Prescription sharing, alcohol use, and street drug use to manage pain among veterans.
BACKGROUND
Efforts to promote awareness and management of chronic pain have been accompanied by a troubling increase in prescription medication abuse. At the same time, some patients may misuse substances in an effort to manage chronic pain.


OBJECTIVE
This study examines self-reported substance misuse for pain management among veterans and identifies the contributing factors.


METHODS
We analyzed cross-sectional data from the Help Veterans Experience Less Pain study.


RESULTS
Of 343 veterans, 35.3% reported an aberrant pain management behavior (24% reported using alcohol, 11.7% reported using street drugs, and 16.3% reported sharing prescriptions to manage pain). Poorer mental health, younger age, substance use disorders (SUDs), number of nonpain symptoms, and greater pain severity and interference were associated with aberrant pain management behaviors. In multivariate analysis, SUDs (odds ratio [OR]: 3.9, 95% confidence interval [CI]: 2.3-6.7, P<0.000) and poorer mental health (OR: 2.3, 95% CI: 1.3-4.3, P=0.006) were associated with using alcohol or street drugs to manage pain; SUDs (OR: 2.4, 95% CI: 1.3-4.4, P=0.006) and pain interference (OR: 1.1, 95% CI: 1.0-1.2, P=0.047) were associated with prescription sharing; and SUDs (OR: 3.6, 95% CI: 2.2-6.1, P<0.000) and number of nonpain symptoms (OR: 6.5, 95% CI: 1.2-35.4, P=0.031) were associated with any aberrant pain management behavior.


CONCLUSIONS
Veterans with a history of SUDs, greater pain interference, more nonpain symptoms, and mental health concerns should be carefully managed to deter substance misuse for pain management.
School of Nursing, California State University at Long Beach, Long Beach, California 90840-0108, USA. jgoebel@csulb.edu
Joy R
JR
Goebel
Peggy
P
Compton
Lisa
L
Zubkoff
Andy
A
Lanto
Steven M
SM
Asch
Cathy D
CD
Sherbourne
Lisa
L
Shugarman
Karl A
KA
Lorenz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000434:Alcoholic Beverages / Q000706:statistics & numerical data*; D000700:Analgesics / Q000627:therapeutic use; D002140:California / Q000453:epidemiology; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006801:Humans; D013287:Illicit Drugs; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology* / Q000517:prevention & control*; D055553:Prescription Drugs / Q000627:therapeutic use*; D015995:Prevalence; D014728:Veterans / Q000706:statistics & numerical data*
D000700:Analgesics; D013287:Illicit Drugs; D055553:Prescription Drugs