Pain Management: Issues for HIV Clinicians and Other Health Care Providers

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Predictors of Continued Use of Extended-Released Naltrexone (XR-NTX) for Opioid-Dependence: An Analysis of Heroin & Non-Heroin Opioid Users in Los Angeles County

Highlights

• Some studies suggest better pharmacotherapy adherence and/or retention rates among non-heroin opioid users compared to heroin users. Therefore, this study examined predictive associations of subsequent doses of extended-release naltrexone (XR-NTX) among heroin and non-heroin opioid users.
• Non-heroin opioid users and heroin users are retained in XR-NTX treatment for comparable periods of time. However, those who identify as homeless, inject opioids (regardless of opioid-type), or were diagnosed with a mental illness are less likely to be retained in treatment with XR-NTX.
• Further, XR-NTX may contribute to decreases in urges to use among heroin and non-heroin opioid users.

Extended-release naltrexone (XR-NTX) is associated with an increased number of opioid-free days, improved adherence rates in substance use disorder treatment programs, and reduced cravings and drug-seeking behaviors. 

There is little evidence on the predictive associations between baseline characteristics of opioid-dependent patients and XR-NTX utilization. Some studies have demonstrated better pharmacotherapy adherence and/or retention rates among non-heroin opioid users compared to heroin users. 

This study examines predictive associations between characteristics of patients and XR-NTX utilization, as well as participants’ urge to use opiates. Our findings suggest that XR-NTX may contribute to decreases in urges to use among both heroin and non-heroin opioid users. Non-heroin opioid users and heroin users were retained in XR-NTX treatment for comparable periods of time. However, those who identified as homeless, injected opioids (regardless of opioid-type), or were diagnosed with a mental illness were less likely to be retained in treatment with XR-NTX.

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By:   Sarah J. Cousins, M.P.H., Seyed Ramin Radfar, M.D., M.P.H.,  Desirée Crèvecoeur-MacPhail, Ph.D., Alfonso Ang, Ph.D., Kendall Darfler, B.A., Richard A. Rawson, Ph.D.

Affiliations

University of California, Los Angeles, Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, USA 90025

Correspondence

Corresponding author at: UCLA Integrated Substance Abuse Programs (http://www.uclaisap.org/), Semel Institute for Neuroscience and Human Behavior, at the David Geffen School of Medicine, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025.

SarahJCousins@ucla.edu

DOI: http://dx.doi.org/10.1016/j.jsat.2015.12.004

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Denial of Prescription Analgesia among People Who Inject Drugs In A Canadian Setting

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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By:   Voon P1, Callon C, Nguyen P, Dobrer S, Montaner JS, Wood E, Kerr T.

• 1British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada.

 

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