Examining the Direct and Mediated Associations Between Perceived Discrimination and Prescription Opioid Misuse Among Individuals with Chronic Pain.

OBJECTIVE

Experiences of discrimination, a notable psychosocial stressor, are considered an important risk factor for problematic opioid use. We examined whether pain severity, pain interference, anxiety, and depressive symptoms are pathways through which discrimination may be associated with increased prescription opioid misuse behaviors among individuals with chronic pain.

METHOD

A total of 234 participants who reported being prescribed opioids for chronic pain management were included from a parent longitudinal study collected from Amazon's MTurk. Study variables were collected at baseline and 12-month follow-up. Path analyses tested the hypothesized model, with socio-demographic variables and outcomes measured at baseline included as covariates. Mediated effects were examined using percentile bootstrap method.

RESULTS

After controlling for socio-demographic covariates, pain severity, pain interference, anxiety, and depressive symptoms, baseline discrimination was significantly associated with greater prescription opioid misuse behaviors (=.020) at 12 months. Baseline discrimination was also significantly associated with anxiety (<.001) and depressive symptoms (<.001) at 12 months. However, pain severity, pain interference, anxiety, and depressive symptoms were not significantly associated with prescription opioid misuse at 12 months. Mediation analyses indicated no significant effects.

CONCLUSIONS

Discrimination may play an important role in prescription opioid misuse behaviors among individuals with chronic pain. Furthermore, discrimination is a risk factor contributing to elevated anxiety and depressive symptoms, with broad clinical implications for individuals coping with chronic pain. However, pain severity, pain interference, anxiety and depressive symptoms did not emerge as underlying mechanisms that link discrimination and prescription opioid misuse. Replication and extension in future studies are warranted.