INTRODUCTION AND AIMS:
Despite
the high prevalence of pain among people who inject drugs (PWIDs), clinicians
may be reluctant to prescribe opioid-based analgesia to those with a history of
drug use or addiction. We sought to examine the prevalence and correlates of
PWIDs reporting being denied of prescription analgesia (PA). We also explored
reported reasons for and actions taken after being denied PA.
DESIGN AND METHODS:
Using
data from two prospective cohort studies of PWIDs, multivariate logistic
regression was used to identify the prevalence and correlates of reporting
being denied PA. Descriptive statistics were used to characterise reasons for
denials and subsequent actions.
RESULTS:
Approximately
two-thirds (66.5%) of our sample of 462 active PWIDs reported having ever been
denied PA. We found that reporting being denied PA was significantly and
positively associated with having ever been enrolled in methadone maintenance
treatment (adjusted odds ratio 1.76, 95% confidence interval 1.11-2.80) and
daily cocaine injection (adjusted odds ratio 2.38, 95% confidence interval
1.00-5.66). The most commonly reported reason for being denied PA was being
accused of drug seeking (44.0%). Commonly reported actions taken after being
denied PA included buying the requested medication off the street (40.1%) or
obtaining heroin to treat pain (32.9%).
DISCUSSION AND CONCLUSIONS:
These
findings highlight the challenges of addressing perceived pain and the need for
strategies to prevent high-risk methods of self-managing pain, such as
obtaining diverted medications or illicit substances for pain. Such strategies
may include integrated pain management guidelines within methadone maintenance
treatment and other substance use treatment programs.
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