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Tseng TY, Mitchell MM, Chander G, Latkin C, Kennedy C, Knowlton AR. Patient-centered Engagement as a Mediator in the Associations of Healthcare Discrimination, Pain Care Denial, and Later Substance Use Among a Sample of Predominately African Americans Living with HIV. AIDS Behav 2024; 28:429-438. [PMID: 38060111 DOI: 10.1007/s10461-023-04235-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2023] [Indexed: 12/08/2023]
Abstract
Chronic pain is prevalent and often under-addressed among people with HIV and people who use drugs, likely compounding the stress of discrimination in healthcare, and self-medicating along with its associated overdose risk or other problematic coping. Due to challenges in treating pain and HIV in the context of substance use, collaborative, patient-centered patient-provider engagement (PCE) may be particularly important for mitigating the impact of pain on illicit drug use and promoting sustained recovery. We examined whether PCE with primary care provider (PCE-PCP) mediated the effects of pain, discrimination, and denial of prescription pain medication on later substance use for pain among a sample of 331 predominately African Americans with HIV and a drug use history in Baltimore, Maryland, USA. Baseline pain level was directly associated with a higher chance of substance use for pain at 12 months (Standardized Coefficient = 0.26, p < .01). Indirect paths were observed from baseline healthcare discrimination (Standardized Coefficient = 0.05, 95% CI=[0.01, 0.13]) and pain medication denial (Standardized Coefficient = 0.06, 95% CI=[0.01, 0.14]) to a higher chance of substance use for pain at 12 months. Effects of prior discrimination and pain medication denial on later self-medication were mediated through worse PCE-PCP at 6 months. Results underscore the importance of PCE interpersonal skills and integrative care models in addressing mistreatment in healthcare and substance use in this population. An integrated approach for treating pain and substance use disorders concurrently with HIV and other comorbidities is much needed. Interventions should target individuals at multiple risks of discriminations and healthcare professionals to promote PCE.
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Affiliation(s)
- Tuo-Yen Tseng
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | | | | | - Carl Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Kennedy
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Amy R Knowlton
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Bendiks S, Cheng DM, Blokhina E, Vetrova M, Verbitskaya E, Gnatienko N, Bryant K, Krupitsky E, Samet JH, Tsui JI. Pilot study of tolerability and safety of opioid receptor antagonists as novel therapies for chronic pain among persons living with HIV with past year heavy drinking: a randomized controlled trial. AIDS Care 2023; 35:1191-1200. [PMID: 33682527 PMCID: PMC8421451 DOI: 10.1080/09540121.2021.1896663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/23/2021] [Indexed: 10/22/2022]
Abstract
CLINICAL TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03278886.
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Affiliation(s)
- Sally Bendiks
- Department of Medicine, Section of General Internal Medicine,
Boston Medical Center, Clinical Addiction Research and Education (CARE)
Unit, Boston, MA, USA
| | - Debbie M. Cheng
- Department of Biostatistics, Boston University School of Public
Health, Boston, MA,USA
| | - Elena Blokhina
- First Pavlov State Medical University of St. Petersburg, St.
Petersburg, Russian Federation
| | - Marina Vetrova
- First Pavlov State Medical University of St. Petersburg, St.
Petersburg, Russian Federation
| | - Elena Verbitskaya
- First Pavlov State Medical University of St. Petersburg, St.
Petersburg, Russian Federation
| | - Natalia Gnatienko
- Department of Medicine, Section of General Internal Medicine,
Boston Medical Center, Clinical Addiction Research and Education (CARE)
Unit, Boston, MA, USA
| | - Kendall Bryant
- HIV/AIDS Research, National Institute on Alcohol Abuse and
Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Evgeny Krupitsky
- First Pavlov State Medical University of St. Petersburg, St.
Petersburg, Russian Federation; Department of Addictions, V.M. Bekhterev
National Medical Research Center for Psychiatry and Neurology, St.
Petersburg, Russian Federation
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine,
Boston University School of Medicine/Boston Medical Center, Clinical
Addiction Research and Education (CARE) Unit, Boston, MA, USA; Department of
Community Health Sciences, Boston University School of Public Health,
Boston, MA, USA
| | - Judith I. Tsui
- Department of Medicine, Division of General Internal Medicine,
University of Washington/Harborview Medical Center, Seattle, WA, USA
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Ripamonti E, Clerici M. Living With Chronic HIV Disease in the Antiretroviral Era: The Impact of Neurocognitive Impairment on Everyday Life Functions. TOPICS IN ANTIVIRAL MEDICINE 2021; 29:386-396. [PMID: 34370420 PMCID: PMC8384087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 03/25/2021] [Indexed: 06/13/2023]
Abstract
Although there is extensive literature around the biologic correlations of neurocognitive function in HIV/AIDS, less is known about the impact in everyday living. We conducted a systematic review of the association of neurocognitive impairment with everyday life functions in people with HIV on antiretroviral therapy. We specifically focused on attention, executive function, processing speed, and the central executive component of the working memory. We considered 3 domains of everyday functions: (1) autonomy, (2) decision making and adherence to treatment, and (3) quality of life and psychologic wellbeing. The relationship between neurocognitive impairment and mental health was examined, given its correlation with everyday life functions. Results indicate that people with HIV do experience problems with autonomy of daily living (especially if aged older than 50 years) and with decision making, and neurocognitive impairment plays a role in this regard. Psychologic wellbeing is associated with executive function and processing speed. These patients may also have a reduced quality of life, but the relationship between quality of life and cognition is uncertain or could be mediated by other factors. Neurocognitive impairment correlates with depression and anxiety; however, the relationship of cognitive performance with apathy is still controversial.
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Affiliation(s)
- Enrico Ripamonti
- Send correspondence to Enrico Ripamonti, Milan Center for Neuroscience NeuroMI, University of Milan-Bicocca, Piazza dell'Ateneo Nuovo 1, 20126, Milano, Italy, or email
| | - Mario Clerici
- Head of the Department of Pathophysiology and Transplantation at the University of Milan in Italy
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Ventuneac A, Hecht G, Forcht E, Duah BA, Tarar S, Langenbach B, Gates J, Cain D, Rendina HJ, Aberg JA, Perlman DC. Chronic High Risk Prescription Opioid Use Among Persons With HIV. FRONTIERS IN SOCIOLOGY 2021; 6:645992. [PMID: 34095287 PMCID: PMC8176351 DOI: 10.3389/fsoc.2021.645992] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 04/26/2021] [Indexed: 05/07/2023]
Abstract
Persons with HIV (PWH) are a population at risk for adverse sequelae of opioid use. Yet, few studies have examined correlates of chronic high risk opioid use and its impact on HIV outcomes. Trends in prescribing patterns and identification of factors that impact the use of opioid prescriptions among PWH are crucial to determine prevention and treatment interventions. This study examined electronic medical records (EMR) of patients receiving HIV care to characterize prescribing patterns and identify risk factors for chronic high risk prescription opioid use and the impact on HIV outcomes among PWH in primary care from July 1, 2016-December 31, 2017. EMR were analyzed from 8,882 patients who were predominantly male and ethnically and racially diverse with half being 50 years of age or older. The majority of the 8,744 prescriptions (98% oral and 2% transdermal preparations) given to 1,040 (12%) patients were oxycodone (71%), 8% were morphine, 7% tramadol, 4% hydrocodone, 4% codeine, 2% fentanyl, and 4% were other opioids. The number of monthly prescriptions decreased about 14% during the study period. Bivariate analyses indicated that most demographic and clinical variables were associated with receipt of any opioid prescription. After controlling for patient socio-demographic characteristics and clinical factors, the odds of receipt of any prescription were higher among patients with pain diagnoses and opioid use and mental health disorders. In addition, the odds of receipt of high average daily morphine equivalent dose (MED) prescriptions were higher for patients with pain diagnoses. Lastly, patients with substance use disorders (SUD) had an increased likelihood of detectable viral load compared to patients with no SUD, after adjusting for known covariates. Our findings show that despite opioid prescribing guidelines and monitoring systems, additional efforts are needed to prevent chronic high risk prescriptions in patients with comorbid conditions, including pain-related, mental health and substance use disorders. Evidence about the risk for chronic high risk use based on prescribing patterns could better inform pain management and opioid prescribing practices for patients receiving HIV care.
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Affiliation(s)
- Ana Ventuneac
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
- *Correspondence: Ana Ventuneac,
| | - Gavriella Hecht
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Emily Forcht
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Bianca A. Duah
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Shafaq Tarar
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Blanche Langenbach
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Jay Gates
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - Demetria Cain
- Department of Psychology, Hunter College, City University of New York, NY, NY, United States
| | - H. Jonathon Rendina
- Department of Psychology, Hunter College, City University of New York, NY, NY, United States
- Health Psychology and Clinical Science PhD Program, The Graduate Center, City University of New York, NY, NY, United States
| | - Judith A. Aberg
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
| | - David C. Perlman
- Icahn School of Medicine at Mount Sinai, Division of Infectious Diseases, NY, NY, United States
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Robinson-Papp J, Aberg J, Benn EK, Bryan A, Cedillo G, Chikamoto Y, George MC, Horn B, Kamler A, Navis A, Nmashie A, Scherer M, Starkweather A, Vickrey B, Weiss L, Yang Q, Fisher J. Decreasing risk among HIV patients on opioid therapy for chronic pain: Development of the TOWER intervention for HIV care providers. Contemp Clin Trials Commun 2019; 16:100468. [PMID: 31701042 PMCID: PMC6831717 DOI: 10.1016/j.conctc.2019.100468] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 09/24/2019] [Accepted: 10/10/2019] [Indexed: 12/18/2022] Open
Abstract
Many people with HIV (PWH) experience chronic pain that limits daily function and quality of life. PWH with chronic pain have commonly been prescribed opioids, sometimes for many years, and it is unclear if and how the management of these legacy patients should change in light of the current US opioid epidemic. Guidelines, such as the Centers for Disease Control and Prevention Guideline for Prescribing Opioids for Chronic Pain (CDCG), provide recommendations for the management of such patients but have yet to be translated into easily implementable interventions; there is also a lack of strong evidence that adhering to these recommendations improves patient outcomes such as amount of opioid use and pain levels. Herein we describe the development and preliminary testing of a theory-based intervention, called TOWER (TOWard SafER Opioid Prescribing), designed to support HIV primary care providers in CDCG-adherent opioid prescribing practices with PWH who are already prescribed opioids for chronic pain. TOWER incorporates the content of the CDCG into the theoretical and operational framework of the Information Motivation and Behavioral Skills (IMB) model of health-related behavior. The development process included elicitation research and incorporation of feedback from providers and PWH; testing is being conducted via an adaptive feasibility clinical trial. The results of this process will form the basis of a large, well-powered clinical trial to test the effectiveness of TOWER in promoting CDCG-adherent opioid prescribing practices and improving outcomes for PWH with chronic pain.
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Affiliation(s)
| | - Judith Aberg
- Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Diseases, USA
| | - Emma K.T. Benn
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
| | - Angela Bryan
- University of Colorado Boulder, Department of Psychology and Neuroscience, USA
| | - Gabriela Cedillo
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | | | | | - Brady Horn
- University of New Mexico Center on Alcoholism, Substance Abuse and Addictions, USA
| | - Alexandra Kamler
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | - Allison Navis
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Alexandra Nmashie
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Maya Scherer
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | | | - Barbara Vickrey
- Icahn School of Medicine at Mount Sinai, Department of Neurology, USA
| | - Linda Weiss
- New York Academy of Medicine, Center for Evaluation and Applied Research, USA
| | - Qiuchen Yang
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
| | - Jeffrey Fisher
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Policy, USA
- University of Connecticut, Institute for Collaboration on Health, Intervention, and Policy (InCHIP), USA
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Lira MC, Tsui JI, Liebschutz JM, Colasanti J, Root C, Cheng DM, Walley AY, Sullivan M, Shanahan C, O’Connor K, Abrams C, Forman LS, Chaisson C, Bridden C, Podolsky MC, Outlaw K, Harris CE, Armstrong WS, del Rio C, Samet JH. Study protocol for the targeting effective analgesia in clinics for HIV (TEACH) study - a cluster randomized controlled trial and parallel cohort to increase guideline concordant care for long-term opioid therapy among people living with HIV. HIV Res Clin Pract 2019; 20:48-63. [PMID: 31303143 PMCID: PMC6693587 DOI: 10.1080/15284336.2019.1627509] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 12/12/2022]
Abstract
Background: People living with HIV (PLWH) frequently experience chronic pain and receive long-term opioid therapy (LTOT). Adherence to opioid prescribing guidelines among their providers is suboptimal. Objective: This paper describes the protocol of a cluster randomized trial, targeting effective analgesia in clinics for HIV (TEACH), which tested a collaborative care intervention to increase guideline-concordant care for LTOT among PLWH. Methods: HIV physicians and advanced practice providers (n = 41) were recruited from September 2015 to December 2016 from two HIV clinics in Boston and Atlanta. Patients receiving LTOT from participating providers were enrolled through a waiver of informed consent (n = 187). After baseline assessment, providers were randomized to the control group or the year-long TEACH intervention involving: (1) a nurse care manager and electronic registry to assist with patient management; (2) opioid education and academic detailing; and (3) facilitated access to addiction specialists. Randomization was stratified by site and LTOT patient volume. Primary outcomes (≥2 urine drug tests, early refills, provider satisfaction) were collected at 12 months. In parallel, PLWH receiving LTOT (n = 170) were recruited into a longitudinal cohort at both clinics and underwent baseline and 12-month assessments. Secondary outcomes were obtained through patient self-report among participants enrolled in both the cohort and the RCT (n = 117). Conclusions: TEACH will report the effects of an intervention on opioid prescribing for chronic pain on both provider and patient-level outcomes. The results may inform delivery of care for PLWH on LTOT for chronic pain at a time when opioid practices are being questioned in the US.
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Affiliation(s)
- Marlene C. Lira
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
| | - Judith I. Tsui
- Section of General Internal Medicine, Department of Medicine, University of Washington and Harborview Medical Center
| | - Jane M. Liebschutz
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Jonathan Colasanti
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Christin Root
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Debbie M. Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
| | - Alexander Y. Walley
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Meg Sullivan
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Christopher Shanahan
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
| | - Kristen O’Connor
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
| | - Catherine Abrams
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Leah S. Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Christine Chaisson
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA
| | - Carly Bridden
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
| | - Melissa C. Podolsky
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
| | - Kishna Outlaw
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Catherine E. Harris
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Wendy S. Armstrong
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Carlos del Rio
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA
| | - Jeffrey H. Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA
- Department of Medicine, Boston University School of Medicine, Boston, MA
- Department of Community Health Sciences, Boston University School of Public Health, Boston, MA
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Pain in people living with HIV and its association with healthcare resource use, well being and functional status. AIDS 2018; 32:2697-2706. [PMID: 30289809 DOI: 10.1097/qad.0000000000002021] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE We describe the prevalence of pain and its associations with healthcare resource utilization and quality-of-life. DESIGN The POPPY Study recruited three cohorts: older people living with HIV (PLWH; ≥50 years, n = 699), younger demographically/lifestyle similar PLWH (less than 50 years, n = 374) and older demographically/lifestyle similar HIV-negative (≥50 years, n = 304) people from April 2013 to February 2016. METHODS Current pain and pain-related healthcare use was collected via a self-reported questionnaire. Logistic regression assessed between-group differences in the prevalence of pain in the past month and current pain after controlling for potential confounders. Associations between current pain and healthcare resource use, reported joint problems, depressive symptoms, quality-of-life and functional status were assessed in PLWH using Mann-Whitney U and chi-squared tests. RESULTS Pain in the past month was reported by 473 out of 676 (70.0%) older PLWH, 224 out of 357 (62.7%) younger PLWH and 188 out of 295 (63.7%) older HIV-negative controls (P = 0.03), with current pain reported in 330 (48.8%), 134 (37.5%) and 116 (39.3%), respectively (P = 0.0007). Older PLWH were more likely to experience current pain, even after adjustment for confounders. Of those with pain in the past month, 56 out of 412 (13.6%) had missed days of work or study due to pain, and 520 (59%) had seen a doctor about their pain. PLWH experiencing current pain had more depressive symptoms, poorer quality-of-life on all domains and greater functional impairment, regardless of age group. CONCLUSION Even in the effective antiretroviral therapy era, pain remains common in PLWH and has a major impact on quality-of-life and associated healthcare and societal costs. Interventions are required to assist clinicians and PLWH to proactively manage pain.
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Paolillo EW, Obermeit LC, Tang B, Depp CA, Vaida F, Moore DJ, Moore RC. Smartphone-based ecological momentary assessment (EMA) of alcohol and cannabis use in older adults with and without HIV infection. Addict Behav 2018; 83:102-108. [PMID: 29126667 DOI: 10.1016/j.addbeh.2017.10.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 09/22/2017] [Accepted: 10/23/2017] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Ecological momentary assessment (EMA) has been used to characterize substance use among adult populations; however, little is known about the validity of EMA and the patterns and predictors of substance use among older adults with and without HIV infection. METHODS Thirty-five (22 HIV-positive, 13 HIV-negative) older adults aged 50-74 were assessed for 14days and completed up to four smartphone-based surveys per day. RESULTS Participants completed an average of 89.5% of possible EMA surveys. EMA self-reported alcohol and cannabis use were significantly positively correlated with laboratory-assessed, self-reported days of alcohol (r=0.52, p=0.002) and cannabis (r=0.61, p<0.001) used and quantity of alcohol (r=0.42, p=0.013) and cannabis (r=0.41, p=0.016) used in the 30days prior to baseline assessment. In a subset of 15 alcohol or cannabis users, preliminary analyses of the effects of mood and pain on alcohol or cannabis use showed: 1) greater anxious mood predicted substance use at the next EMA survey (OR=1.737, p=0.023), 2) greater happiness predicted substance use later in the day (OR=1.383, p<0.001), and 3) higher pain level predicted substance use earlier in the day (OR=0.901, p=0.005). CONCLUSIONS Findings demonstrate that EMA-measured alcohol and cannabis use has convergent validity among older adults with and without HIV infection. Preliminary results showing predictors of substance use highlight the importance of gathering EMA data to examine daily variability and time-dependent antecedents of substance use among this population.
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Mukerji S, Haghighat R, Misra V, Lorenz DR, Holman A, Dutta A, Gabuzda D. Longitudinal Modeling of Depressive Trajectories Among HIV-Infected Men Using Cocaine. AIDS Behav 2017; 21:1985-1995. [PMID: 28550378 DOI: 10.1007/s10461-017-1801-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Cocaine use is prevalent among HIV-infected individuals. While cross-sectional studies suggest that cocaine users may be at increased risk for depression, long-term effects of cocaine on depressive symptoms remain unclear. This is a longitudinal study of 341 HIV-infected and uninfected men (135 cocaine users and 206 controls) ages 30-60 enrolled in the Multicenter AIDS Cohort Study during 1996-2009. The median baseline age was 41; 73% were African-American. In mixed-effects models over a median of 4.8 years of observation, cocaine use was associated with higher depressive symptoms independent of age, education level, and smoking (n = 288; p = 0.02); HIV infection modified this association (p = 0.03). Latent class mixed models were used to empirically identify distinct depressive trajectories (n = 160). In adjusted models, cocaine use was associated with threefold increased odds of membership in the class with persistent high depressive symptoms (95% confidence interval (CI) 1.38-6.69) and eightfold increased odds (95% CI (2.73-25.83) when tested among HIV-infected subjects only. Cocaine use is a risk factor for chronic depressive symptoms, particularly among HIV-infected men, highlighting the importance of integrating mental health and substance use treatments to address barriers to well-being and successful HIV-care.
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Abstract
We analyzed baseline data from an observational cohort of HIV-infected ART-naïve patients in St. Petersburg, Russia to explore whether pain was associated with HIV risk behaviors. The primary outcomes were (1) unprotected vaginal or anal sex in the past 90 days and (2) sharing of needles or equipment in the past month. Secondary outcomes included: use of alcohol prior to sex, current injection drug use, number of unprotected sex and sharing episodes, and days injected in the past month. The main independent variable was any past week pain. Multivariable regression models were fit for outcomes. After adjustment, the association with unprotected sex was of borderline significance (AOR = 2.06; 95 % CI 0.98-4.36, p = 0.058); there was no significant association between any past week pain and sharing of needles/equipment (AOR = 1.52; 95 % CI 0.65-3.59, p = 0.33). Participants with pain had higher odds of reporting alcohol use prior to sex (AOR = 2.42; 95 % CI 1.10-5.28, p = 0.03).
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Safo SA, Blank AE, Cunningham CO, Quinlivan EB, Lincoln T, Blackstock OJ. Pain is Associated with Missed Clinic Visits Among HIV-Positive Women. AIDS Behav 2017; 21:1782-1790. [PMID: 27388160 DOI: 10.1007/s10461-016-1475-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Pain is highly prevalent among HIV-positive individuals, with women representing a large subset of those with pain. However, little is known about the relationship between pain and retention in HIV medical care. Among a cohort of HIV-positive women of color, we evaluated the association between pain and retention in care, as measured by missed clinic visits. The Health Resources and Services Administration's Women of Color Initiative was a multi-site observational cohort study evaluating demonstration projects to engage HIV-positive women in medical care. From November 2010 to July 2013, 921 women were enrolled in the study across nine U.S. sites; baseline interviews collected data on socio-demographic, clinical, and risk behavior characteristics. Pain was assessed at baseline based on number of days in pain over the last 30 days and was categorized as no pain (0 days), infrequent pain (1-13 days), and frequent pain (14-30 days), with 14 days being the median. Missed visits over the one-year follow-up period, evaluated by chart abstraction, were dichotomized as ≤1 missed visit versus >1 missed visit. We conducted multivariate logistic regression to assess the association between pain at baseline and missed visits, adjusting for pertinent covariates. Among our sample (N = 862), 52.2 % of women reported no pain, 23.7 % reported infrequent pain and 24.1 % reported frequent pain. Forty-five percent had >1 missed visit during the one-year follow-up period. Overall, we did not find a significant association between pain and missed visits (aOR 2.30; 95 % CI 1.00-5.25). However, in planned stratified analyses, among women reporting current substance use at baseline, reporting frequent pain was associated with a higher odds of missed visits as compared with reporting no pain (aOR 15.14; 95 % CI 1.78-128.88). In our overall sample, pain was not significantly associated with missed visits. However, frequent pain was associated with missed visits among HIV-positive women of color who reported substance use at baseline. A better understanding of the relationship between pain and missed visits could guide efforts to improve retention in care in this population.
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Affiliation(s)
| | | | - Chinazo O Cunningham
- Montefiore Medical Center, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
| | - E Byrd Quinlivan
- Institute for Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
- Center for AIDS Research, University of North Carolina, Chapel Hill, NC, USA
| | - Thomas Lincoln
- Baystate Medical Center & Tufts University School of Medicine, Springfield, MA, USA
| | - Oni J Blackstock
- Montefiore Medical Center, Bronx, NY, USA
- Albert Einstein College of Medicine, Bronx, NY, USA
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12
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Taets GGDC, Figueiredo NMAD. A quasi-experimental nursing study on pain in comatose patients. Rev Bras Enferm 2016; 69:927-932. [PMID: 27783736 DOI: 10.1590/0034-7167-2015-0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 06/25/2016] [Indexed: 11/21/2022] Open
Abstract
Objective: to verify whether comatose patients feel pain during the bed bath nursing procedure. Method: nineteen patients aged 61 ± 17.39 years participated in the study. A quantitative analysis was conducted on the P substance (PS) in the saliva collected before and during a bed bath, using the ELISA method. Program Graph Pad Prisma 6 was used to analyze the data. The verification of normality was made through the Shapiro Wilk test, which determined the choice for the Wilcoxon nonparametric test. Results: the study showed a statistically significant increase (∆= 5.62%, p<0.001) in the PS level of the patients studied during the nursing procedure. Conclusion: when caring for comatose patients during a bed bath, professionals cause or add painful stimuli; therefore, they feel pain.
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Affiliation(s)
| | - Nébia Maria Almeida de Figueiredo
- Universidade Federal do Estado do Rio de Janeiro, Centro de Ciências Biológicas e da Saúde, Escola de Enfermagem Alfredo Pinto. Rio de Janeiro-RJ, Brasil
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13
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Vallerand AH, Crawley J, Pieper B, Templin TN. The Perceived Control Over Pain Construct and Functional Status. PAIN MEDICINE 2016; 17:692-703. [PMID: 26350223 DOI: 10.1111/pme.12924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Belief in one's ability to control pain is a significant predictor of health outcomes and is related to improved functional status. The purpose of this study was to introduce a novel formulation of the construct, Perceived Control Over Pain and to test its effects on functional status. METHODS Participants (N = 301) were primarily African American (92%); and were adults with low income attending a primary care clinic and reporting pain within the past 2 weeks. A cross-sectional design was used with confirmatory factor analysis and structural equation modeling. The Perceived Control Over Pain construct consisted of four measures-two specific measures of control over pain and two general measures of control over life events. Perceived Control Over Pain has not been defined in this way previously. RESULTS Mean worst pain scores for the past week were 8.4, where "0" (no pain) to "10" (pain as bad as you can imagine). The model demonstrated good construct validity for the components of pain, Perceived Control Over Pain and functional status. Mediation by Perceived Control Over Pain was partial but strong, accounting for a reduction of 29% in the effect of pain on functional status. DISCUSSION In minority populations with low income, factors such as perceived control over pain and its effect on the outcome of patient function need to be considered. Improving Perceived Control Over Pain has the potential for improving patients' feelings of life control and purpose or meaning in life, and psychological and physical functioning for adults living with pain.
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Affiliation(s)
| | - Jamie Crawley
- University of Windsor, Faculty of Nursing, Windsor, Canada
| | - Barbara Pieper
- *Wayne State University, College of Nursing, Detroit, Michigan, USA
| | - Thomas N Templin
- *Wayne State University, College of Nursing, Detroit, Michigan, USA
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14
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Mwesiga EK, Mugenyi L, Nakasujja N, Moore S, Kaddumukasa M, Sajatovic M. Depression with pain co morbidity effect on quality of life among HIV positive patients in Uganda: a cross sectional study. Health Qual Life Outcomes 2015; 13:206. [PMID: 26718268 PMCID: PMC4697332 DOI: 10.1186/s12955-015-0403-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 12/23/2015] [Indexed: 11/20/2022] Open
Abstract
Background Depression with pain comorbidity (DPC) has not been clearly defined among HIV positive patients in sub-Saharan Africa. It still remains a challenge despite many studies in Africa documenting a high prevalence of pain and depression among people living with HIV/AIDS. Both are associated with a grave impact on the health related outcomes in this pandemic. This study aimed at determining the prevalence, factors associated and effect on quality of life of DPC among HIV positive patients. Methods In a cross-sectional survey, 345 HIV positive patients were enrolled into the study. Using a pre-tested standardised questionnaire the presence of DPC was assessed after a written informed consent. The associations between DPC, quality of life, depression history, severity, and cognition were determined. A p-value of <0.05 was considered to be significant. Results Among people living with HIV/AIDS (PLWHA), the prevalence of DPC was about 5 %. PLWHA with DPC were more likely to perceive their overall quality of life as poor and scored poorly in all the domains on the WHOQOL-BREF. They were also more likely to have more severe forms of depression and recurrent episodes of depression. Conclusions DPC is common, under diagnosed and undertreated in PLWHA in Uganda. Depression and pain screening as well as appropriate access to care for DPC have potential to improve quality of life and health outcomes. This calls for the integration and training of mental health services into HIV/AIDS care and future efforts by policy makers and HIV caregivers to address this treatment gap to advance the care of people living with HIV in Uganda.
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Affiliation(s)
| | - Levi Mugenyi
- Infectious Disease Research Collaboration, Mulago Hill Road, MUJHU3 Building, P.O. Box 7475, Kampala, Uganda
| | - Noeline Nakasujja
- College of Health Sciences, Makerere University, 7072, Kampala, Uganda
| | - Shirley Moore
- Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
| | - Mark Kaddumukasa
- College of Health Sciences, Makerere University, 7072, Kampala, Uganda
| | - Martha Sajatovic
- Neurological and Behavioral Outcomes Center, University Hospital Case Medical Center, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH, 44106, USA
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15
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Merlin JS. Chronic Pain in Patients With HIV Infection: What Clinicians Need To Know. TOPICS IN ANTIVIRAL MEDICINE 2015; 23:120-124. [PMID: 26518396 PMCID: PMC6148933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic pain is common in individuals with HIV infection. The primary goal of treatment of chronic pain is not only to improve pain but also to improve physical and emotional function. Patients with chronic pain should be assessed for concurrent psychiatric and substance use disorders, as these conditions often coexist. Treatment of chronic pain may have limited success in the absence of treatment of psychiatric disorders. Treatments for chronic pain include nonopioid pharmacologic therapies and nonpharmacologic therapies (eg, cognitive and behavioral therapy, physical therapy), and the latter option is often the most effective for improving patient function. Care must be taken when initiating or continuing treatment with opioids, and the risks and benefits of treatment with opioids should be regularly assessed. This article summarizes a presentation by Jessica S. Merlin, MD, MBA, at the IAS-USA continuing education program held in New York, New York, in March 2015.
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16
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Uebelacker LA, Weisberg RB, Herman DS, Bailey GL, Pinkston-Camp MM, Stein MD. Chronic Pain in HIV-Infected Patients: Relationship to Depression, Substance Use, and Mental Health and Pain Treatment. PAIN MEDICINE 2015; 16:1870-81. [PMID: 26119642 DOI: 10.1111/pme.12799] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE As the advent of highly active antiretroviral therapy, HIV has become a chronic disease for most individuals in developed countries. Chronic pain is a common occurrence for HIV-infected patients and has an impact on quality of life and antiretroviral adherence. The objective of this study was to examine relationships between chronic pain and depression, substance use, mental health treatment, and pain treatment in HIV-infected patients. DESIGN Cross-sectional study. SETTING Three primary care sites where HIV+ patients receive treatment. SUBJECTS Two hundred and thirty eight HIV-infected primary care patients. METHODS We collected self-report and chart-review information on demographics, HIV clinical status, chronic pain, depression, substance use, mental health treatment, and pain treatment. We collected data between October 2012 and November 2013. RESULTS Of the patients enrolled in this study, 107 reported no chronic pain, 24 reported mild chronic pain, and 107 reported moderate-severe chronic pain. Participants in the moderate-severe pain group were more likely to have high levels of depressive symptoms than those in the no chronic pain group. Similarly, there was a significant relationship between chronic pain status and interference with life activities due to pain. Participants with moderate-severe chronic pain were more likely to be taking an antidepressant medication than those with mild chronic pain, and more likely to be taking a prescription opioid than the other two groups. We did not find a significant relationship between problematic substance use and chronic pain status. CONCLUSIONS Despite pharmacologic treatment, moderate-severe chronic pain and elevated depression symptoms are common among HIV-infected patients and frequently co-occur.
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Affiliation(s)
- Lisa A Uebelacker
- Butler Hospital, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Risa B Weisberg
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Boston VA Healthcare System, Boston, Massachusetts
| | - Debra S Herman
- Butler Hospital, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Genie L Bailey
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,Stanley Street Treatment and Resources, Fall River, Massachusetts
| | - Megan M Pinkston-Camp
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,The Immunology Center, The Miriam Hospital, Providence, Rhode Island, USA
| | - Michael D Stein
- Butler Hospital, Providence, Rhode Island.,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.,The Immunology Center, The Miriam Hospital, Providence, Rhode Island, USA
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17
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Hart TA, Mustanski B, Ryan DT, Gorbach PM, Stall RD, Surkan PJ, Plankey M. Depression and sexual dysfunction among HIV-positive and HIV-negative men who have sex with men: mediation by use of antidepressants and recreational stimulants. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:399-409. [PMID: 24671728 PMCID: PMC4177518 DOI: 10.1007/s10508-014-0279-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 10/12/2013] [Accepted: 01/02/2014] [Indexed: 06/02/2023]
Abstract
Erectile dysfunction and other forms of sexual dysfunction are highly prevalent among HIV+ men who have sex with men (MSM). Research has not previously identified the mechanisms by which depression may be associated with sexual dysfunction among HIV-positive and HIV-seronegative (HIV-negative) MSM. The present study examined the role of antidepressant use, stimulant use, and smoking as mediators of the relation between depression and sexual dysfunction among HIV-positive and HIV-negative MSM. Participants enrolled in the Multicenter AIDS Cohort Study, an ongoing prospective study of the natural and treated histories of HIV infection among MSM in the United States, completed a modified version of the International Index of Erectile Function for MSM. The study sample included 1,363 participants, with 619 HIV-positive men and 744 HIV-negative men. A structural equation model examined depression as a predictor of subsequent sexual dysfunction, mediated by antidepressant use, stimulant use, and smoking. Depression predicted subsequent sexual function among both HIV-negative and HIV-positive MSM. This effect appeared to be both a direct effect and an indirect effect via antidepressant use. Findings suggest that antidepressant medication use may partially explain sexual dysfunction among MSM.
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Affiliation(s)
- Trevor A Hart
- Department of Psychology, Ryerson University, 350 Victoria St., Toronto, ON, M5B 2K3, Canada,
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18
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Pain is associated with risky drinking over time among HIV-infected persons in St. Petersburg, Russia. Drug Alcohol Depend 2014; 144:87-92. [PMID: 25220898 PMCID: PMC4252482 DOI: 10.1016/j.drugalcdep.2014.08.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pain is highly prevalent among persons with HIV. Alcohol may be used to "self-medicate" pain. This study examined the association between pain and risky alcohol use over time in a cohort of HIV-infected Russian drinkers. METHODS This secondary analysis utilized longitudinal data from a randomized trial of a behavioral intervention. Subjects included HIV-infected adults who reported past 6-month risky drinking and unprotected sex and were recruited from HIV and addiction treatment sites in St. Petersburg, Russia. The main independent variable was pain that at least moderately interfered with daily living. The primary outcome was past month risky drinking amounts based on NIAAA guidelines. General estimating equations (GEE) logistic regression models were used to calculate odds ratios and 95% confidence intervals for the association between pain and risky drinking over time (i.e., baseline, 6 and 12 months), adjusting for potential confounders. RESULTS Baseline characteristics of participants (n=699) were mean age of 30 (SD ±5) years, 41% female, and 22% <9th grade education. Nearly one quarter (24%) had a CD4 cell count <200 cells/μl, and only 17% were on antiretroviral therapy. Nearly half (46%) reported at least moderate pain interference in the past month and 81% were drinking risky amounts. In adjusted longitudinal GEE models, pain was significantly associated with greater odds of reporting past month risky drinking (AOR = 1.34, 95% CI: 1.05-1.71, p value=0.02). CONCLUSIONS Among a cohort of HIV-infected Russian drinkers, pain that at least moderately interfered with daily living was associated with higher odds of reporting risky drinking amounts over time.
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Jeevanjee S, Penko J, Guzman D, Miaskowski C, Bangsberg DR, Kushel MB. Opioid analgesic misuse is associated with incomplete antiretroviral adherence in a cohort of HIV-infected indigent adults in San Francisco. AIDS Behav 2014; 18:1352-8. [PMID: 24077929 DOI: 10.1007/s10461-013-0619-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
There is little or no data examining the association between either pain or the use or misuse of opioid analgesic with adherence to antiretroviral medications (ARVs) among HIV-infected adults. We interviewed a community-based cohort of HIV-infected indigent adults prescribed antiretroviral medications (ARVs) quarterly to examine the association between (1) pain, (2) receipt of opioid analgesics, and (3) opioid analgesic misuse with self-reported ARV adherence. Of 281 participants, most (82.5 %) reported severe or moderate pain, half (52.4 %) received a prescription for opioids, and one quarter (24.6 %) misused opioid analgesics. Most (71.9 %) reported >90 % ARV adherence. In a GEE model, neither pain (unadjusted OR 1.14, CI 0.90–1.45) nor prescription of opioid analgesics (unadjusted OR 1.11, CI 0.84–1.49) were significantly associated with ARV adherence. Misuse of opioid analgesics was associated with incomplete adherence (AOR 1.42, CI 1.09–1.86). Individuals who misuse opioid analgesics, like those who use illicit substances, may have difficulty adhering to medication regimens.
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20
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McKenna GJ. The current status of medical marijuana in the United States. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2014; 73:105-8. [PMID: 24765557 PMCID: PMC3998227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Medical marijuana is currently a controversial issue in medicine. There are strong pro and con opinions but relatively little scientific data on which to base medical decisions. The unfortunate scheduling of marijuana in class I has limited research and only serves to fuel the controversy. This article will review the history of laws to regulate drugs in the United States in the 20th century to provide context for the current status of medical marijuana. It will include the rationale for opposing medical marijuana laws and the problem of the Schedule I inclusion of marijuana as well as other drugs. It will examine the problems associated with smoking raw marijuana and review other routes of administration. Finally, it examines the inadvisability of medicine's promotion of smoked marijuana.
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21
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Tsui JI, Cheng DM, Coleman SM, Blokhina E, Bridden C, Krupitsky E, Samet JH. Pain is associated with heroin use over time in HIV-infected Russian drinkers. Addiction 2013; 108:1779-87. [PMID: 23773361 PMCID: PMC4012755 DOI: 10.1111/add.12274] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate whether pain was associated with increased risk of using heroin, stimulants or cannabis among HIV-infected drinkers in Russia. DESIGN 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. SETTING Recruitment occurred at HIV and addiction treatment sites in St Petersburg, Russian Federation. PARTICIPANTS Six hundred and ninety-nine HIV-infected adult drinkers. MEASUREMENTS 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. FINDINGS 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.
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Affiliation(s)
- Judith I. Tsui
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA
| | - Debbie M. Cheng
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA,Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave., 3 Floor, Boston, MA 02118-2605, USA
| | - Sharon M. Coleman
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Ave., 3 Floor, Boston, MA 02118-2605, USA
| | - Elena Blokhina
- Institute of Pharmacology, St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russia
| | - Carly Bridden
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA
| | - Evgeny Krupitsky
- Laboratory of Clinical Pharmacology of Addictions, St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russia,Department of Addictions, Bekhterev Research Psychoneurological Institute, Bekhtereva St., 3, St. Petersburg 192019, Russia
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA,Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118-2605, USA
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22
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Merlin JS, Zinski A, Norton WE, Ritchie CS, Saag MS, Mugavero MJ, Treisman G, Hooten WM. A Conceptual Framework for Understanding Chronic Pain in Patients with HIV. Pain Pract 2013; 14:207-16. [DOI: 10.1111/papr.12052] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 01/05/2013] [Indexed: 12/27/2022]
Affiliation(s)
- Jessica S. Merlin
- Division of Infectious Diseases, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
- Division of Gerontology, Geriatrics, and Palliative Care, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Anne Zinski
- Division of Infectious Diseases, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Wynne E. Norton
- Department of Health Behavior; School of Public Health, University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Christine S. Ritchie
- Division of Geriatrics, Department of Medicine; University of California at San Francisco, Jewish Home of San Francisco Center for Research on Aging; San Francisco California U.S.A
| | - Michael S. Saag
- Division of Infectious Diseases, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Michael J. Mugavero
- Division of Infectious Diseases, Department of Medicine; University of Alabama at Birmingham; Birmingham Alabama U.S.A
| | - Glenn Treisman
- Department of Psychiatry and Behavioral Sciences; Johns Hopkins University School of Medicine; Baltimore Maryland U.S.A
| | - W. Michael Hooten
- Department of Anesthesiology, Department of Psychiatry and Psychology; The Mayo Clinic; Rochester Minnesota U.S.A
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