Cocaine Use, Unhealthy Alcohol Use, and Pain Interference Among People with HIV

Area of Science:

• Public Health
• Neuroscience
• Addiction Medicine

Background:

• Pain is a common issue for people with HIV (PWH).
• Many PWH also engage in substance use, including alcohol and illicit drugs.
• The impact of cocaine use and co-use with alcohol on pain in PWH remains unclear.

Purpose of the Study:

• To investigate the association between cocaine use and co-use of cocaine and alcohol with pain interference in PWH.
• To analyze how different substance use patterns affect pain experiences in this population.

Main Methods:

• Secondary analysis of the Boston Alcohol Research Collaboration on HIV/AIDS (ARCH) study.
• Used Generalized Estimating Equation (GEE) ordinal logistic regression.
• Adjusted for demographics, opioid, and cannabis use; measured pain interference (Brief Pain Inventory) and substance use (Addiction Severity Index, Timeline Follow Back).

Main Results:

• Cocaine use was linked to significantly greater pain interference (aOR: 1.73).
• Co-use of cocaine and unhealthy alcohol use showed even higher pain interference compared to no substance use (aOR: 2.27).
• The association between cocaine and pain interference was consistent regardless of alcohol use status.

Conclusions:

• Cocaine use and combined cocaine-alcohol use are associated with increased pain interference in people with HIV.
• Clinicians should consider substance use patterns when discussing pain management strategies with PWH.
• This highlights the need for integrated care addressing both substance use and pain in HIV-positive individuals.