Adverse childhood experience effects on opioid use initiation, injection drug use, and overdose among persons with opioid use disorder
Open accessAbstract
Introduction Adverse childhood experiences are associated with the development of substance use disorders. With opioid use disorder, a growing concern in the United States, we were interested in examining the relationship between adverse experiences and three landmarks of opioid use: age of opioid initiation, injection drug use, and lifetime overdose. Methods Between May and December 2015, we interviewed consecutive persons seeking inpatient opioid detoxification. Participants were asked about age of opioid initiation, last month injection drug use, and lifetime history of overdose, and completed the ten-item Adverse Childhood Experience (ACE) questionnaire. Results Participants (n=457) averaged 32.2 (± 8.64) years of age, 71.3% were male, and 82.5% were non-Hispanic White. The mean score on the ACE scale was 3.64 (± 2.75). Mean age at time of initiating opioid use was 21.7 (± 7.1) years, 68.7% had injected drugs within the past month, and 39.0% had overdosed. After adjusting for age, gender, and ethnicity, the ACE score was inversely associated with age of initiating opioid use (b = −0.50, 95% CI −0.70; −0.29, p < .001), and positively associated with recent injection drug use (OR = 1.11, 95% CI 1.02; 1.20, p = .014) and the likelihood of experiencing an overdose (OR = 1.10, 95% CI 1.02; 1.20, p = .015) in a graded dose response manner. Conclusion Greater adverse childhood experiences are associated with three landmarks of opioid use risk. ACE screening may be useful in identifying high-risk subsets of opioid-using populations.
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People in treatment for an addiction have a higher prevalence of ACEs than the general population.
“In fact, people in treatment for an addiction have a higher prevalence of ACEs than the general population.”
From Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review (2021) · cites this paper as Stein et al., 2017
The Discussion reports that people with opioid use disorder entering a detoxification program had substantially higher ACE scores than those in general-population studies; nearly half had four or more ACEs, versus 15.5% in one community-based study. This supports the comparison for the study sample, but not the broader claim about people in treatment for any addiction. (LLM, conf=0.87)
Experimental — accuracy not yet measuredTwo of the included studies reported a positive relation between the presence of SUD and an earlier onset of substance use.
“Two studies reported a positive relation between the presence of SUD with an earlier onset of substance use (Gomez et al., 2018;Stein et al., 2017).”
From Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review (2021) · cites this paper as Stein et al., 2017
The Introduction (page unavailable) states that people who initiate drug use earlier are more likely to develop drug dependence problems, supporting the general association. But the Methods and Results (page unavailable) show that Stein et al. studied the association between adverse childhood experiences and age of opioid initiation among people with opioid use disorder; they did not compare onset ages by the presence or absence of SUD. (LLM, conf=0.85)
Experimental — accuracy not yet measuredAmong patients with addiction problems, the rates of having suffered at least one ACE range from 85.4% to 100%.
“Among patients with addiction problems, the rates of having suffered at least one ACE ranges from 85.4% to 100% (Chandler et al., 2018;Philogene-Khalid et al., 2020;Stein et al., 2017).”
From Adverse childhood experiences (ACEs) and substance use disorder (SUD): A scoping review (2021) · cites this paper as Stein et al., 2017
People with OUD have high rates of childhood abuse and psychological trauma and may be especially prone to dropout.
“People with OUD have high rates of childhood abuse and psychological trauma, and may be particularly susceptible to dropout (Ecker & Hundt, 2018; Stein et al., 2017).”
From Feasibility and acceptability of mindful recovery opioid use care continuum (M-ROCC): A concurrent mixed methods study (2021) · cites this paper as Stein et al., 2017
Adverse childhood experiences are linked to the initiation of opioid use.
“Strong links between ACEs and the initiation of opioid use have been described (72, 73).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [73]
Adverse childhood experiences are linked to age of opioid initiation, intravenous use of the drug, and lifetime overdose in a graded, dose-response manner.
“ACEs have been linked to age of opioid initiation, intravenous use of the drug, and lifetime overdose in a graded, dose-response manner (73).”
From A Biopsychosocial Overview of the Opioid Crisis: Considering Nutrition and Gastrointestinal Health (2019) · cites this paper as [73]
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- Authors
- Stein, M. D., Conti, M. T., Kenney, S., Anderson, B. J., Flori, J. N., Risi, M. M., & Bailey, G. L.
- Affiliations
- Boston University (US)
- Butler Hospital (US)
- Brown University (US)
- Corresponding author
- Stein, Michael D.
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2017-10
- Volume
- 179
- Pages
- 325-329
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC5599365
- OpenAlex
- W2742757430
- Semantic Scholar
- d1999fa4007c04047b41c3b1a380296da21681bf
- Cited by
- 206
- References
- 47
- Citations by year
- 2026: 15 · 2025: 22 · 2024: 25 · 2023: 27 · 2022: 32 · 2021: 33 · 2020: 29 · 2019: 15 · 2018: 6 · 2016: 1
- FWCI
- 12.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Drug and Alcohol Dependence (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (Clinical Trial # NCT01751789, RO1 DA034261, NCT01751789)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Keywords
- adverse childhood experiences, opioid use disorder, intravenous drug use, opioid overdose, opioid detoxification, ACE screening, dose-response relationship, childhood trauma
- MeSH terms
- Analgesics, Opioid, Humans, Inpatients, Life Change Events, Opioid-Related Disorders, United States, Substance Abuse, Intravenous, Young Adult, Drug Overdose
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