A Systematic Review of the Relationship between Childhood Trauma and Adolescent Opioid Use

BACKGROUND AND PURPOSE: Although studies have linked childhood trauma to adolescent opioid use (Johnson & Zaidi, 2022), no systematic review of the literature has explored the role childhood trauma plays in adolescent opioid use. Understanding how childhood trauma influences opioid use is important because opioids are responsible for approximately 90% of adolescent (14-18) overdose deaths and overdose deaths have been increasing since 2019 (Tanz et al. 2022).

This systematic review has 3 aims: (1) First, the review will identify studies that link childhood trauma to adolescent opioid misuse; (2) Second, the review will explore how childhood trauma is measured; and (3) Third, the review will assess the methods used.

METHODS: This systematic review is part of a series of systematic reviews exploring the relationship between childhood trauma and opioid use over different stages of development. 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 originally conducted from May 17, 2018, through June 30, 2018, and updated through May 2023 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"). Our review included empirical studies of adults (18+), published in peer-reviewed academic journals, and excluded studies that did not provide opioid related outcomes, and those written in languages other than English.

RESULTS: The search yielded 432 relevant records (81 CINAHL Plus, 101 PsychINFO, 249 PubMed, and 1 source derived from a snowballing procedure of reviewing the references of the included articles). After removing 158 duplicates and excluding 268 studies, 22 titles were reviewed, and 3 relevant articles were included in the review. Two studies used samples of high school students in China (Guo et al., 2017, n=23,039: Yiling et al., 2018, n=10,94), while the third included 79,960 youth involved in Florida’s juvenile justice system between 2007 and 2015 (Johnson & Zaidi, 2022). The Chinese studies measured childhood trauma with the Child Trauma Questionnaire Short-Form in Chinese, while the U.S study used the Positive Achievement Change Tool. In each study, physical and/or sexual abuse increased the odds of opioid misuse. Physical and/or sexual abuse increased the odds of opioid misuse. Gender differences were evident in each of the studies, with girls being more affected by childhood trauma than boys.

CONCLUSIONS: More studies are needed to understand the effects of multiple forms of childhood trauma. Substance use treatment programs need to address childhood trauma.