Exploring the Relationship between Childhood Trauma and Adult Opioid Use: A Systematic Review of the Literature

BACKGROUND AND PURPOSE: Numerous scholars, policymakers, and practitioners are calling for responses to the opioid epidemic that address histories of childhood trauma (CTFIPP, 2017). Childhood trauma has been correlated with opioid use, misuse, and opioid use disorders (Quinn et al., 2016). To date no systematic literature review evaluates the literature linking childhood trauma to later opioid use, misuse, or opioid disorders. Thus, this review will begin to fill this gap. The purpose of this systematic review is to: (1) identify studies that link childhood trauma to adult opioid misuse; (2) examine the approaches used to measure child maltreatment; and (3) assess the methods used in these studies.

Opioids are a class of drugs that lessen pain signals’ intensity by activating opioid receptor proteins in the body and the brain (NIDA, 2016a). Childhood trauma may involve social processes that are tantamount to the emotional pain experienced when someone is rejected, excluded, or receives negative feedback (van Harmelen et al., 2014). Furthermore, several studies have found that having a history of childhood trauma may increase the risk of experiencing chronic pain, which can contribute to opioid misuse (Burke et al., 2017).

METHODS: Search strategies and inclusion criteria were specified in advance using the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The literature search was conducted from May 17, 2018 through June 30, 2018 in the following bibliographic databases: CINAHL Plus, PsychINFO, and PubMed. We used the following search string without limits to conduct nested searching: ("child maltreatment" OR "child abuse" OR "child abuse and neglect" OR “child neglect” OR "supervisory neglect" OR "physical neglect" OR "general neglect" OR “physical abuse” OR “psychological abuse” OR “emotional abuse” OR "emotional neglect" OR “sexual abuse" OR "multiple types of abuse" OR "multiple types of maltreatment" OR polyvictimization OR polyvictim OR "childhood trauma") AND ("opioid use" OR "opioid misuse" OR "opioid use disorder" OR "opioid abuse" OR "opioid dependence" OR "opiate misuse" OR "opiate use" OR  "opiate abuse" OR "opiate dependence" OR "heroin use" OR "heroin abuse" OR "heroin dependence"). Since the language to describe childhood maltreatment has changed over time, we used a snowballing procedure to locate articles not found in the databases. Our review included empirical studies of adults (18+), published in peer-reviewed academic journals. We excluded articles that did not focus exclusively on opioid related outcomes.

RESULTS: The search yielded 51 relevant records in CINAHL Plus, 101 PsychINFO, and 130 in PubMed. After removing 144 duplicates, this review included 31 empirical studies comprised of three quasi-experimental, nine longitudinal, 17 cross-sectional, and three case-control designs with sample sizes ranging from 30 to 34,653 participants. Key findings include 31% (n=10) of the studies indicated relationships between three or more categories of child maltreatment and opioid use disorders including prescription opioids and heroin. The relationship between sexual abuse and opioid use disorder was consistently reported across 90% (n=9) of these studies.

CONCLUSIONS AND IMPLICATIONS: This review’s findings underscore childhood trauma’s enduring effects.  These traumatic experiences need to be addressed in opioid treatment programs.