraq War, 2003-2011
  • Male
  • Military Medicine*
  • Military Personnel*
  • Morphine / therapeutic use*
  • Risk
  • Stress Disorders, Post-Traumatic / epidemiology
  • Stress Disorders, Post-Traumatic / prevention & control*
  • Survivors / psychology*
  • United States
  • Warfare*
  • Wounds and Injuries / psychology*
  • Wounds and Injuries / therapy*
  • Young Adult


  • Analgesics, Opioid
  • Morphine