Pharmacologic 

Guidelines for 

Treating Individuals 

with Post-Traumatic Stress 

Disorder and Co-Occurring 

Opioid Use Disorders
Pharmacologic 

Guidelines for 

Treating Individuals 

with Post-Traumatic Stress 

Disorder and Co-Occurring 

Opioid Use Disorders

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration
Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and CoOccuring Opioid Use Disorders

Acknowledgments

This document was produced for the Substance Abuse and Mental Health Services Administration (SAMHSA) by 

Westat under the Co-Occurring Mental Health and Substance Abuse Disorder (COD) Knowledge Synthesis, Product 

Development, and Technical Assistance (CODI) contract (reference number 283-07-0610). Charlene E. Le Fauve, 

Ph.D.; Tison Thomas, M.S.W.; Onaje Salim, M.A., L.P.C.; Jayme S. Marshall, M.S.; and Deborah Stone, Ph.D. served 

as the Government Project Officers. 

Disclaimer

The views, opinions, and content of this publication are those of the authors and contributors 

and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. 

Public Domain Notice

All material appearing in this publication is in the public domain and may be reproduced or copied without 

permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced 

or distributed for a fee without specific, written authorization from the Office of Communications, SAMHSA, HHS.

Electronic Access

This publication may be downloaded at http://store.samhsa.gov. 

Or call SAMHSA at 1-877-SAMHSA-7 (1-877-726-4727) (English and Español). 

Recommended Citation

Substance Abuse and Mental Health Services Administration, Pharmacologic Guidelines for Treating Individuals with 

Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders. HHS Publication No. SMA-12-4688, Rockville, 

MD: Substance Abuse and Mental Health Services Administration, 2012. 

Originating Office

Centers for Substance Abuse Treatment and Mental Health Services (CSAT and CMHS), SAMHSA

1 Choke Cherry Road

Rockville, MD 20857

HHS Publication No. SMA-12-4688. 

Printed 2012 

SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 1

Individuals with co-occurring mental and substance use 

disorders (COD) are common in behavioral health and 

primary health settings. These individuals frequently 

benefit from pharmacologic interventions, whether 

for mental disorders, substance use disorders, or both. 

While principles for providing COD services establish 

a framework for prescribing pharmacologic agents to 

individuals diagnosed with COD, specific combinations of 

disorders have unique features that must be considered in 

developing pharmacologic strategies. 

Currently, there are no documents that address PostTraumatic Stress Disorder (PTSD) and co-occurring 

opioid use disorders in a brief, easy-to-use format 

that provides guidance to both frontline practitioners, 

as well as to system or program policymakers. As a 

companion to the Substance Abuse and Mental Health 

Services Administration’s (SAMHSA’s) General Principles 

for the Use of Pharmacological Agents to Treat Individuals 

with Co-Occurring Mental and Substance Use Disorders, 

this document provides guidelines for pharmacologic 

interventions for individuals with PTSD and cooccurring opioid use disorders.

Development of the Guidelines

The Pharmacologic Guidelines for Treating Individuals with 

Post-Traumatic Stress Disorder and Co-Occurring Opioid Use 

Disorders were assembled by a task order work group, 

which included federal SAMHSA staff and contractors. 

These guidelines were developed from a search of 

relevant, peer-reviewed literature available on PubMed, 

and from practice guidelines currently in clinical use. 

Treatment recommendations were made if supported 

by more than one clinical study or randomized, doubleblind clinical trial showing the efficacy of a treatment or 

medication, or if a pharmacotherapy were specifically 

approved by the U.S. Food and Drug Administration for 

treatment of PTSD or opioid dependence. Each of the 

guidelines is supported by an evidence base—a reference 

list accompanies this document.

The guidelines were reviewed and rated by an expert 

Consensus Panel (i.e., on a 5-point scale, “How much 

do you agree or disagree that each statement should be 

included in the final Guidelines Document?”). The panel 

was convened on January 27 and March 1, 2011 to discuss 

the guidelines. The role of the Consensus Panel was to 

provide guidance based on up-to-date research, their 

experiences, and expertise. The panel was made up of 33 

individuals who are identified as experts in psychiatry, 

pharmacotherapy, COD, mental health, addictions, health 

center administration, and health reform. All panelists were 

nominated by national professional organizations or the 

SAMHSA federal staff. The Consensus Panel process and 

Consensus Panel membership are discussed in more detail 

in a separate summary report. 

Target Audience

The primary target audience for these guidelines is 

providers who prescribe medication for adults with COD. 

This includes psychiatrists, primary care physicians, 

nurse practitioners and other nurse prescribers, physician 

assistants, and other licensed prescribers. In the document, 

the term “prescribers” is used to describe this audience.

The secondary target audience is individuals who work in 

administrative and leadership roles at the program, agency, 

or system level. This may include medical directors, clinical 

directors, executives, quality managers, and regulators. 

These guidelines can assist in the design of policies 

and protocols to support best practice pharmacologic 

interventions for individuals with COD in all settings. They 

are intended to support the attainment of valued recovery 

outcomes and the more efficient and effective use of 

resources for individuals with complex challenges.

Structure of the Document

The guidelines are organized in the sequence that a 

practitioner will likely meet, engage, and intervene with an 

individual with co-occurring PTSD and opioid disorders. 

These guidelines are not intended to set a standard of 

care for individuals with these CODs, but rather suggest 

parameters that clinicians should consider in their 

prescribing practices.
SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 2

Introduction

The co-occurrence of PTSD and co-occurring opioid use 

disorders was selected for guideline development because 

of the high rates of trauma in substance users and high 

rates of PTSD amongst those with substance use disorders. 

The lifetime prevalence of PTSD in adults in the United 

States is approximately 7 percent (Hildago & Davidson, 

2000; Kessler, Berglund, et al., 2005), and past year 

prevalence is about 4 percent (Kessler, Chiu, et al., 2005). 

The lifetime prevalence of PTSD among women (9.7%) is 

2.5 times that of men (3.6%), and the 12-month prevalence 

for women (5.2%) is nearly three times that of men (1.8%) 

(National Comorbidity Survey, 2005). Veterans have a 

greater prevalence of PTSD than the general population. 

Lifetime prevalence for Vietnam veterans is 30.9 percent for 

men and 26.9 percent for women, with current prevalence 

of 15.2 percent for men and 8.1 percent for women (Kulka 

et al., 1990). Veterans from the Afghanistan and Iraq 

wars have a current PTSD prevalence of approximately 

14 percent (Tanielian & Jacox, 2008). Among those with 

PTSD, substance use disorders occur in 21-43 percent 

of the population (Jacobson et al., 2001). In those with 

substance use disorders, lifetime prevalence of PTSD 

ranges from 26-52 percent (Mills et al., 2005; Reynolds et 

al., 2005), and current PTSD ranges from 15-41 percent 

(Clark et al., 2004; Dom et al., 2007; Schafer & Najavits, 

2007).

Some of the most problematic substances of abuse in 

PTSD are opioids. For example, for returning veterans 

from Iraq and Afghanistan, both the widespread 

availability of opioids and their use in managing the pain 

of injured soldiers will likely increase the prevalence of 

this co-occurring condition in clinical settings in this 

country.

Untreated PTSD in opioid dependent individuals 

receiving opioid dependence therapies (methadone or 

buprenorphine maintenance, detoxification treatment, and 

drug-free residential treatment) has been associated with 

ongoing mental, physical, and occupational disability, 

despite improvements in substance abuse (Mills et 

al., 2007). Symptoms of PTSD do not improve with 

opioid therapy in those with co-occurring PTSD and 

opioid dependence (Trafton et al., 2006). Therefore, it is 

important to screen those presenting for treatment with 

opioid dependence for co-occurring PTSD. Likewise, it is 

important to screen those with trauma symptoms for 

concurrent opioid abuse. It is essential to develop a 

treatment plan that will appropriately address both 

disorders. 

Effective treatments for PTSD in individuals with opioid 

disorders include both psychosocial interventions 

(e.g., relapse prevention, contingency management, 

prolonged exposure, and teaching coping skills) and 

pharmacotherapies. The types and sequencing of these 

modalities will vary between individuals and be influenced 

by individual choice. Prescribers should discuss risks and 

benefits of medications so every individual can make an 

informed choice regarding different treatment options. 

Psychosocial interventions are key to effective treatment of 

both conditions. They serve to educate individuals about 

both disorders, improve awareness on how these problems 

interact to contribute to poor outcomes, and assist in 

the development of coping skills to manage PTSD and 

opioid use disorder symptoms (both in the early and later 

phases of treatment). A review of effective psychosocial 

interventions is beyond the scope of these guidelines 

(publications and practice guidelines are located at http://

apa.org/pubs and http://www.psych.org).

Guidelines

1 Screening Because of the significant rates of COD, those with opioid use disorders should 

be proactively screened and assessed for PTSD, and those with PTSD should be 

proactively screened and assessed for opioid use disorders (American Psychiatric 

Association, 2006a,b).
SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 3

2 Concomitant 

Treatment

If an individual is diagnosed with COD, specific treatment should be initiated for both 

disorders and should occur concurrently using coordinated, evidence-based treatments 

including effective psychosocial interventions and pharmacotherapies (American 

Psychiatric Association, 2006a,b).

3 Pharmacotherapy 

– PTSD

Pharmacotherapies for individuals with COD should be based on the following:

•	 An understanding of effective medications for each disorder;

•	 An assessment that includes consideration of current target symptoms; 

•	 The severity of the opioid use disorder and the PTSD;

•	 The response to previous treatments for PTSD and/or opioid dependence;

•	 The presence of other substance use disorders, mental disorders, and/or medical 

disorders;

•	 Other concomitant medications;

•	 Psychiatric stability including risk of harm to self or others;

•	 The need for structure and support in treatment;

•	 The need for and ability to access other psychotherapeutic options for PTSD in

conjunction with opioid dependence pharmacotherapy treatment;

•	 An analysis of the risks and benefits of any medication therapy; and

•	 Individual preferences.

Additional information regarding Guideline 3

Pharmacotherapies shown to be effective for PTSD include:

•	 Selective Serotonin Reuptake Inhibitors (SSRI) are first-line treatments (sertraline and 

paroxetine are FDA-approved) (Brady et al., 2000; Brady & Verduin, 2005; Davidson 

et al., 2001; Marshall et al., 2001; Tucker et al., 2001). Of note, paroxetine has the 

potential to inhibit methadone metabolism, which could result in increased blood 

levels of methadone because paroxetine is an inhibitor of cytochrome P450 2D6, 

which is a metabolic pathway for methadone metabolism (Ferrari et al., 2004).

Other medications for PTSD have been studied and found to have varying degrees of 

evidence for effectiveness. These medications are listed below. It is important to note 

that none of these clinical trials have been undertaken in individuals with opioid use 

disorders, and use of these medications is off-label, but consideration of these medications 

for symptomatic relief, particularly in combination with FDA-approved medications for 

treatment of PTSD, might be considered on a case-by-case basis.

•	 SNRI medications: Venlafaxine has been associated with improvement in some for 

symptoms of numbing and/or re-experiencing the trauma (Davidson, et al., 2006).

•	 Tricyclic antidepressants (TCAs): Imipramine (Kosten et al., 1991) and amitriptyline 

(Davidson et al., 1990) have been shown to significantly reduce PTSD symptoms. In 

those with opioid dependence and possibly other co-occurring drug use disorders, 

caution should be exercised in considering TCAs because of the risk of cardiac toxicity, 

seizures, and potential lethality in overdose or suicide attempt in this population.
SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 4

•	 Monoamine Oxidase Inhibitors: Phenelzine has been shown to significantly reduce 

PTSD symptoms in controlled clinical trials (Kosten et al., 1991). However, the need 

to avoid tyramine containing foods, alcohol, certain medications (SSRIs, stimulants, 

meperidine, decongestants), and illicit drugs, indicates that caution with detailed 

attention to the individual’s history, including impulsivity, be considered before 

recommending monoamine oxidase inhibitors.

•	 Other Antidepressants: 

•	 Mirtazepine and Nefazodone have been studied in small clinical trials with some 

positive response on improvement in depressive symptoms, sleep, and anxiety. 

These are considered second line medications according to VA/DoD Practice 

Guidelines (http://www.Healthquality.Va.Gov/PTSD-FULL-2010c.pdf) (The 

Management of Post-Traumatic Stress Working Group, 2010).

•	 Prazosin is reported to reduce PTSD-associated psychological distress during the 

daytime, and it has been reported to decrease trauma-associated nightmares and nonnightmare distressed awakenings (Taylor et al., 2006; Thompson et al., 2008).

•	 Atypical Antipsychotics: Risperidone has been associated with improvement in PTSD 

symptoms of hyperarousal and intrusive thoughts in several studies (Padala et al., 

2006; Reich et al., 2004) and may be helpful as an augmentation strategy for those 

who do not respond to Sertraline in selected individuals (Rothbaum et al., 2008).

•	 Benzodiazepines may be used in other anxiety disorders in unique circumstances with 

clear guidelines, but they should not be used to treat PTSD.

•	 In PTSD, early use of benzodiazepines (within 1 week of trauma [range 2- to 18-

days]) has been associated with higher incidence of PTSD at one and six

month follow-up (Gelpin et al., 1996). 

•	 Benzodiazepines have been associated with toxic drug interaction with opioids, 

including methadone and buprenorphine. Diazepam and alprazolam, used in this 

context, can be associated with performance impairment (Lintzeris et al., 2006, 

2007; Rogers et al., 1997). 

•	 Benzodiazepines are also one of the most frequently mentioned classes of

drugs found to be present in deaths associated with methadone or buprenorphine 

use (Maxwell & McCance-Katz, 2010).
SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 5

4 Pharmacotherapy 

– Opioid

Dependence

Current FDA-approved pharmacotherapies for opioid dependence include buprenorphine, 

methadone, and naltrexone (oral and extended-release injectable formulations) (Center for 

Substance Abuse Treatment, 2005). There is no endorsement of one of these medications 

over another in those with COD.

When prescribing medications for PTSD in opioid-dependent individuals receiving either 

methadone or buprenorphine, consideration must be given to the potential for drug 

interactions between the opioid and the psychotropic medication. Information on drug 

interactions between opioids and other medications can be found at:

http://www.atforum.com/rx-methadone/index.php#drugint.

Additional information regarding Guideline 4

When prescribing medications to an individual diagnosed with COD, several drug 

interactions should be considered:

•	 Methadone:

•	 If medications that might increase methadone concentrations are to be used to treat 

PTSD symptoms, then obtaining a cardiogram that gives a corrected QT interval (a 

measure of electrical function of the heart) should be considered. Those at higher 

risk for prolongation of the QT interval include those with family history of long QT 

syndrome or a history of risk factors including structural heart disease, syncope, and 

arrhythmia (Krantz et al., 2009).

•	 Individuals should be followed for evidence of opioid toxicity, including

altered mental status and decreased respiration. Some drugs that are frequently 

co-administered with methadone and reportedly increase plasma methadone 

concentrations include several antibiotics (ciprofloxacin, fluconazole), psychotropics 

(quetiapine, amitriptyline), and HIV medications (delavirdine) (McCance-Katz et al., 

2010).

•	 If drugs are administered that could lower methadone plasma concentrations 

resulting in an increase in daily methadone dose, care should be taken to adjust 

methadone dose downward to avoid methadone toxicity if the medication(s) 

contributing to the lower methadone concentrations is/are discontinued.

•	 Buprenorphine:

•	 Drug interaction studies in humans between buprenorphine and psychotropic drugs 

are limited.

Clinicians should, however, be aware that drugs used in the treatment of PTSD (and other 

medical/mental disorders) could possibly alter buprenorphine metabolism.

Pharmacotherapies for the treatment of opioid use disorders are described in

SAMHSA’s Treatment Improvement Protocols (TIP);

•	 TIP 40: Clinical Guidelines for the Use of Buprenorphine in the Treatment of

Opioid Addiction (http://buprenorphine.Samhsa.Gov/bup_guidelines.Pdf) 

(McNicholas, 2004); and

•	 TIP 43: Medication-Assisted Treatment for Opioid Addiction in Opioid Treatment 

Programs (http://store.Samhsa.Gov/product/sma08-4214) (Center for Substance Abuse 

Treatment, 2005).
SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 6

5 Longitudinal

Care

After the resolution of symptoms associated with either PTSD or opioid use disorders, 

clinicians should continue to assess for symptoms of each disorder and provide any 

needed treatment. For example, it is possible that as opioid use diminishes through 

treatment, PTSD symptoms may either emerge or worsen. This is because substances 

sometimes obscure PTSD symptoms (American Psychiatric Association, 2006b).

6 Polysubstance

Abuse

Polysubstance abuse occurs frequently in those with opioid dependence and/or PTSD. The 

potential adverse impact of polysubstance abuse (McFarlane et al., 2009; Price et al., 2004; 

Salgado et al., 2007) underscores the importance of prescribers to screen, assess, and treat 

for these conditions.

Additional information regarding Guideline 6

Common co-occurring substances used include:

•	 Alcohol use disorders frequently occur in those with opioid use disorders and 

PTSD frequently co-occurs in those with opioid and alcohol use disorder (American 

Psychiatric Association, 2006a,b; Bonin et al., 2000; McNicholas, 2004; National 

Comorbidity Survey, 2005). While opioid therapy does not effectively treat alcohol 

problems in this population (Srivastava et al., 2008), several medications are available 

for the treatment of alcohol use disorders including:

•	 Naltrexone (oral and extended-release injectable formulations), Acamprosate 

(Willenbring et al., 2009), and Disulfiram (Barth & Malcolm, 2010), which are FDAapproved for the treatment of alcohol dependence. Note, Naltrexone cannot be used 

in individuals who require agonist therapy for opioid dependence; and

•	 Topiramate, with evidence supporting its use in treatment of alcohol use disorders, 

is not currently FDA-approved for that indication (Willenbring et al., 2009).

•	 Nicotine dependence, cannabis, cocaine, and amphetamine use disorders (Norman 

et al., 2010) frequently co-occur in those with PTSD, and treatment of nicotine 

dependence has been associated with improved outcomes in smoking cessation in 

veterans with PTSD (McFall et al., 2010).

•	 FDA-approved pharmacotherapies for nicotine dependence include nicotine 

replacement therapies, bupropion, and varenicline (Fant et al., 2009). 

•	 While there are no accepted effective pharmacotherapies for cannabis, cocaine, 

or amphetamine use disorders, ongoing use of these substances may reduce 

the effectiveness of treatments initiated for opioid dependence and PTSD, and 

consequently should be addressed in substance abuse treatment settings (Center 

for Substance Abuse Treatment, 2005).
SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 7

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Acknowledgments

We wish to acknowledge the many people who contributed to all aspects of this project. In particular, we wish to 

acknowledge the following contributors and consultants.

PLANNING COMMITTEE MEMBERS

H. Westley Clark, M.D., J.D., M.P.H., C.A.S., F.A.S.A.M.

Director of the Center for Substance Abuse Treatment 

SAMHSA

Rockville, Maryland

Dulari Gandhi

Co-Occurring Disorders Integration and

Innovation (CODI) Research Assistant

Westat

Rockville, Maryland

Shoma Ghose, Ph.D.

Co-Occurring Disorders Integration and

Innovation (CODI) Task Lead

Westat

Appleton, WI

Nina Hamburg, M.B.A.

Project Manager, Co-Occurring Disorders 

Integration and Innovation (CODI)

Westat

Rockville, Maryland

Charlene Le Fauve, Ph.D.

Chief, Co-Occurring and Homeless Activities Branch 

Center for Substance Abuse Treatment

SAMHSA 

Rockville, Maryland

Robert Lubran, M.S., M.P.A.

Director, Division of Community Programs

Center for Substance Abuse Treatment 

SAMHSA

Rockville, Maryland

Mary Anne Myers, Ph.D.

Project Director, Co-Occurring Disorders 

Integration and Innovation (CODI)

Westat

Rockville, Maryland

Fred Osher, M.D.

Director, Health Systems and Services Policy

Council of State Governments Justice Center

Johns Island, South Carolina

Dr. Lawrence D. Rickards

Consultant to Westat

Washington, DC 

Onaje Salim, M.A., L.P.C.

Public Health Advisor

Center for Substance Abuse Treatment 

SAMHSA 

Rockville, Maryland

Deborah Stone, Ph.D.

Social Science Analyst

Center for Mental Health Services

SAMHSA

Rockville, Maryland
SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 12

SAMHSA’S PHARMACOTHERAPY EXPERT CONSENSUS PANEL MEMBERS

J. Craig Allen, M.D.

Chief Medical Officer

National Council of Community Behavioral Healthcare

Rushford Center, Inc.

Meriden, Connecticut

John Paul Allen, Ph.D., M.P.A.

National Mental Health Director, Addictive Disorders

Office of Mental Health Services

Veterans Health Administration

Washington, DC

Michael H. Allen, M.D.

Trustee and Past President

American Association of Emergency Psychiatry

Director of Research

University of Colorado Depression Center

Aurora, Colorado

Tony B. Campbell, R.Ph., D.O.

Medical Officer, Division of Pharmacologic Therapies

Center for Substance Abuse Treatment 

SAMHSA 

Rockville, Maryland

Jason Carter, Pharm.D.

Chief Pharmacist, Tennessee Department 

of Mental Health and Developmental Disabilities

State Opioid Treatment Authority

Associate Professor, Clinical Pharmacy

University of Tennessee College of Pharmacy

Nashville, Tennessee

Anthony Dekker, D.O., F.A.O.A.A.M.

Hospital Vice President for Medical Affairs 

and Chief Medical Officer Brighton Hospital

Brighton, Michigan

Walter Ginter, C.M.A.

Project Director, Medication Assisted 

Recovery Support (MARS) Project

Port Morris Wellness Center

Bronx, New York

Janice Kauffman, R.N., M.P.H., C.A.S.

Vice President, Addiction Treatment Services

North Charles Foundation, Inc.

Somerville, Massachusetts

Jeffrey A. Kelman, M.D., M.M.Sc.

Chief Medical Officer, Center for Beneficiary Choices

Centers for Medicare and Medicaid Services

Baltimore, Maryland

Jag H. Khalsa, Ph.D.

Chief, Medical Consequences of Drug Abuse 

and Co-Occurring Infections Branch

Division of Pharmacotherapies and Medical 

Consequences of Drug Abuse

National Institute on Drug Abuse, NIH

Bethesda, Maryland

R. Gregory Lande, D.O., F.A.C.N.

Clinical Consultant, Department of Psychiatry

Walter Reed Army Medical Center

Army Substance Abuse Program

Washington, DC 

Raye Z. Litten, Ph.D.

Associate Director, Division of Treatment 

and Recovery Research

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland
SAMHSA • Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use Disorders • May 2012 13

SAMHSA’S PHARMACOTHERAPY EXPERT CONSENSUS PANEL MEMBERS (cont.)

Elinore McCance-Katz, M.D., Ph.D.

Director, Addiction Medicine Research

San Francisco General Hospital

Adjunct Professor, Psychiatry

University of California, San Francisco

San Francisco, California

Laura McNicholas, M.D., Ph.D.

American Psychiatric Association 

Philadelphia, Pennsylvania

Fran Randolph, Dr.P.H.

Director of the Division of Pharmacologic Therapies

Center for Substance Abuse Treatment

SAMHSA

Rockville, Maryland

Bob Rappaport, M.D.

Director, Division of Anesthesia and Analgesia Products

Food And Drug Administration

Silver Spring, Maryland

Nicholas Reuter, M.P.H.

Senior Public Health Analyst, Division 

of Pharmacologic Therapy

Center for Substance Abuse Treatment

SAMHSA 

Rockville, Maryland

Deidra Roach, M.D.

Medical Director, Division of Treatment 

and Recovery Research

National Institute on Alcohol Abuse and Alcoholism

Bethesda, Maryland

Richard N. Rosenthal, M.D.

Senior Associate Dean 

Arthur J. Antenucci Professor of Clinical Psychiatry

Columbia University College of Physicians and Surgeons

Chairman, Department of Psychiatry 

St. Luke’s Roosevelt Hospital Center

New York, New York

Matthew Rudorfer, M.D.

Associate Director for Treatment and Research

Division of Services and Intervention Research

National Institute of Mental Health

Bethesda, Maryland

Steven Samra, M.P.A.

Recovery Specialist

Center for Social Innovation

Newton Center, Massachusetts

Tison Thomas, M.S.W.

Public Health Advisor 

Center for Substance Abuse Treatment

SAMHSA

Rockville, Maryland

Douglas Ziedonis, M.D., M.P.H.

Professor and Chairman of the Department of Psychiatry

University of Massachusetts Medical School and

University of Massachusetts Memorial Health Care

Worcester, Massachusetts 

Penelope P. Ziegler, M.D., F.A.S.A.M.

Medical Director, Virginia Health Practitioners

American Society of Addiction Medicine

Richmond, Virginia

A special thank you to Dr. Elinore McCance-Katz and Dr. Lawrence D. Rickards for providing the first drafts of 

the Pharmacologic Guidelines for Treating Individuals with Post-Traumatic Stress Disorder and Co-Occurring Opioid Use 

Disorders and General Principles for the Use of Pharmacological Agents to Treat Individuals with Co-Occurring Mental 

and Substance Use Disorders, respectively.
SMA-12-4688. First printed 2012.

This document is not copyright protected.

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