Opioid Misuse among Smokers with Chronic Pain: Relations with Substance Use and Mental Health

Michael J. Zvolensky, Andrew H. Rogers, Lorra Garey, Justin M. Shepherd, Joseph W. Ditre

Research output: Contribution to journalArticlepeer-review


Opioid misuse is a significant public health concern with substantial medical, social, and economic costs. Cross cutting the personal and societal effects of this current crisis, opioid misuse is associated with poorer physical and mental health outcomes that impair function across numerous life domains. Importantly, opioid misuse disproportionately affects persons with chronic pain and individuals who smoke tobacco. Despite the higher risk for smokers with chronic pain to engage in opioid misuse, little work has examined how opioid misuse may be related to mental health problems, including other substance use, among this vulnerable group. The current study examined opioid misuse as a predictor of substance use and mental health problems among 187 (Mage = 39.02, SD = 9.94, 74.9% female) daily cigarette smokers with chronic pain who currently use opioids. Results indicated that opioid misuse is associated with greater tobacco (13% of variance), alcohol (27% of variance), and cannabis (22% of variance) problems, as well as anxiety (26% of variance) and depressive symptoms (26% of variance). These results highlight the potential importance of opioid misuse in terms of concurrent substance and mental health problems among smokers with chronic pain. Future work is needed to explicate directionality and temporal ordering in the observed relations.

Original languageEnglish (US)
Pages (from-to)335-343
Number of pages9
JournalBehavioral Medicine
Issue number4
StatePublished - 2021


  • Alcohol
  • anxiety
  • depression
  • opioid
  • smoking

ASJC Scopus subject areas

  • Applied Psychology
  • Psychiatry and Mental health


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