Objective: The current study examined the mediating role of distress tolerance on the association between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use among an ethno-racially diverse sample of young adults with current pain. Methods: Participants were 141 undergraduate college students (78.7% female, M age = 22.50, SD = 5.41) who reported experiencing current pain. Results: Results indicated that distress tolerance statistically significantly explained the relationship between pain-related disability and addiction to opioids, past-month opioid use, and risky opioid use after controlling for the variance accounted for by pain intensity, negative affectivity, gender, and other substance misuses. Conclusions: Clinical implications are discussed in terms of targeting distress tolerance in the context of pain-related disability among young adults with pain who are at risk for opioid misuse.