Prescription Sharing, Alcohol Use, and Street Drug Use to Manage Pain Among Veterans

CONTEXT: Efforts to promote awareness and management of chronic pain have been accompanied by a troubling increase in prescription medication abuse. At the same time, some patients may misuse substances in an effort to manage chronic pain. OBJECTIVES: This study examines self-reported substance misuse for pain management among veterans and identifies the contributing factors. METHODS: We analyzed cross-sectional data from the Help Veterans Experience Less Pain study. RESULTS: Of 343 veterans, 35.3% reported an aberrant pain management behavior (24% reported using alcohol, 11.7% reported using street drugs, and 16.3% reported sharing prescriptions to manage pain). Poorer mental health, younger age, substance use disorders (SUDs), number of nonpain symptoms, and greater pain severity and interference were associated with aberrant pain management behaviors. In multivariate analysis, SUDs (odds ratio [OR]: 3.9, 95% confidence interval [CI]: 2.3–6.7, P <0.000) and poorer mental health (OR: 2.3, 95% CI: 1.3–4.3, P=0.006) were associated with using alcohol or street drugs to manage pain; SUDs (OR: 2.4, 95% CI: 1.3–4.4, P=0.006) and pain interference (OR: 1.1, 95% CI: 1.0–1.2, P=0.047) were associated with prescription sharing; and SUDs (OR: 3.6, 95% CI: 2.2–6.1, P<0.000) and number of nonpain symptoms (OR: 6.5, 95% CI: 1.2–35.4, P=0.031) were associated with any aberrant pain management behavior. CONCLUSION: Veterans with a history of SUDs, greater pain interference, more nonpain symptoms, and mental health concerns should be carefully managed to deter substance misuse for pain management.