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Associations Between Physical Pain, Pain Management, and Frequency of Nonmedical Prescription Opioid Use Among Young Adults: A Sex-specific Analysis

Evans, Tristan I. ME; Liebling, Elliott J. BA; Green, Traci C. PhD, MSc; Hadland, Scott E. MD, MPH; Clark, Melissa A. PhD; Marshall, Brandon D.L. PhD

doi: 10.1097/ADM.0000000000000318
Original Research

Objectives: We sought to determine sex-specific associations between experiences of physical pain, pain management, and frequency of nonmedical prescription opioid (NMPO) use among young adults.

Methods: Among participants enrolled in the Rhode Island Young Adult Prescription Drug Study, we identified associations between physical pain in the past 6 months, pain history, pain management, polysubstance use, and weekly NMPO use. In sex-specific models, independent correlates of weekly NMPO use were identified via modified stepwise Poisson regression.

Results: Of 199 participants, the mean age was 24.6, and 65.3% were male. The racial composition was 16.6% black, 60.8% white, and 22.1% mixed or other race. A total of 119 (59.8%) participants reported weekly or greater NMPO use. The majority of male (86.2%) and female (84.1%) participants reported ever experiencing severe pain. A majority of males (72.3%) and females (81.2%) reported that they engaged in NMPO use to treat their physical pain, and one-quarter (26.9%) of males and one-third (36.2%) of females had been denied a prescription from a doctor to treat severe pain. Among males, frequent NMPO use was independently associated with white race (P < 0.001) and reporting greater physical pain (P = 0.002). Among females, older age (P = 0.002) and monthly or greater nonmedical benzodiazepine use (P = 0.001) were independently associated with weekly NMPO use.

Conclusions: Among young men in Rhode Island, physical pain may be related to frequent NMPO use. More research is needed to identify sex-specific, pain-related factors that are linked with NMPO use to improve harm reduction and pain management interventions.

Department of Epidemiology, Brown University School of Public Health, Providence (TIE, EJL, TCG, MAC, BDLM); Boston University School of Medicine, Department of Emergency Medicine, Boston, MA (TCG); Department of Emergency Medicine, The Warren Alpert School of Medicine of Brown University, Rhode Island Hospital, Providence, RI (TCG); Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine, Boston, MA (SEH); Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, Boston, MA (SEH); Department of Pediatrics, Harvard Medical School, Boston, MA (SEH); and Department of Quantitative Health Sciences & Center for Health Policy and Research, University of Massachusetts Medical School, Worcester, MA (MAC).

Send correspondence to Brandon D.L. Marshall, PhD, Manning Assistant Professor of Epidemiology, Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Box G-S-121-2, Providence, RI 02912. E-mail:

Received 20 October, 2016

Accepted 3 February, 2017

Funding: The RAPiDS project is supported by the US National Institute on Drug Abuse (R03-DA037770)

Financial disclosures: B.D.L.M. is supported by a Henry Merrit Wriston Fellowship from Brown University. The authors report no conflicts of interest.

© 2017 American Society of Addiction Medicine