Substance Use Coercion, Opioids, and Domestic Violence

Being abused by an intimate partner increases a person’s risk for opioid use, thus a significant proportion of people accessing opioid use disorder treatment programs have experienced domestic and sexual violence (DSV).

While abuse, trauma, and violence across the lifespan play a key role in people’s use of opioids, there has been little attention paid to the role of DSV and substance use coercion in people’s opioid use, opioid-related medical complications, and opioid-related deaths—issues that are critical to consider in developing strategies to address the opioid epidemic.

Survivors who use opioids encounter a unique constellation of risks that directly threaten their physical safety and well-being. For example, it is not uncommon for abusive partners to introduce a partner to opioids, control their supply, and then threaten them with withdrawal, loss of custody, incarceration, or physical violence if they try to reduce their use, access treatment, call the police, or resist demands to engage in illegal activities, including human trafficking.

Other unique risks include coercion into unsafe use, medication sabotage, and being stalked while attending regular appointments. Recognizing the impact of substance use coercion on the current opioid epidemic underscores the importance of incorporating DSV-specific interventions into opioid use disorder treatment and recovery services and addressing DSV as part of broader opioid prevention efforts.