People With Injection Drug Use and Pain Are More Likely to Report Nonmedical Prescription Opioid Use

Nonmedical prescription opioid use (NMPOU) is associated with high morbidity and mortality. People who inject drugs (PWID) have a high burden of chronic pain, but there is a dearth of data identifying a relationship between dimensions of physical pain and their association with NMPOU. This analysis used cross-sectional interview data from 706 PWID in San Francisco, California.

• 48% of participants reported past 24-hour physical pain
• 48% reported past 24-hour pain interference with general activity, physical ability, or mood.
• 15% reported past 24-hour NMPOU.
• Past 24-hour pain level above median was associated with increased odds of past 24-hour NMPOU (adjusted odds ratio [aOR], 2.15).
• Past 24-hour pain interference above median across several domains was similarly associated with increased odds of past 24-hour NMPOU.

Comments: These cross-sectional data do not distinguish between whether the observed association between past 24-hour pain and NMPOU is causal. Importantly, these data highlight the high burden of recent pain among PWID. Furthermore, they suggest that the development of interventions to address NMPOU may benefit from understanding and targeting the motivation for use (e.g., untreated pain, euphoric effects, or minimizing withdrawal symptoms).

Marc R. Larochelle, MD, MPH

Reference: Dahman D, Kral AH, Wenger L, et al. Physical pain is common and associated with nonmedical prescription opioid use among people who inject drugs. Subst Abuse Treat Prev Policy. 2017;12:29.