Pain is associated with heroin use over time in HIV-infected Russian drinkers

Authors

  • Judith I. Tsui,

    1. Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
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  • Debbie M. Cheng,

    1. Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
    2. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
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  • Sharon M. Coleman,

    1. Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA
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  • Elena Blokhina,

    1. Institute of Pharmacology, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia
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  • Carly Bridden,

    1. Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
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  • Evgeny Krupitsky,

    1. Laboratory of Clinical Pharmacology of Addictions, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia
    2. Department of Addictions, Bekhterev Research Psychoneurological Institute, St. Petersburg, Russia
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  • Jeffrey H. Samet

    1. Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
    2. Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Correspondence to: Judith I. Tsui, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, USA. E-mail: judith.tsui@bmc.org

Abstract

Aims

To evaluate whether pain was associated with increased risk of using heroin, stimulants or cannabis among HIV-infected drinkers in Russia.

Design

Secondary analysis of longitudinal data from the HERMITAGE study (HIV's Evolution in Russia—Mitigating Infection Transmission and Alcoholism in a Growing Epidemic), a behavioral randomized controlled trial, with data collected at baseline, 6-month and 12-month visits.

Setting

Recruitment occurred at HIV and addiction treatment sites in St Petersburg, Russian Federation.

Participants

Six hundred and ninety-nine HIV-infected adult drinkers.

Measurements

The primary outcome was past month illicit drug use; secondary outcomes examined each drug (heroin, stimulants and cannabis) separately. The main predictor was pain that interfered at least moderately with daily living. General estimating equations (GEE) logistic regression models were used to evaluate the association between pain and subsequent illicit drug use, adjusting for potential confounders.

Findings

Participants reporting pain appeared to have higher odds of using illicit drugs, although the results did not reach statistical significance [adjusted odds ratio (OR) = 1.32; 95% confidence interval (CI) = 0.99, 1.76, P = 0.06]. There was a significant association between pain and heroin use (OR = 1.54; 95% CI = 1.11–2.15, P = 0.01) but not use of other drugs (OR = 0.75; 95% CI = 0.40–1.40, P = 0.35 for stimulants and OR = 0.70; 95% CI = 0.45–1.07, P = 0.09 for cannabis).

Conclusions

HIV-infected Russian drinkers who report pain are more likely to use heroin over time than HIV-infected Russian drinkers who do not report pain. Pain may be an unrecognized risk factor for persistent heroin use with implications for HIV transmission in Russia.

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