Posttraumatic stress symptoms have been associated with opioid misuse and dependence among adults with chronic pain. Lower levels of perceived distress tolerance (i.e., perceived ability to withstand negative emotional states) have been independently associated with posttraumatic stress symptoms and opioid-related problems among nonchronic pain samples. However, there has not been a test of whether distress tolerance interacts with posttraumatic stress in terms of opioid misuse among trauma-exposed persons with chronic pain. Therefore, the present study examined the interaction between distress tolerance and posttraumatic stress symptoms in relation to opioid misuse and dependence among trauma-exposed adults with chronic pain who were using opioids (N = 289; 70.9% female, Mage = 37.75, SD = 10.83). Results indicated a significant negative interaction of distress tolerance with posttraumatic stress in terms of opioid misuse and dependence, as the relationship between posttraumatic stress symptoms and opioid misuse and dependence was diminished at higher levels of distress tolerance. The current findings help refine our understanding of the subgroups of persons with chronic pain distinguished by low distress tolerance and at the greatest risk for misusing opioids. Furthermore, current models of chronic pain and opioid misuse could be refined by integrating distress tolerance. These findings may help inform interventions for trauma-exposed persons with chronic pain who use opioids. (PsycInfo Database Record (c) 2023 APA, all rights reserved).