Greater Pain Severity is Associated with Inability to Access Addiction Treatment Among a Cohort of People Who Use Drugs
Received 28 March 2020
Accepted for publication 11 August 2020
Published 1 October 2020 Volume 2020:13 Pages 2443—2449
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Michael A Überall
Pauline Voon,1,2 Linwei Wang,3,4 Ekaterina Nosova,1 Kanna Hayashi,1,5 Michael John Milloy,1,6 Evan Wood,1,6 Thomas Kerr1,6
1British Columbia Centre on Substance Use, Vancouver, BC V6Z 2A9, Canada; 2School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada; 3British Columbia Centre for Excellence in HIV/AIDS, St Paul’s Hospital, Vancouver, BC V6Z 1Y6, Canada; 4Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON M5B 1T8, Canada; 5Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada; 6Department of Medicine, University of British Columbia, Vancouver, BC V6Z 2A9, Canada
Correspondence: Thomas Kerr
Department of Medicine, University of British Columbia, 400-1045 Howe Street, Vancouver, BC V6Z 2A9, Canada
Tel +1 778 945-7616
Fax +1 604 428-5183
Aim: Given that co-occurring pain is prevalent among people who use drugs (PWUD), we sought to explore the effect of pain severity on accessing addiction treatment.
Methods: Data were derived from two prospective cohort studies of PWUD in Vancouver, Canada from June 2014 to May 2016. Multivariable generalized linear mixed-effects multiple regression (GLMM) analyses were used to investigate the association between average pain severity and self-reported inability to access addiction treatment.
Results: Among 1348 PWUD, 136 (10.1%) reported being unable to access addiction treatment at least once over the study period. Individuals who reported being unable to access addiction treatment had a significantly higher median average pain severity score (median=5, IQR=0– 7) compared to individuals reporting no inability to access addiction treatment (median=3, IQR=0– 6, p=0.038). Greater pain severity was independently associated with higher odds of reporting inability to access addiction treatment (AOR: 1.75, 95%CI: 1.08– 2.82 for mild-moderate vs no pain; AOR: 1.98, 95%CI: 1.27– 3.09 for moderate-severe vs no pain).
Conclusion: PWUD with greater pain severity may be at higher risk of being unable to access addiction treatment, or vice versa. While further research is needed to confirm causal associations, these data suggest that there may be underlying pathways or mechanisms through which pain may be associated with access to addiction treatment for PWUD.
Keywords: pain, addiction, substance use, health services, opioid agonist treatment, methadone
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