Understanding the link between substance use and chronic pain: A qualitative study among people who use illicit drugs in Montreal, Canada

Abstract

•Background Chronic noncancer pain (CNCP) is highly prevalent among people who use illicit drugs (PWUD). PWUD suffering from CNCP are at the crossroads of two opioid crises: the prescription opioid crisis and the street-opioid overdose crisis. This qualitative study aims to improve knowledge of the substance use habits of PWUD suffering from CNCP and to assess the role of CNCP in the evolution of their substance use patterns.•Methods In-depth semi-structured interviews were conducted with PWUD suffering from CNCP recruited in Montreal (Canada). To be eligible, participants had to self-report using cocaine and/or street opioids and having pain for at least three months. Twenty-five participants were recruited (10 women, 15 men; aged 27 to 61). Interviews were analyzed within a thematic framework.•Results CNCP could contribute to either increasing or distancing from substance use. Participants described patterns of substance use with several interlaced purposes: recreational, CNCP relief, “emotional” pain relief, and withdrawal symptom control. In several cases, participants’ awareness of their CNCP was delayed by the relieving effects of the substances they used for recreational purposes. Self-medication for CNCP was seldom the primary purpose of the participants’ substance use. Many participants were reluctant to self-manage CNCP with street drugs, but some did so when experiencing recurrent problems accessing healthcare services for CNCP.•Conclusions Suffering from CNCP complexifies PWUD’s substance use patterns. In the opioid crisis context, new health policies and interventions should be implemented to improve PWUD’s pain management and foster their addiction recovery.