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1.
Am J Prev Med ; 2020 Mar 09.
Artigo em Inglês | MEDLINE | ID: mdl-32192802

RESUMO

INTRODUCTION: Motor vehicle crashes are a leading cause of injury death in the U.S. Restrictive alcohol policies protect against crashes involving alcohol above the legal blood alcohol concentration of 0.08%. Characteristics of motor vehicle crash fatalities involving blood alcohol concentrations below the limit and their relationships to alcohol control policies have not been well characterized. METHODS: Motor vehicle crash fatality data and crash and decedent characteristics from 2000 to 2015 came from the Fatality Analysis Reporting System and were analyzed in 2018-2019. Alcohol Policy Scale scores characterized alcohol policy environments by state-year. Generalized estimating equation alternating logistic regression models assessed these scores and the odds that a fatality involved alcohol below the legal threshold. RESULTS: Of 612,030 motor vehicle crash fatalities, 223,471 (37%) died in alcohol-involved crashes, of which 33,965 (15% of alcohol-involved fatalities or 6% of all fatalities) had a blood alcohol concentration <0.08%. A 10 percentage point increase in Alcohol Policy Scale score, approximating the interquartile range among states, was associated with reduced odds of fatalities involving alcohol <0.08% vs 0.00% (AOR=0.91, 95% CI=0.89, 0.93). These findings held across multiple subgroup analyses by decedent and crash characteristics. Similar results were found for odds of alcohol involvement <0.05% vs 0.00% (AOR=0.90, 95% CI=0.88, 0.93), and ≥0.05% but <0.08% vs <0.05% (AOR=0.93, 95% CI=0.89, 0.96). CONCLUSIONS: The number of lower blood alcohol concentration fatalities is substantial. States with more restrictive alcohol policies tend to have reduced odds of lower blood alcohol concentration motor vehicle crashes than states with weaker policies.

2.
J Stud Alcohol Drugs ; 81(1): 58-67, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32048602

RESUMO

OBJECTIVE: U.S. policymakers and public health practitioners lack composite indicators (indices) to assess and compare the restrictiveness of state-level alcohol policy environments, conceptualized as the presence of multiple policies in effect in a particular place and time. The purposes of this study were to characterize the alcohol policy environment in each U.S. state and Washington, DC, in 2018, and to examine changes during the past 20 years. METHOD: State-specific Alcohol Policy Scale (APS) scores from 1999 to 2018 were based on 29 policies, after weighting each present policy by its efficacy and degree of implementation. Modified APS scores were also calculated on the basis of two sets of mutually exclusive policy subgroups. RESULTS: APS scores in 2018 varied considerably between states, ranging from 25.6 to 67.9 on a theoretical scale of 0 to 100; the median score was 43.5 (based on a 0-100 range), and 43 states had scores less than 50. The median change in state APS scores from 1999 to 2018 was positive (+4.9, range: -7.4 to +10.3), indicating increases in the restrictiveness of policy environments, with decreases in only five states. The increases in APS scores were primarily attributable to the implementation of stronger impaired-driving laws, whereas policies to reduce excessive drinking were unchanged. There was no correlation between states' excessive drinking policy scores and their impaired-driving scores (r = .05, p = .74). CONCLUSIONS: Based on this policy scale, few states have restrictive policy environments. Although states adopted policies targeting impaired driving during the study period, there was no change in policies to reduce excessive drinking.

3.
J Acquir Immune Defic Syndr ; 82(2): 195-201, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31513554

RESUMO

BACKGROUND: Medical marijuana is legal in 29 US states and the District of Columbia: both HIV and chronic pain are "approved conditions" for receipt. Chronic pain is common among people living with HIV (PLWH). We anticipate PLWH will question their providers about medical marijuana for chronic pain. We examined marijuana use and its associations with pain, opioid dose, and HIV viral suppression among PLWH receiving chronic opioid therapy. METHODS: PLWH prescribed chronic opioid therapy were recruited into the Targeting Effective Analgesia in Clinics for HIV cohort. The main exposure variable was any past 12-month marijuana use. The primary outcomes were (1) opioid misuse (≥9 on the Current Opioid Misuse Measure) and (2) opioid dose (morphine equivalent daily dose). HIV viral load (VL) suppression (<200 copies/µL) and pain severity and interference using the Brief Pain Inventory were exploratory outcomes. RESULTS: Participants (n = 166) were men (65%), Black (72%), and had an undetectable VL (89%). We found no significant association between current marijuana use and opioid misuse, opioid dose, or pain. Current marijuana use was associated with 3.03 times the odds of having a detectable VL (95% odds ratio: 1.11-8.31, P = 0.03) while controlling for depressive symptoms and other substance use. DISCUSSION: We did not detect an association between marijuana use and opioid misuse behaviors, opioid dose, or pain. In an exploratory analysis, current marijuana use was associated with 3× greater odds of having a detectable VL. This study provides insights into potential consequences of marijuana use among PLWH with chronic pain.

4.
HIV Res Clin Pract ; 20(2): 48-63, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31303143

RESUMO

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.

5.
Am J Prev Med ; 57(2): 172-179, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31239088

RESUMO

INTRODUCTION: Intimate partner violence (IPV) results in deaths of both primary and corollary (i.e., nonintimate partner) victims. Alcohol use is a known risk factor for IPV, yet the relationship between alcohol policies and IPV homicides is unclear. This repeated cross-sectional study characterizes alcohol involvement, and the relationship between alcohol policies and alcohol involvement, among victims of IPV homicides in the U.S. METHODS: Homicide victim data from 17 states in the National Violent Death Reporting System from 2003 to 2012 were analyzed in 2017-2018. Alcohol Policy Scale scores characterized alcohol policies by state year and were used in generalized estimating equation logistic regression models to predict the odds of alcohol involvement among victims of IPV homicide. RESULTS: Among victims of IPV homicide, 36.5% of primary and 41.1% of corollary victims had a blood alcohol concentration (BAC) >0.00%. Of the victims with a positive BAC, 67.6% had a BAC ≥0.08%. In adjusted models, a 10-percentage point increase in Alcohol Policy Scale score was associated with reduced odds of having a positive BAC (AOR=0.77, 95% CI=0.64, 0.93) and having a BAC ≥0.08% (AOR=0.82, 95% CI=0.68, 0.99) among all victims, primary victims (AOR=0.78, 95% CI=0.63, 0.98; AOR=0.82, 95% CI=0.65, 1.04), and corollary victims (AOR=0.61, 95% CI=0.42, 0.89; AOR=0.68, 95% CI=0.48, 0.97). CONCLUSIONS: Alcohol use was prevalent among victims of IPV homicide, and more-restrictive alcohol policies were associated with reduced odds of alcohol involvement. Strengthening alcohol policies is a promising strategy to reduce alcohol-involved IPV homicide victimization.

6.
AIDS Care ; 31(9): 1140-1144, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30632790

RESUMO

We describe HIV providers' opioid prescribing practices and assess whether belief that chronic opioid therapy (COT) keeps people living with HIV (PLWH) engaged in care is associated with differences in these practices among providers from two HIV clinics. We conducted logistic regression to evaluate the association between the belief that COT keeps PLWH engaged in care and at least one component of guideline-recommended care (i.e., urine drug tests, treatment agreements, and/or prescription monitoring program use). The sample included 41 providers with a median age of 42 years, 63% female, 37% non-white. Routine adherence to guideline-recommended practices was: 34% urine drug tests, 27% treatment agreements, and 17% prescription monitoring program. Over half [54%] agreed that COT keeps PLWH engaged in care. There was no significant association between belief that COT keeps PLWH engaged in care and routinely providing any recommended COT care component (aOR 2.38; 95% CI 0.65-8.73). Most HIV providers do not routinely follow guidelines for opioid prescribing. We observed a positive association between belief that COT keeps PLWH engaged in care and following any guideline-recommended prescribing practices, although the result was not statistically significant. Interventions are needed to improve guideline-concordant care for COT by HIV providers.

7.
Clin Infect Dis ; 68(2): 291-297, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-29860411

RESUMO

Background: Chronic opioid therapy (COT) is common in people living with human immunodeficiency virus (PLHIV), but is not well studied. We assessed opioid risk behaviors, perceptions of risk, opioid monitoring, and associated Current Opioid Misuse Measure (COMM) scores of PLHIV on COT. Methods: COT was defined as ≥3 opioid prescriptions ≥21 days apart in the past 6 months. Demographics, substance use, COMM score, and perceptions of and satisfaction with COT monitoring were assessed among PLHIV on COT from 2 HIV clinics. Results: Among participants (N = 165) on COT, 66% were male and 72% were black, with a median age of 55 (standard deviation, 8) years. Alcohol and drug use disorders were present in 17% and 19%, respectively. In 43%, the COMM score, a measure of potential opioid misuse, was high. Thirty percent had an opioid treatment agreement, 66% a urine drug test (UDT), and 12% a pill count. Ninety percent acknowledged opioids' addictive potential. Median (interquartile range) satisfaction levels (1-10 [10 = highest]) were 10 (7-10) for opioid treatment agreements, 9.5 (6-10) for pill counts, and 10 (8-10) for UDT. No association was found between higher COMM score and receipt of or satisfaction with COT monitoring. Conclusions: Among PLHIV on COT, opioid misuse and awareness of the addictive potential of COT are common, yet COT monitoring practices were not guideline concordant. Patients who received monitoring practices reported high satisfaction. Patient attitudes suggest high acceptance of guideline concordant care for PLHIV on COT when it occurs.


Assuntos
Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Infecções por HIV , Adulto , Idoso , Estudos de Coortes , Esquema de Medicação , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides , Guias de Prática Clínica como Assunto , Medição de Risco , Fatores de Risco , Detecção do Abuso de Substâncias
8.
AIDS Behav ; 23(4): 1057-1061, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30519904

RESUMO

Clinical practice that utilizes chronic opioid therapy has been recognized as one major cause of the opioid crisis. Among patients living with HIV, the risks associated with chronic opioid therapy may be complicated by factors such as co-occurring mental health diagnoses, substance use, and economic marginalization. Improving opioid prescribing practices in HIV clinics requires attention to these and other characteristics common to HIV care. In the context of a randomized controlled trial testing an intervention to improve opioid prescribing practices in HIV outpatient clinics, we interviewed physicians about their perspectives on chronic opioid therapy. Overwhelmingly, physicians voiced ambivalence about their own knowledge and comfort with prescription opioids. They raised concerns about the impact of opioid prescribing on patient-provider relationships and the increasing workload associated with prescribing and monitoring patients. In this report, we explore these concerns and propose several strategies for improving clinical care in which chronic opioid therapy is addressed.


Assuntos
Analgésicos Opioides/efeitos adversos , Dor Crônica/etiologia , Infecções por HIV/psicologia , Relações Médico-Paciente , Médicos/psicologia , Padrões de Prática Médica , Analgésicos Opioides/administração & dosagem , Dor Crônica/tratamento farmacológico , Prescrições de Medicamentos , Feminino , Infecções por HIV/complicações , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Transtornos Relacionados ao Uso de Substâncias
9.
JAMA Intern Med ; 178(7): 894-901, 2018 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-29813162

RESUMO

Importance: Motor vehicle crashes are a leading cause of mortality. However, the association between the restrictiveness of the alcohol policy environment (ie, based on multiple existing policies) and alcohol-related crash fatalities has not been characterized previously to date. Objective: To examine the association between the restrictiveness of state alcohol policy environments and the likelihood of alcohol involvement among those dying in motor vehicle crashes in the United States. Design, Setting, and Participants: This investigation was a repeated cross-sectional study in which state alcohol policies (operationalized by the Alcohol Policy Scale [APS]) from 1999 to 2014 were related to motor vehicle crash fatalities from 2000 to 2015 using data from the Fatality Analysis Reporting System (1-year lag). Alternating logistic regression models and generalized estimating equations were used to account for clustering of multiple deaths within a crash and of multiple crashes occurring within states. The study also examined independent associations of mutually exclusive subgroups of policies, including consumption-oriented policies vs driving-oriented policies. The study setting was the 50 US states. Participants were 505 614 decedents aged at least 21 years from motor vehicle crashes from 2000 to 2015. Main Outcomes and Measures: Odds that a crash fatality was alcohol related (fatality stemmed from a crash in which ≥1 driver had a blood alcohol concentration [BAC] ≥0.08%). Results: From 2000 to 2015, there were 505 614 adult motor vehicle crash fatalities in the United States, of which 178 795 (35.4%) were alcohol related. Each 10-percentage point increase in the APS score (corresponding to more restrictive state policies) was associated with reduced individual-level odds of alcohol involvement in a crash fatality (adjusted odds ratio [aOR], 0.90; 95% CI, 0.89-0.91); results were consistent among most demographic and crash-type strata. More restrictive policies also had protective associations with alcohol involvement among crash fatalities associated with BACs from greater than 0.00% to less than 0.08%. After accounting for driving-oriented policies, consumption-oriented policies were independently protective for alcohol-related crash fatalities (aOR, 0.97; 95% CI, 0.96-0.98 based on a 10-percentage point increased APS score). Conclusions and Relevance: Strengthening alcohol policies, including those that do not specifically target impaired driving, could reduce alcohol-related crash fatalities. Policies may also protect against crash fatalities involving BAC levels below the current legal limit for driving in the United States.


Assuntos
Acidentes de Trânsito/mortalidade , Consumo de Bebidas Alcoólicas/legislação & jurisprudência , Dirigir sob a Influência/legislação & jurisprudência , Acidentes de Trânsito/prevenção & controle , Estudos Transversais , Dirigir sob a Influência/prevenção & controle , Humanos , Governo Estadual , Estados Unidos
10.
J Stud Alcohol Drugs ; 78(5): 781-788, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28930066

RESUMO

OBJECTIVE: The purpose of this study was to examine the associations between the alcohol policy environment and alcohol involvement in homicide victims in the United States, overall and by sociodemographic groups. METHOD: To characterize the alcohol policy environment, the presence, efficacy, and degree of implementation of 29 alcohol policies were used to determine Alcohol Policy Scale (APS) scores by state and year. Data about homicide victims from 17 states from 2003 to 2012 were obtained from the National Violent Death Reporting System. APS scores were used as lagged exposure variables in generalized estimating equation logistic regression models to predict the individual-level odds of alcohol involvement (i.e., blood alcohol concentration [BAC] > 0.00% vs. = 0.00% and BAC ≥ 0.08% vs. ≤ 0.079%) among homicide victims. RESULTS: A 10 percentage point increase in APS score (representing a more restrictive policy environment) was associated with reduced odds of alcohol-involved homicide with BAC greater than 0.00% (adjusted odds ratio [AOR] = 0.89, 95% CI [0.82, 0.99]) and BAC of 0.08% or more (AOR = 0.91, 95% CI [0.82, 1.02]). In stratified analyses of homicide victims, more restrictive policy environments were significantly protective of alcohol involvement at both BAC levels among those who were female, ages 21-29 years, Hispanic, unmarried, victims of firearm homicides, and victims of homicides related to intimate partner violence. CONCLUSIONS: More restrictive alcohol policy environments were associated with reduced odds of alcohol-involved homicide victimization overall and among groups at high risk of homicide. Strengthening alcohol policies is a promising homicide prevention strategy.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Vítimas de Crime/estatística & dados numéricos , Homicídio/estatística & dados numéricos , Adolescente , Adulto , Concentração Alcoólica no Sangue , Etanol/sangue , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Violência por Parceiro Íntimo/estatística & dados numéricos , Modelos Logísticos , Masculino , Razão de Chances , Maus-Tratos Conjugais/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
11.
Alcohol Clin Exp Res ; 40(10): 2056-2072, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27696523

RESUMO

Alcohol use is common among people living with human immunodeficiency virus (HIV). In this narrative review, we describe literature regarding alcohol's impact on transmission, care, coinfections, and comorbidities that are common among people living with HIV (PLWH), as well as literature regarding interventions to address alcohol use and its influences among PLWH. This narrative review identifies alcohol use as a risk factor for HIV transmission, as well as a factor impacting the clinical manifestations and management of HIV. Alcohol use appears to have additive and potentially synergistic effects on common HIV-related comorbidities. We find that interventions to modify drinking and improve HIV-related risks and outcomes have had limited success to date, and we recommend research in several areas. Consistent with Office of AIDS Research/National Institutes of Health priorities, we suggest research to better understand how and at what levels alcohol influences comorbid conditions among PLWH, to elucidate the mechanisms by which alcohol use is impacting comorbidities, and to understand whether decreases in alcohol use improve HIV-relevant outcomes. This should include studies regarding whether state-of-the-art medications used to treat common coinfections are safe for PLWH who drink alcohol. We recommend that future research among PLWH include validated self-report measures of alcohol use and/or biological measurements, ideally both. Additionally, subgroup variation in associations should be identified to ensure that the risks of particularly vulnerable populations are understood. This body of research should serve as a foundation for a next generation of intervention studies to address alcohol use from transmission to treatment of HIV. Intervention studies should inform implementation efforts to improve provision of alcohol-related interventions and treatments for PLWH in healthcare settings. By making further progress on understanding how alcohol use affects PLWH in the era of HIV as a chronic condition, this research should inform how we can mitigate transmission, achieve viral suppression, and avoid exacerbating common comorbidities of HIV and alcohol use and make progress toward the 90-90-90 goals for engagement in the HIV treatment cascade.


Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Coinfecção/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Pesquisa/tendências , Comorbidade , Humanos
12.
Drug Alcohol Depend ; 166: 26-31, 2016 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-27422763

RESUMO

AIMS: In a sample of patients receiving opioid agonist therapy, we evaluated whether having chronic pain was associated with (a) craving for opioids and (b) illicit opioid use. METHODS: In a cross-sectional study of adults on buprenorphine or methadone maintenance recruited from an urban medical center, we examined any craving for opioids (primary dependent variable) in the past week and recent illicit opioid use (secondary dependent variable). Illicit opioid use was defined as a positive urine drug test (UDT) for opiates and chronic pain was defined as bodily pain that had been present for at least 3 months. Multivariable logistic regression models were fit for each outcome, adjusting for age, sex, and non-white race. Additional models adjusted for depression (PHQ-9) and anxiety (STAI). RESULTS: The sample included 105 adults on methadone or buprenorphine maintenance. Mean age was 43.8 (SD ±9.4)years; 48% were female and 32% non-white; 19% were on methadone. Chronic pain was present in 68% of the sample, 51% reported craving opioids in the past week, and 16% had a positive UDT. Chronic pain was associated with 3-fold higher odds of reporting craving in the past week (aOR=3.10; 95% CI: 1.28-7.50, p-value=0.01). The relative odds for having a positive UDT were not statistically significant (aOR=2.52; 95% CI: 0.64-9.90, p=0.18). CONCLUSION: In this sample of patients treated with opioid agonist therapy, those with chronic pain had higher odds of reporting craving for opioids. Chronic pain with associated opioid craving potentially places this population at risk for relapse.


Assuntos
Analgésicos Opioides/uso terapêutico , Dor Crônica/tratamento farmacológico , Dor Crônica/epidemiologia , Fissura , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Adulto , Buprenorfina/uso terapêutico , Dor Crônica/psicologia , Estudos Transversais , Depressão/tratamento farmacológico , Depressão/epidemiologia , Depressão/psicologia , Feminino , Humanos , Masculino , Metadona/uso terapêutico , Pessoa de Meia-Idade , Tratamento de Substituição de Opiáceos/métodos , Tratamento de Substituição de Opiáceos/psicologia , Transtornos Relacionados ao Uso de Opioides/psicologia
13.
J Acquir Immune Defic Syndr ; 73(4): 403-410, 2016 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-27171742

RESUMO

BACKGROUND: Mortality in patients with HIV infection is increasingly due to comorbid medical conditions. Research on how adherence to medications for comorbidities relates to antiretroviral (ARV) medication adherence and how interrelations between illness perceptions and medication beliefs about HIV and comorbidities affect medication adherence is needed to inform adherence interventions. METHODS: HIV-infected adults with hypertension (HTN) (n = 151) or chronic kidney disease (CKD; n = 41) were recruited from ambulatory practices at an academic medical center. Illness perceptions and medication beliefs about HIV and HTN or CKD were assessed and adherence to one ARV medication and one medication for either HTN or CKD was electronically monitored for 10 weeks. RESULTS: Rates of taking, dosing, and timing adherence to ARV medication did not differ from adherence to medication for HTN or CKD, with the exception that patients were more adherent to the timing of their ARV (78%) than to the timing of their antihypertensive (68%; P = 0.01). Patients viewed HIV as better understood, more chronic, having more negative consequences, and eliciting more emotions, compared with HTN. Patients viewed ARVs as more necessary than medication for HTN or CKD. Having a realistic view of the efficacy of ARVs (r = -0.20; P < 0.05) and a high level of perceived HIV understanding (r = 0.21; P < 0.05) correlated with better ARV adherence. CONCLUSIONS: Patients with HIV showed similar rates of adherence to ARVs as to medications for comorbidities, despite perceiving HIV as more threatening and ARVs as more important. This can be used in adapting existing interventions for ARV adherence to encompass adherence to medications for comorbid conditions.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/complicações , Adesão à Medicação , Insuficiência Renal Crônica/complicações , Fármacos Anti-HIV/administração & dosagem , Anti-Hipertensivos/administração & dosagem , Anti-Hipertensivos/uso terapêutico , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Carga Viral
14.
Drug Alcohol Depend ; 153: 286-92, 2015 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-26048638

RESUMO

BACKGROUND: Patients with opioid use disorders on opioid agonist therapy (OAT) have lower pain tolerance compared to controls. While chronic viral infections such as HCV and HIV have been associated with chronic pain in this population, no studies have examined their impact on pain sensitivity. METHODS: We recruited 106 adults (41 uninfected controls; 40 HCV mono-infected; and 25 HCV/HIV co-infected) on buprenorphine or methadone to assess whether HCV infection (with or without HIV) was associated with increased experimental pain sensitivity and self-reported pain. The primary outcome was cold pain tolerance assessed by cold-pressor test. Secondary outcomes were cold pain thresholds, wind-up ratios to repetitive mechanical stimulation (i.e., temporal summation) and acute and chronic pain. Multivariable regression models evaluated associations between viral infection status and outcomes, adjusting for other factors. RESULTS: No significant differences were detected across groups for primary or secondary outcomes. Adjusted mean cold pain tolerance was 25.7 (uninfected controls) vs. 26.8 (HCV mono-infection) vs. 25.3 (HCV/HIV co-infection) seconds (global p-value=0.93). Current pain appeared more prevalent among HCV mono-infected (93%) compared to HCV/HIV co-infected participants (76%) and uninfected controls (80%), as did chronic pain (77% vs. 64% vs. 61%, respectively). However, differences were not statistically significant in multivariable models. CONCLUSION: This study did not detect an association between HCV infection and increased sensitivity to pain among adults with and without HIV who were treated with buprenorphine or methadone for opioid use disorders. Results reinforce that pain and hyperalgesia are common problems in this population.


Assuntos
Buprenorfina/uso terapêutico , Hepatite C/complicações , Metadona/uso terapêutico , Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides/complicações , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Limiar da Dor , Adulto , Estudos de Casos e Controles , Coinfecção , Feminino , Infecções por HIV/complicações , Infecções por HIV/psicologia , Hepatite C/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/psicologia , Limiar da Dor/psicologia
15.
Drug Alcohol Depend ; 144: 87-92, 2014 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-25220898

RESUMO

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.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Dor/diagnóstico , Dor/epidemiologia , Adulto , Consumo de Bebidas Alcoólicas/psicologia , Alcoolismo/epidemiologia , Alcoolismo/psicologia , Estudos de Coortes , Feminino , Infecções por HIV/psicologia , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Dor/psicologia , Federação Russa/epidemiologia , Fatores de Tempo
16.
AIDS Care ; 26(8): 1013-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24382133

RESUMO

Overdoses and HIV infection are common among Russians who inject drugs, yet risk factors have not been studied. We analyzed baseline data of 294 participants with 30-day injection drug use from an HIV secondary prevention trial for persons reporting "heavy" alcohol use (National Institute on Alcohol Abuse and Alcoholism [NIAAA] risky drinking definition) and risky sex in the past 6 months. The outcome was any self-reported overdose in the previous 3 months. We examined demographic, HIV-related, criminal justice, mental health, substance use, and injection risk factors. Participants' characteristics included median age 29 years, 117/294 (40%) female, and median CD4 cell count 345/µl. Over three quarters 223/294 (76%) reported a history of overdose and 47/294 (16%) reported overdose in the past 3 months. Past month injection frequency (adjusted odds ratio [AOR] 4.77, 95% confidence interval [CI]: 1.63-14.0 highest vs. lowest quartile; AOR 3.58, 95% CI: 1.20-10.69 second highest vs. lowest quartile) and anti-retroviral therapy (ART) at time of interview (AOR 3.96 95% CI: 1.33-11.83) were associated with 3-month overdose. Nonfatal overdose among HIV-infected Russians who inject drugs is common. Risk factors include injection frequency and anti-retroviral therapy (ART), which warrant further study. Overdose prevention efforts are needed among HIV-infected Russians who inject drugs.


Assuntos
Alcoolismo/epidemiologia , Overdose de Drogas/epidemiologia , Infecções por HIV/psicologia , Assunção de Riscos , Abuso de Substâncias por Via Intravenosa/epidemiologia , Adulto , Alcoolismo/prevenção & controle , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Intervalos de Confiança , Estudos Transversais , Overdose de Drogas/prevenção & controle , Feminino , Humanos , Masculino , Razão de Chances , Fatores de Risco , Federação Russa/epidemiologia , Autorrevelação , Abuso de Substâncias por Via Intravenosa/prevenção & controle
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