Self-medication for pain common among people living with HIV and substance use disorder

Reports of pain—and the use of multiple types of substances to self-medicate—are extremely common among people living with HIV who have substance use disorders, according to a study conducted in Boston. The authors urged clinicians caring for people living with HIV who also use substances to ask their patients about specific self-medication behaviors, including other substances and alcohol.

About This Study

“Self-medication of pain and discomfort with alcohol and other substances by people with HIV infection and substance use disorder: preliminary findings from a secondary analysis” was published online on Nov. 1, 2023, in AIDS Care. The lead author is Michael D. Stein, M.D., of the Department of Health Law, Policy and Management at Boston University School of Public Health in Massachusetts.

Key Research Findings

This cross-sectional analysis of data from 2012-2014, in 248 people living with HIV who had substance use disorders investigated self-medication of pain and discomfort. Participants were mostly Black and Brown men (50% of participants Black, 25% Latinx, 37% women), and had CD4 counts > 200 cells/mm³ (89% of participants).

Pain, assessed using the Brief Pain Inventory, was common, with 54% of participants reporting it during the last week and 61% of these said they had experienced pain for ≥ 3 months. Pain severity did not differ between participants who self-medicated and those who did not.

Among the 125 participants who self-medicated during the prior three months, 9% only used alcohol, 49% only used other substances, and 42% used both alcohol and other substances. Participants who self-medicated were younger, less likely to be employed, and less likely to be virally suppressed than those not reporting self-medication. Depression and anxiety symptoms were also associated with greater likelihood of using alcohol or substances to manage pain.

Discussion Highlights and Implications for Practice

Study limitations reported included the inability to determine causality, the fact that all participants had a history of substance use, a lack of information on specific symptoms for which participants self-medicated, and no distinction among the substances used–including no differentiation between medical vs. recreational cannabis. In addition, the size of the sample does not allow for analyses of potential synergistic effects of multiple types of substance use on self-medication, or for modification of substance use effects by characteristics such as age or depression. The prescription medications used for self-medication were not clarified.

Because self-medicating was not associated with the overall level of pain severity, the researchers suggested that self-medication may have reduced previously higher levels of pain to a level experienced by non-using participants. Past trauma, worse functioning, or psychiatric comorbidity could explain why some participants self-medicated their pain while others did not.

Since polysubstance use was common, the authors recommended that clinicians ask patients who use substances about alcohol use and vice versa. To address self-medication, pain management and substance use treatment could be integrated with HIV care, offering alternatives such as cognitive behavioral therapy, physical therapy, or mindfulness techniques.

By Barbara Jungwirth