Perceived Discrimination and Problematic Opioid Use Among Black Individuals With Chronic Musculoskeletal Pain

Objective: Chronic musculoskeletal pain (CMP) is prevalent, burdensome, and associated with an increased risk for opioid use disorder. Evidence suggests that perceived racial/ethnic discrimination is associated with problematic substance use among Black individuals, but studies have not focused on problematic opioid use among Black individuals with CMP specifically or explored the contribution of perceived discrimination, pain intensity, and pain-relevant psychological factors to this association. Method: We recruited 401 Black individuals (M-age = 35.98, 51.9% female) with self-reported CMP and prescription opioid use. We tested whether perceived discrimination (a) was associated with self-reported problematic opioid use and (b) explained unique variance in this outcome after accounting for pain intensity, demographic factors, and psychological factors previously implicated in problematic opioid/substance use (distress tolerance and pain avoidance). Results: Hierarchical linear regression analysis revealed that our model as a whole explained significant variance in problematic opioid use, R-2 = .30, F(6, 394) = 28.66, p < .001. Perceived discrimination specifically was associated with more problematic opioid use (beta = .39, SE = .05, p < .001) and explained unique variance in this outcome even after accounting for pain intensity (beta = .06, SE = .04, p = .20), distress tolerance (beta = -.10, SE = .05, p = .04), pain avoidance (beta = .12, SE = .05, p = .02), age (beta = -.10, SE = .05, p < .05), and employment status (beta = .13, SE = .11, p < .01). Conclusions: Systemic efforts to combat racism along with individualized therapeutic approaches to process and cope with perceived racial discrimination may be particularly important to prevent and reduce problematic opioid use among Black individuals with CMP.