The relationships of childhood trauma and adulthood prescription pain reliever misuse and injection drug use

•Prevalence of prescription pain reliever misuse was 28% by adulthood.•Injection drug use prevalence was 1.24% by emerging adulthood.•28% reported at least one of nine traumatic events before age 18.•Increasing number of childhood traumas is associated with drug misuse in adulthood.

BackgroundWe examined associations between childhood trauma and adulthood prescription pain reliever misuse (PPRM) and injection drug use (IDU) in a nationally-representative U.S. sample to further understanding of factors associated with these epidemics.MethodsNational Longitudinal Study of Adolescent to Adult Health data (N = 12,288) yielded nine childhood traumas: neglect; emotional, physical, sexual abuse; parental incarceration and binge drinking; witnessed, threatened with, and experienced violence. We estimated adjusted odds ratios (AOR) and 95% confidence intervals for the association of each trauma and cumulative trauma and drug initiation in emerging and later adulthood.ResultsOutcome prevalences were 20% (PPRM) and 1% (IDU) in emerging adulthood and 10% PPRM in adulthood. We observed dose-response relationships that varied across outcomes. Cumulative trauma (referent = none) was associated with 34–79% greater odds of PPRM (emerging adulthood) across one to five+ trauma categories. The gradient was most consistent and associations strongest for adulthood PPRM: one trauma AOR = 1.46(1.12, 1.91); two AOR = 1.71(1.23, 2.36); three AOR = 2.16(1.43, 2.36); four AOR = 2.70(1.42, 5.62); five+ AOR = 3.09(1.52, 6.30). Dose-response was less consistent for IDU, but 4 and 5+ traumas were associated with approximately seven and five times the odds of IDU. Neglect, emotional abuse, and parental incarceration and binge drinking were associated with 25–55% increased odds of PPRM. Sexual abuse and witnessed violence were associated with nearly 3 and 5 times the odds of IDU.ConclusionsAssociations between childhood trauma and PPRM/IDU highlight the need for trauma-informed interventions for drug users and early trauma screening and treatment for prevention of drug misuse over the life course.