Adverse childhood experience subtypes and lifetime prescription opioid misuse among U.S. Adolescents: findings from the 2023 youth risk behavior survey

Background: Although adverse childhood experiences (ACEs) are associated with substance use, less is known about which ACE subtypes are independently associated with adolescent prescription opioid misuse.Objective: To examine associations between ACE subtypes and lifetime prescription opioid misuse among adolescents in the United States.Methods: Data were drawn from the 2023 Youth Risk Behavior Survey, a nationally representative sample of U.S. high school students. The analytic sample included 19,928 adolescents aged 14–18 years (48.2% female). Lifetime prescription opioid misuse was assessed as misuse of prescription pain medication at least once. Multivariable logistic regression examined the association between nine ACE subtypes and prescription opioid misuse while adjusting for demographic characteristics, psychosocial vulnerabilities, and protective factors.Results: Overall, 11.3% reported lifetime prescription opioid misuse. In the fully adjusted model, neighborhood violence (AOR = 1.67, 95% CI = 1.41–1.99) sexual abuse (AOR = 1.41, 95% CI = 1.10–1.82), physical neglect (AOR = 1.37, 95% CI = 1.04–1.81), and household substance use (AOR = 1.24, 95% CI = 1.04–1.47) were associated with higher odds of prescription opioid misuse. School bullying (AOR = 1.27, 95% CI = 1.04–1.55), cyberbullying (AOR = 1.57, 95% CI = 1.29–1.91), and persistent sadness or hopelessness (AOR = 1.87, 95% CI = 1.52–2.31) were also associated with higher odds. High parental monitoring was associated with lower odds (AOR = 0.66, 95% CI = 0.53–0.82).Conclusions: Neighborhood violence had the largest adjusted odds ratio among the ACE subtypes examined. Sexual abuse, physical neglect, and household substance use were also associated with lifetime prescription opioid misuse. These findings highlight specific forms of adversity to consider when identifying adolescents who may benefit from prevention and support.