Association of childhood abuse and neglect with prescription opioid misuse: Examination of mediation by adolescent depressive symptoms and pain

Previous research has demonstrated an association between childhood abuse and neglect and prescription opioid misuse in adulthood. However, potential mechanisms underlying this association remain unclear. Based on the self-medication hypothesis and the existing research literature, we hypothesized that pain and depressive symptoms would mediate this association. Data were from Waves I (1994-1995) and III (2002) of the National Longitudinal Study of Adolescent to Adult Health (Add Health; N = 14,322). We conducted structural equation modeling to examine the association of childhood abuse and neglect with prescription opioid misuse in early adulthood and to assess for mediation by depressive symptoms and pain in adolescence. One in five respondents (20.1%) reported prescription opioid misuse in early adulthood. Childhood abuse and neglect was directly associated with an increase in the predicted probability of prescription opioid misuse (β = 0.232, p < 0.001). Pain, but not depressive symptoms, in adolescence was a significant mediator of this association (β = 0.019, p < 0.001). Pain may represent a complex stress-related response to early trauma among adolescents and may contribute to subsequent prescription opioid misuse as a coping mechanism. Results highlight the need to promote positive coping skills among adolescents who have experienced childhood abuse and neglect and underscore the importance of trauma-informed treatment services for individuals misusing prescription opioids.