Opioid use disorder is a growing public health concern in the United States with high prevalence, morbidity, and mortality (1-3). The Centers for Disease Control (CDC) estimated there have been more than 500,000 opioid overdose deaths in the United States over the past two decades (4). Nationally, fatal opioid overdoses reached an all-time high in the United States in 2022, with more than 80,000 opioid-related overdose death reported (5). Whereas opioid use is emerging as an epidemic, the United States has faced a chronic struggle with interpersonal trauma, which include sexual and physical violence. Sexual violence encompasses forcing or attempting to force a person to engage in sexual activity or touching and physical violence involves hurting, attempting to hurt, or threatening to hurt another person by use of physical force or weapons (6). In the United States, both physical and sexual violence is highly prevalent. For example, in their lifetimes, 23.1% of women and 19.3% of men experienced physical violence (7), 19.3% of women and 1.7% of men have been raped, and 43.9% of women and 23.4% of men experienced other forms of sexual violence such as unwanted sexual contact (6).
These two public health concerns, namely opioid use and interpersonal trauma, are interrelated and bidirectional in nature. Prior research has highlighted the role of interpersonal trauma in contributing to problematic opioid use outcomes, including opioid use disorder and opioid overdose (8-10). This can be explained by the self-medication model which posits that individuals with a history of interpersonal trauma may use opioids to cope with trauma-related psychological distress [e.g., posttraumatic stress disorder (PTSD)], physical pain and injuries, and psychosomatic symptoms (e.g., headaches, backpains), which increases their risk for developing opioid use disorder (11-15). Opioid use also increases the risk of experiencing interpersonal trauma (16-21). Contextual factors such as the decreased ability to assess risk when impaired by drugs, dependence on sexual partners for drug supply, coercion from an abusive partner to use drugs, and being forced to have sex in exchange for drugs or money, have all shown an increased risk for interpersonal trauma (18, 22-25). Notably, the co-occurrence of opioid use and interpersonal trauma is marked by worsened clinical consequences associated with opioid use (e.g., exacerbations of psychological distress, increased opioid use), increased social consequences (e.g., legal, financial, and/or family problems), and poorer opioid use disorder treatment outcomes (e.g., higher rates of treatment drop out, more missed treatment appointments) (26-33).
Whereas extant research provides robust evidence for the relationship between opioid use and interpersonal trauma, there is an important gap. Namely, prior studies tended to limit their investigation to a single type of interpersonal trauma [e.g., only sexual violence (11, 18, 33, 34)]. When studies have examined multiple types of interpersonal trauma, they combined different types of interpersonal violence (such as sexual violence and physical violence) in a single composite variable (35-37). This limits insight into whether different types of interpersonal trauma are differently related to consequences associated with opioid use. Nascent research has begun investigating the role of different types of trauma in the development and maintenance of opioid use disorder. For example, one study examined the impact of different types of interpersonal violence (i.e., intimate partner violence, sexual assault, and adverse childhood experiences) on problematic opioid use and found that only intimate partner violence and adverse childhood experiences were related to problematic opioid use (38). Two studies examined the pathways from childhood abuse to lifetime problematic opioid use among women and found that only sexual abuse—but not physical abuse, emotional abuse, or neglect—was associated with problematic opioid use (39, 40). These findings underscore the need for further investigation into the potentially differential impact of distinct types of interpersonal trauma.
Present Study
Opioid use and interpersonal trauma co-occur at high rates (9, 11) and leads to worse outcomes (26, 27, 30, 33). Prior investigation into the impact of interpersonal trauma among individuals who use opioids is limited by examination of single types of trauma (11, 33) or by combining different types of trauma into a single composite variable (38), which limits our understanding of the potentially unique impact of different types of trauma. Robust evidence indicates that a history of sexual violence, compared to other interpersonal trauma types, leads to worse outcomes (41, 42). For example, seminal studies have found that survivors of sexual violence endorse higher levels of PTSD symptoms compared to survivors of combat trauma (43-45), motor vehicle accident (46), and even physical violence (41, 42). Thus, one may expect that sexual violence, in particular, would be associated with severe consequences of opioid use as well. Thus, the current study investigated consequences associated with opioid use based on participant’s history of interpersonal trauma, specifically physical and sexual violence. It was hypothesized as follows:
Hypothesis 1. Individuals with a history of physical violence would report significantly more consequences of opioid use, compared to those without a history of physical violence.
Hypothesis 2. Individuals with a history of sexual violence would report significantly more consequences of opioid use, compared to those without a history of sexual violence.