Self-Medicating Social Pain? Bullying, Suicidality, and Opioid-Specific Risk in US Adolescents
5 affiliations
- 1Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
- 2Comprehensive Center for Pain & Addiction, University of Arizona, Tucson, Arizona
- 3Harm Reduction Research Lab, College of Nursing, University of Arizona, Tucson, Arizona
- 4Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona, Tucson, Arizona
- 5Department of Pharmacology, College of Medicine-Tucson, University of Arizona, Tucson, Arizona
Abstract
OBJECTIVE:: Many adversities predict adolescent substance use, but it is unknown which produce opioid-specific risk vs general substance use liability. We tested whether bullying, suicidality, polysubstance use, risk behavior, sexual victimization, household adversity, and community safety adversity show opioid-specific associations with nonmedical prescription opioid use (NMPOU).
METHODS:: Using 2023 Youth Risk Behavior Survey data (N = 20 103), survey-weighted logistic regressions modeled 7 composite predictors. Average marginal effects quantified probability-scale associations. A stacked-outcome test compared associations across 5 substances (NMPOU, alcohol, marijuana, cigarettes, cocaine). Karlson-Holm-Breen decomposition quantified polysubstance mediation.
RESULTS:: Predictor-substance associations differed significantly across substance types (P = .0075). Bullying was uniquely associated with NMPOU (3.8 percentage points [pp], 95% CI: 1.5 to 6; adjusted odds ratio [AOR] = 1.48, 95% CI: 1.18–1.86) and not with any other substance. Suicidality was associated with NMPOU (6.2 pp, 95% CI: 4.2 to 8.3; AOR = 1.89, 95% CI: 1.58–2.26) and marijuana but not alcohol, indicating partial opioid specificity. Polysubstance use had the largest overall association (6.3 pp, 95% CI: 4.1 to 8.5; AOR = 2.09, 95% CI: 1.63–2.66) but reflected general substance use liability. All 7 predictors were independently significant in the fully adjusted model (n = 9401).
CONCLUSION:: Bullying and suicidality are associated with opioid-specific hazard, indicating why certain adolescents turn to opioids, whereas polysubstance use, sexual victimization, household adversity, and community safety adversity reflect general substance use liability. Where bullying or suicidality is identified, targeted opioid prevention is warranted; where NMPOU is present, clinicians should screen for bullying victimization and unmet mental health needs.
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BibTeX
@article{morales2026selfmedicating,
title = {{Self-Medicating Social Pain? Bullying, Suicidality, and Opioid-Specific Risk in US Adolescents}},
author = {Mario Morales and Maeve E. Wallace and Beth E. Meyerson and Jennifer S. De La Rosa},
journal = {Pediatrics open science},
year = {2026},
month = jul,
doi = {10.1542/pedsos.2026-001614},
url = {https://doi.org/10.1542/pedsos.2026-001614},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Self-Medicating Social Pain? Bullying, Suicidality, and Opioid-Specific Risk in US Adolescents
AU - Mario Morales
AU - Maeve E. Wallace
AU - Beth E. Meyerson
AU - Jennifer S. De La Rosa
PY - 2026
DA - 2026/07/24
JO - Pediatrics open science
DO - 10.1542/pedsos.2026-001614
UR - https://doi.org/10.1542/pedsos.2026-001614
AB - OBJECTIVE:: Many adversities predict adolescent substance use, but it is unknown which produce opioid-specific risk vs general substance use liability. We tested whether bullying, suicidality, polysubstance use, risk behavior, sexual victimization, household adversity, and community safety adversity show opioid-specific associations with nonmedical prescription opioid use (NMPOU). METHODS:: Using 2023 Youth Risk Behavior Survey data (N = 20 103), survey-weighted logistic regressions modeled 7 composite predictors. Average marginal effects quantified probability-scale associations. A stacked-outcome test compared associations across 5 substances (NMPOU, alcohol, marijuana, cigarettes, cocaine). Karlson-Holm-Breen decomposition quantified polysubstance mediation. RESULTS:: Predictor-substance associations differed significantly across substance types (P = .0075). Bullying was uniquely associated with NMPOU (3.8 percentage points [pp], 95% CI: 1.5 to 6; adjusted odds ratio [AOR] = 1.48, 95% CI: 1.18–1.86) and not with any other substance. Suicidality was associated with NMPOU (6.2 pp, 95% CI: 4.2 to 8.3; AOR = 1.89, 95% CI: 1.58–2.26) and marijuana but not alcohol, indicating partial opioid specificity. Polysubstance use had the largest overall association (6.3 pp, 95% CI: 4.1 to 8.5; AOR = 2.09, 95% CI: 1.63–2.66) but reflected general substance use liability. All 7 predictors were independently significant in the fully adjusted model (n = 9401). CONCLUSION:: Bullying and suicidality are associated with opioid-specific hazard, indicating why certain adolescents turn to opioids, whereas polysubstance use, sexual victimization, household adversity, and community safety adversity reflect general substance use liability. Where bullying or suicidality is identified, targeted opioid prevention is warranted; where NMPOU is present, clinicians should screen for bullying victimization and unmet mental health needs.
SN - 3066-2761
ER -