The opioid epidemic is an ongoing concern in the United States and efforts to ameliorate this crisis are underway on multiple fronts. Opiate use is an important consideration for patients undergoing lumbar spine surgery with concurrent psychiatric diagnoses and more information is needed regarding the factors involved in these patients. That information may help guide opioid prescribing practices for individual patients with certain psychiatric conditions that are undergoing these procedures. This study was done to identify psychiatric conditions that are associated with preoperative and postoperative opioid use in this cohort of veteran patients undergoing elective lumbar spine surgery.A 3 month preoperative and 3 month postoperative chart review was conducted on 25 patients per year who underwent elective lumbar spine surgery over a 16-year period at the Veterans Affairs Nebraska-Western Iowa Healthcare Center (n = 376 after exclusion criteria applied). The association between psychiatric comorbidities and use of opioids during the 90-day period after surgery was assessed using a linear model that adjusted for surgical type, opioid use prior to surgery, and other relevant comorbidities.Patients are more likely to use opioids preoperatively if they have major depression (P = .02), hepatitis C (P = .01), or musculoskeletal disorders (P = .04). PTSD (P = .02) and lumbar fusion surgery (P < .0001) are associated with increased postoperative use, after adjusting for preoperative use and other comorbidities.Certain psychiatric comorbidities are significantly correlated with opioid use for this cohort of lumbar spine surgery patients in the preoperative and postoperative periods. Awareness of an individual's psychiatric comorbidity burden may help guide opioid prescription use.