Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs

Abstract

BackgroundPeople who inject drugs (PWID) often have poor health and lack access to health care. The aim of this study was to examine whether PWID engage in self-treatment through nonmedical prescription opioid use (NMPOU). We describe the prevalence and features of self-reported physical pain and its association with NMPOU.MethodsPWID (N = 702) in San Francisco, California (age 18+) were recruited to complete interviewer administered surveys between 2011 and 2013. Multivariate logistic regression analysis was conducted to examine the associations among self-reported pain dimensions (past 24-h average pain, pain interference with functional domains) and NMPOU, controlling for age, sex, psychiatric illness, opioid substitution treatment, homelessness, street heroin use and unmet healthcare needs.ResultsAlmost half of the sample reported pain, based on self-reported measures in the 24 h before their interview. The most common pain locations were to their back and lower extremities. Past 24-h NMPOU was common (14.7%) and associated with past 24 h average pain intensity on a 10 point self-rating scale (adjusted odds ratio [AOR] = 2.15, 95% confidence interval [CI] 1.21–3.80), and past 24 h pain interference with general activity (AOR 1.82 [95% CI 1.04–3.21]), walking ability (AOR 2.52 [95% CI 1.37–4.63]), physical ability (AOR 2.01 [95% CI 1.16–3.45]), sleep (AOR 1.98 [95% CI 1.13–3.48]) and enjoyment of life (AOR 1.79 [95% CI 1.02–3.15]).ConclusionBoth pain and NMPOU are common among PWID, and highly correlated in this study. These findings suggest that greater efforts are needed to direct preventive health and services toward this population.

Characterising the association between positive hepatitis C virus antibody and pain among people who inject drugs

“…The high prevalence of pain in our study was not surprising, given that PWID are vulnerable to skin infections, venous ulcers, co‐morbidities, unstable housing and poverty, which are directly causal or known risk factors for pain . Findings from the present study showed a similar prevalence of pain among PWID who have been exposed to HCV compared to available literature .…”

“…Although the mechanisms and pathways are not clearly known, inflammatory cytokines in HCV are theorised to play a role . Additionally, chronic pain is a common condition among PWID, occurring in one‐third to half of the population . These individuals are often exposed to soft tissue infections due to injections, as well as poor health and nutrition .…”

“…Additionally, chronic pain is a common condition among PWID, occurring in one‐third to half of the population . These individuals are often exposed to soft tissue infections due to injections, as well as poor health and nutrition . In both HCV infection and PWID, clinical and behavioural factors (e.g.…”

Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis

“…The overdose crisis is also the culmination of shifting opioid usage trends (i.e., from initiating opioids via heroin to initiating with pharmaceutical opioids [4]) that can be traced back, in part, to the over-prescription of pharmaceutical opioids for chronic non-cancer pain [5]. Despite this trend of liberal opioid prescribing, certain marginalized populations experiencing high rates of pain, including people who use drugs (PWUD), lack access to adequate pain management through the healthcare system [6,7]. Under-or untreated pain in this population can promote higher-risk substance use, as patients may seek illicit opioids (i.e., unregulated heroin or counterfeit/diverted pharmaceutical opioids) to manage pain [6,7].…”

“…Despite this trend of liberal opioid prescribing, certain marginalized populations experiencing high rates of pain, including people who use drugs (PWUD), lack access to adequate pain management through the healthcare system [6,7]. Under-or untreated pain in this population can promote higher-risk substance use, as patients may seek illicit opioids (i.e., unregulated heroin or counterfeit/diverted pharmaceutical opioids) to manage pain [6,7]. In Vancouver, this practice poses a particularly high risk of accidental overdose, as estimates show that almost 90% of drugs sold as heroin are contaminated with synthetic opioids, such as fentanyl [8].…”