Adverse Effects of Non-Medical Use of Cannabis or Opioids Associated with Adverse Childhood Experiences

Non-medical use of cannabis (NmC) and/or opioids (NmO) can lead to adverse health effects (AHEs), yet the proportion of these harms attributable to adverse childhood experiences (ACEs) remains unclear. This study estimated the contribution of ACEs to AHEs from NmC and/or NmO among adults aged ≥18 years using 2019-2020 Behavioral Risk Factor Surveillance System data from Arizona and Massachusetts. We conducted a retrospective cohort analysis of 24,739 respondents, linking past ACE exposure to self-reported NmC/NmO/NmC&NmO and related AHEs. Generalized linear models with a log link and binomial distribution adjusted for socio-demographic, healthcare access, and geographic factors were used to estimate associations and population-attributable fractions (PAFs). Propensity score methods matched respondents with and without ACEs on demographic and location characteristics. Among all the adults, 17.9% reported NmC, 5.8% reported NmO, and 2.4% reported NmC&NmO; among users of NmC/NmO/NmC&NmO, 5.0%/13.2%/36.0% reported AHEs. Among the respondents reporting AHEs from non-medical substance use, exposure to ≥2 ACEs was common (NmC: 89%; NmO: 82%; NmC&NmO: 84%). Compared to adults without ACEs, those with ≥2 ACEs had a higher likelihood of AHEs for NmC (adjusted relative risk [aRR] = 3.54, 95% CI: 1.65-7.59) and NmO (aRR = 3.64, 95% CI: 1.99-6.66) but not NmC&NmO (aRR: 1.86, 95% CI: 0.84-4.09). PAFs indicated that 63% (NmC) to 64% (NmO) of AHEs among the adults reporting NmC or NmO were attributable to ≥2 ACEs. Preventing childhood adversity may substantially reduce substance-related harms in adulthood.