Impact of Emotional Distress on Prescription Opioid Abuse in a Rural Juvenile Drug Court Sample

Background: Ohio is at the epicenter of the opioid epidemic, and the current crisis disproportionately burdens rural areas. The Self-Medication Hypothesis and work examining adverse childhood experiences posit that drug use may be understood as a coping strategy to address emotional distress.Methods: Juvenile drug court participants in a Northwest Ohio county were administered a standardized biopsychosocial assessment. Intake interviews from January 2010 and November 2018 were used to evaluate the relationship between emotional distress reported using the Emotional Problem Scale (EPS) and lifetime nonmedical use of prescription opioids. Linear regression was used to examine temporal trends in EPS scores. Logistic regression was used to examine the relationship between EPS scores and prescription opioid misuse, controlling for temporal trends.Results: Linear regression showed a significant increase in emotional distress over the study period for both pre-scription opioid users and nonusers. Average scores increased 29.5 points (on a 100 point scale) over the duration of the study (P <0.0001). A 10-point increase in EPS score was associated with a nearly 50% increase in the lifetime odds of pre-scription opioid misuse (OR = 1.46, 95% CI: 1.19-1.82, P = 0.0004). The odds of prescription opioid misuse declined each year (OR = 0.63, 95% CI: 0.48-0.81, P = 0.0006).Conclusion: Rates of prescription opioid misuse have decreased over time despite a significant association be-tween emotional distress and opioid misuse and trend toward increasing EPS scores. While efforts to reduce prescription opioid misuse appear to have been effective in this population, significant work is needed to reduce underlying risk fac-tors.