Discrimination, depressive symptoms, and prescription opioid misuse among adults with chronic pain who engage in hazardous drinking

Background: Prescription opioid misuse (i.e. use without a prescription or in ways other than prescribed) is a significant health concern among individuals with chronic pain. Hazardous alcohol use (i.e. drinking that increases risk of negative consequences) is common among individuals with pain, including among those who are prescribed opioids. Everyday discrimination, which is characterized by interpersonal experiences of identity-based harassment, has been independently linked to both depressive symptoms and prescription opioid misuse. Although promising as a potentially modifiable intervention target, the mediating role of depressive symptoms in associations between everyday discrimination and prescription opioid misuse remain largely unexplored. Further, it is important to identify factors associated with prescription opioid misuse among individuals with chronic pain who engage in hazardous alcohol use, as both are positively associated with prescription opioid misuse.Objectives: To examine indirect associations between everyday discrimination and prescription opioid misuse via depressive symptoms among adults with chronic pain who engage in hazardous drinking.Methods: Participants included 150 adults with pain (35.7% Black/African American; 59.7% female; Mage = 44.27) who were prescribed opioids and drank hazardously.Results: A process model revealed that depressive symptoms acted as mediator of associationsbetween everyday discrimination and prescription opioid misuse (b = 0.26, bootstrapped 95% CI [0.15, 0.39]). Specifically, everyday discrimination was associated with greater depressive symptoms, which in turn was associated with greater prescription opioid misuse.Conclusion: These findings suggest that providers should screen for depressive symptoms in the context of prescription opioid misuse, particularly among individuals who experience discrimination.