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Drug Alcohol Rev. 2020 Jan;39(1):71-82. doi: 10.1111/dar.13001. Epub 2019 Nov 22.

Childhood abuse as a risk factor for injection drug use: A systematic review of observational studies.

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British Columbia Centre on Substance Use, Vancouver, Canada.
School of Population and Public Health, University of British Columbia, Vancouver, Canada.
HIV/STI Surveillance Research Center and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.
Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada.



Childhood abuse is a public health challenge with lifelong impacts, including future drug use. However, previous research has been mixed regarding impacts on injection drug use. This systematic review examines the impact of childhood abuse (sexual, physical and emotional) on adult injection drug use.


We searched MEDLINE, EMBASE, PsycINFO, CINAHL, Web of Science and grey literature to identify relevant studies from database inception to 26 September 2018. Studies were eligible if: (i) they were empirical original research published in English; (ii) considered childhood abuse as potential risk factors for lifetime history of injection drug use; and (iii) included adult participants. Risk of bias was assessed using the modified Newcastle-Ottawa Scale.


Of the 1994 articles screened, 17 studies met the inclusion criteria. Most studies were conducted in the USA and utilised cross-sectional research designs. All of the 17 studies measured sexual abuse, six studies measured physical abuse and three studies measured emotional abuse; most (N = 11) of which reported a statistically significant and positive association between at least one sub-scale of childhood abuse and injection drug use.


Our findings highlight the need for devising interventions to reduce the harms associated with childhood abuse.


The evidence base suggests a significant positive association between experiences of childhood physical abuse and elevated risks of injection drug initiation with mixed results for sexual and emotional abuse.


child trauma; childhood emotional abuse; childhood physical abuse; childhood sexual abuse; people who inject drugs


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