Morphine treatment linked to the prevention of PTSD

“Opiates reduce the activation of norepinephrine, and when you reduce norepinephrine, you should also reduce PTSD,” said neuroscientist James McGaugh of the Center for the Neurobiology of Learning and Memory at the University of California, Irvine.

In the latest study, a team from the Naval Health Research Center in San Diego considered the treatment histories of 696 military personnel who were injured in Iraq between 2004 and 2006 and cared for at medical treatment facilities in the field. A total of 243 patients went on to develop PTSD. Among that group, 60 percent were treated with morphine to alleviate the pain of their injuries. Of the 453 people who did not get PTSD, 76 percent received morphine.

Overall, the patients who received morphine were about half as likely to develop PTSD compared to those who did not, said epidemiologist Troy Lisa Holbrook, who led the study.

Because painful events are more likely to be traumatizing, the most logical conclusion could be that morphine worked by decreasing patients' pain, Holbrook and her colleagues wrote. But the results also support the theory that morphine can affect the way memories are encoded, they wrote.

In the civilian world, researchers have tested other candidates for pre-emptive treatment — including the beta blocker propranolol and the epilepsy drug gabapentin — by comparing them to placebos. (It would not be ethical to withhold morphine from a patient who needed it for pain relief.) The drugs did not seem to help in these small clinical trials, though the researchers say their results could be due to the delay in getting the drugs to patients. In the military study, more than 70 percent of patients who got morphine received it within an hour.

“We can't get to people for four to six hours,” said Dr. Roger K. Pitman of Harvard Medical School, who has conducted studies of possible PTSD interventions among trauma patients brought to the ER. “That's probably a big obstacle we cannot overcome.”

There are also ethical issues to consider. Fear is an important emotion, and it could be dangerous to tinker with the potentially life-saving instinct to avoid places and situations associated with past traumas, Saxe said.

But an effective drug would not erase traumatic memories, just reduce their emotional intensity into the normal range, said Erik Parens, a senior research scholar at the Hastings Center, a bioethics research institute in Garrison, N.Y.

“If the treatment is safe and effective, it would be unethical to refuse it to a patient,” he said.

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