Pauline Voon1, Linwei Wang2, Ekaterina Nosova3, Kanna Hayashi4, M-J Milloy5, Evan Wood5, Thomas Kerr5. 1. British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: pauline.voon@bccsu.ubc.ca. 2. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, British Columbia, Canada; Centre for Urban Health Solutions, St Michael's Hospital, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada. 3. British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada. 4. British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada. 5. British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Abstract
BACKGROUND: The opioid overdose crisis underscores the need for health services among people who use drugs (PWUD) with concurrent pain. AIMS: Investigating the effect of pain on barriers to accessing health services among PWUD. DESIGN: Prospective cohort study. SETTINGS: A setting of universal access to no-cost medical care in Vancouver, Canada from June 2014 to May 2016. PARTICIPANTS/ SUBJECTS: PWUD who completed at least one study interview. METHODS: Data derived from interviewer-administered questionnaires were used for multivariable generalized linear mixed-effects multiple regression (GLMM) analyses. RESULTS: Among 1,348 PWUD, 469 (34.8%) reported barriers to accessing health services at least once during the study period. The median average pain severity was 3 (IQR: 0-6) out of 10. A dose-response relationship was observed between greater pain and increased odds of reporting barriers to accessing health services (adjusted odds ratio [AOR]: 1.59, 95% confidence interval [CI]: 1.15-2.21, p = .005 for mild versus no pain; AOR: 1.76, 95% CI: 1.30-2.37, p < .001 for moderate versus no pain; AOR: 2.55, 95% CI: 1.92-3.37, p < .001 for severe versus no pain). Common barriers included poor treatment by health professionals, socio-structural barriers such as transportation or mobility, and long wait lists or wait times. CONCLUSIONS: Pain may be a significant risk factor associated with increased barriers to accessing health services among PWUD. Attention to pain management may improve access to health services, and reducing barriers to health services may conversely improve pain management and its related risks and harms.
BACKGROUND: The opioid overdose crisis underscores the need for health services among people who use drugs (PWUD) with concurrent pain. AIMS: Investigating the effect of pain on barriers to accessing health services among PWUD. DESIGN: Prospective cohort study. SETTINGS: A setting of universal access to no-cost medical care in Vancouver, Canada from June 2014 to May 2016. PARTICIPANTS/ SUBJECTS: PWUD who completed at least one study interview. METHODS: Data derived from interviewer-administered questionnaires were used for multivariable generalized linear mixed-effects multiple regression (GLMM) analyses. RESULTS: Among 1,348 PWUD, 469 (34.8%) reported barriers to accessing health services at least once during the study period. The median average pain severity was 3 (IQR: 0-6) out of 10. A dose-response relationship was observed between greater pain and increased odds of reporting barriers to accessing health services (adjusted odds ratio [AOR]: 1.59, 95% confidence interval [CI]: 1.15-2.21, p = .005 for mild versus no pain; AOR: 1.76, 95% CI: 1.30-2.37, p < .001 for moderate versus no pain; AOR: 2.55, 95% CI: 1.92-3.37, p < .001 for severe versus no pain). Common barriers included poor treatment by health professionals, socio-structural barriers such as transportation or mobility, and long wait lists or wait times. CONCLUSIONS: Pain may be a significant risk factor associated with increased barriers to accessing health services among PWUD. Attention to pain management may improve access to health services, and reducing barriers to health services may conversely improve pain management and its related risks and harms.
Authors: S A Strathdee; A Palepu; P G Cornelisse; B Yip; M V O'Shaughnessy; J S Montaner; M T Schechter; R S Hogg Journal: JAMA Date: 1998-08-12 Impact factor: 56.272
Authors: Hariharan Regunath; Kelly Cochran; Kasey Cornell; James Shortridge; Daniel Kim; Syed Akbar; Barbara Boshard; Rebecca Chitima-Matsiga; Jyotsna Reddy; Steven Keithahn; James P Koller Journal: Mo Med Date: 2016 Jan-Feb
Authors: Dan Lewer; Joseph Freer; Emma King; Sarah Larney; Louisa Degenhardt; Emily J Tweed; Vivian D Hope; Magdalena Harris; Tim Millar; Andrew Hayward; Dan Ciccarone; Katherine I Morley Journal: Addiction Date: 2020-02-10 Impact factor: 7.256