Greater Pain Severity is Associated with Inability to Access Addiction Treatment Among a Cohort of People Who Use Drugs

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.