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Pain among people who use drugs : implications for health, risk behaviours and clinical care Voon, Pauline


Background: Pain is a common concern among people who use drugs (PWUD), yet there remains a lack of research and evidence-based guidelines for managing pain in this population. As a result of inadequate pain management in the clinical setting, PWUD may self-manage pain in ways that pose high risk for morbidity and mortality, which is especially concerning in the context of the ongoing opioid overdose crisis in recent years. This research aims to fill current gaps in the literature by exploring the associations between pain, substance use and other health outcomes, risk behaviours, and clinical care. Methods: Quantitative data were derived between June 2014 to December 2018 from two community-recruited prospective cohort studies of PWUD in Vancouver, Canada. Data on pain were ascertained using the Brief Pain Inventory. A variety of longitudinal and cross-sectional analytic approaches were used to classify and examine the associations between pain and substance use, risk behaviours, sociodemographic and clinical characteristics, and ability to access health care services including addiction treatment. Results: A latent class analysis classified and compared observations among four subgroups of PWUD with pain: opioid agonist treatment (OAT) with low substance use, no OAT with low substance use, primarily daily heroin use (presumed heroin but may have contained fentanyl contamination), and primarily daily cocaine use. A generalized linear regression analysis found that greater pain-related functional interference was positively and independently associated with depressive symptoms as well as overdose and daily heroin use among PWUD. Additional multivariable regression analyses found that PWUD with greater pain severity were at higher risk of reporting barriers to accessing health services and inability to access addiction treatment. Conclusion: These findings highlight subgroups and specific risk factors, such as high-intensity heroin use and depressive symptoms, that may be associated with higher risk for morbidity or mortality related to pain and substance use among PWUD. These findings also identify a possible relationship between pain and ability to access health services, including addiction treatment, among PWUD. Altogether, this research provides evidence that may help to support more targeted, comprehensive, and accessible clinical services, policies and practices for PWUD with pain.

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