title: Pain is associated with heroin use over time in HIV-infected Russian drinkers.
abstract: OBJECTIVE
  To evaluate whether pain was associated with increased risk of using heroin, stimulants or cannabis among HIV-infected drinkers in Russia.
  
  
  METHODS
  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.
  
  
  METHODS
  Recruitment occurred at HIV and addiction treatment sites in St Petersburg, Russian Federation.
  
  
  METHODS
  Six hundred and ninety-nine HIV-infected adult drinkers.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: 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.
authors.forename: Judith I
authors.initials: JI
authors.lastname: Tsui
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Coleman
authors.forename: Elena
authors.initials: E
authors.lastname: Blokhina
authors.forename: Carly
authors.initials: C
authors.lastname: Bridden
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D000437:Alcoholism / Q000150:complications / Q000453:epidemiology*; D002188:Cannabis; D000697:Central Nervous System Stimulants / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000453:epidemiology*; D006556:Heroin Dependence / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010146:Pain / Q000150:complications / Q000453:epidemiology*; D012307:Risk Factors; D012426:Russia / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000150:complications / Q000453:epidemiology
chemical_list: D000697:Central Nervous System Stimulants
keywords: HIV; Heroin; pain; substance use