Associations between opioid misuse and social relationship factors among American Indian, Alaska Native, and Native Hawaiian college students in the U.S

•AI/AN/NH college students have higher opioid misuse prevalence than most other groups.•AI/AN/NH students reporting traumatic or violent relationships were at greater risk.•AI/AN/NH students reporting loneliness or family problems also exhibited greater risk.•The Social Development Model emphasis on prosocial relationships appears to apply. Despite declining overall rates of opioid misuse among college students, racial and ethnic differences in percentage and correlates of opioid misuse among student populations remains unclear. This study seeks to estimate percentages of opioid misuse among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students and determine whether problems in social bonds affect AI/AN/NH opioid misuse. Guided by social relationship factors associated with substance use in the Social Development Model, we used 2015–2019 data from the American College Health Association-National College Health Assessment survey in multivariable logistic regression models to examine the role of social bonds with peers and family in opioid misuse (prescription and non-prescription) among AI/AN/NH college students across the U.S. The percentage of opioid misuse was highest among AI/AN/NH college students (7.12 %) relative to other race/ethnicity groups. AI/AN/NH college students who reported experiencing loneliness (aOR: 1.68; 95 % CI 1.33−2.12; P < .0001), difficult social relationships (aOR: 1.27; 95 % CI 1.04−1.55; P = 0.0196), family problems (aOR: 1.32; 95 % CI 1.07−1.63; P = 0.0097), and intimate partner violence (aOR: 1.92; 95 % CI 1.56−2.36; P < .0001) were significantly more likely to misuse opioids than students who did not report experiencing these relationship problems. Relationship problems with peers and family increase AI/AN/NH college student risk for opioid misuse, indicating opportunities for colleges to support programs addressing healthy social relationships as a means to reduce opioid misuse among AI/AN/NH students.