TAYLOR B. GOLDBERG, BS
Drexel University College of Medicine
SUMMARY POINTS
Over half of all children experience at least one adverse childhood experience.
At least 1.6 million Americans suffer from opioid use disorder.
Adverse childhood events are associated with increased misuse of prescription opioids.
Further investigation into the direct relationship between adverse childhood experiences and opioid use disorder should be conducted in order to implement early life intervention.
ANALYSIS
Background
Opioid use disorder (OUD) is a chronic disorder characterized by compulsive uncontrolled use of opioids despite physical and social harms. OUD is treatable; however, frequent relapses and high mortality are often associated with the disorder. 1.6 million Americans were reported to have OUD in 2019, making it a serious public health crisis (1). Living with OUD has considerable adverse effects including increased rates of infectious diseases, bacterial infections, and mood disorders. Deaths due to opioid overdoses also continue to rise with nearly 69,000 deaths in 2020 (1). Due to the significant adverse effects of opioid use disorder, risk factors for OUD should be thoroughly investigated with the intention of increased prevention. Adverse Childhood Experiences (ACEs) are potential risk factors that should be explored.
Adverse Childhood Experiences are potentially traumatic events that occur before the age of 18 and are linked to long-term negative health outcomes in adulthood (2). These events include experiencing violence or abuse, witnessing violence in the home, living with a parent with substance use or mental health problems, having a family member attempt or die by suicide, and living with instability due to parental separation or incarceration of a parent (3). 63% of adults report experiencing at least one ACE and 12% reported four or more exposures during childhood (2). This analysis will investigate the relationship between adverse childhood experiences and opioid use disorder.
Analysis
The direct relationship between adverse childhood experiences and increased risk factors for adult diseases such as ischemic heart disease, cancer, and liver disease is well understood. However, the connection between ACEs and opioid use disorder is less known.
The physical effects of toxic stress that lead to increased adult diseases can produce anxiety, anger, and depression in children (3). Anxiety can arise from failure to learn modulation of arousal. Children are born without this ability and rely on their caregivers to teach them how to modulate their level of arousal to different stimuli such as stress and fear (4). Adverse childhood experiences repeatedly expose a child to intense stress and can interrupt the learning of this skill. Adults that have not developed self-modulation may seek external sources for self-soothing. Substance use may provide a temporary relief from the disproportionate arousal when other coping skills are not developed (4). Additionally, high stress situations can teach a child to make rash decisions, without weighing their options, in order to evade an immediate threat. This learned reflexive thinking pattern can lead to poor judgment and poor impulse control (4).
The knowledge of childhood stress and the physical and psychological impact adverse childhood experiences have, make the connection to opioid use disorder easy to understand. One study analyzed the connection between adverse childhood experiences and prescription opioid misuse and found that people with more than one ACE had 2.8 times the odds of misusing prescription opioids (5). Additionally, researchers found that people with opioid use disorder reported high rates of trauma compared to those of the general population (5). Greater than 85% of patients suffering from addiction report at least one ACE and more than 65% report more than two (6,7).
Furthermore, ACEs have been linked to earlier age of opioid injection drug use (IDU) initiation (8). This is especially concerning as there is a greater likelihood of developing drug dependence when IDU is started at a young age. This association is graded, meaning an increased number of ACEs increases the likelihood someone will inject opioids at an earlier age (8).
Discussion
This analysis does have limitations. There is ample evidence to show ACEs are associated with substance use disorder, however, more specific studies analyzing opioid use disorder are lacking. Given the severity of the opioid crisis in the United States, further examination of associations between ACEs and OUD should be completed to understand the potential risk factors. Recognition of adverse childhood experiences as a risk factor for opioid use disorder may help in the prevention and treatment of OUD. The Center for Disease Control (CDC) has created a framework for preventing child abuse and neglect called Essentials for Childhood: Assuring safe, stable, nurturing relationships and environment for all children. This type of early childhood education and intervention may be an important step in reducing the accumulation of ACEs, and therefore future cases of OUD.
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