Comorbidity of Lifetime History of Abuse and Trauma With Opioid Use Disorder: Implications for Nursing Assessment and Care

Abstract

Background: Opioid use disorder (OUD) is a public health crisis and is challenging to treat. Previous research has shown correlations between OUD, abuse/trauma, and chronic pain. Aims: The purpose of this study was to investigate history of lifetime sexual, physical, and/or emotional abuse among participants in a medication-assisted treatment (MAT) program for OUD, and to investigate associations between abuse history and chronic pain. Methods: This is a secondary analysis of intake data from a 2-year, nonexperimental cohort treatment program of patients with OUD in rural Colorado. De-identified data were provided by 476 adult MAT patients using the Adult Addiction Severity Index (ASI-6). The ASI-6 includes three yes/no questions about history of abuse (emotional, physical, and sexual), with separate scoring for “past 30 days” and “lifetime” abuse. Results: Lifetime history among MAT program for OUD patients was 23% for sexual abuse, 43% for physical abuse, and 58% for emotional abuse. History of physical abuse was significantly associated with having a chronic pain diagnosis, χ2 = 4.49, p = .03, and also with higher reported pain levels, t(460) = 2.71, p = .007. Conclusion: Lifetime history of physical abuse was associated with OUD and chronic pain, yet standard pain assessments do not assess these factors. In health care settings, the implementation of standardized trauma-informed screening tools, prompt recognition of abuse/trauma history, and adjunct psychological interventions may reduce stigma, reduce opioid use escalation, and help patients overcome OUD.

Clinician commentary on adapting psychotherapy in collaborative care for treating opioid use disorder and co-occurring psychiatric conditions in primary care.

“…Our primary concern about the proposed treatment pathway is the lack of an explicit effort to measure and address physical and psychological trauma. Patients with OUD entering treatment, particularly low-threshold treatment settings, often live in dangerous environments that can be traumatizing (Driscoll Powers et al, 2022). Sexual violence and coercion are common and often ongoing.…”

Trauma Exposure Across the Lifespan among Individuals Engaged in Treatment with Medication for Opioid Use Disorder: Differences by Gender, PTSD Status, and Chronic Pain

“…Studies specific to examining trauma among those treated with MOUD have been relatively limited in scope and/or small in sample size. For example, one study (N = 919) examined interpersonal trauma only (physical, sexual, or emotional abuse) and found that 23% reported sexual abuse, 43% physical abuse, and 58% emotional abuse and that there were no differences by gender on any of these categories ( 12 ). Unfortunately, this study by Powers did not distinguish whether the traumatic events occurred in childhood or as adults.…”