Pain is associated with reduced adherence to safer injection practices among people who inject opioids

BACKGROUND: Injection opioid use is associated with fatal and non-fatal harms including accidental overdose and infectious diseases. Syringe service programs offer sterile injection equipment and safer injection training to reduce the incidence of injection-related harms. Nevertheless, factors that might reduce adherence to safer injection practices are understudied. This report explores pain as one such factor. METHODS: People who inject opioids (n = 130) were recruited from a syringe service program for a cross-sectional survey assessing the relationship between fluctuations in pain severity and adherence to safer injection practices over the past 7 days. RESULTS: A within-subjects Sign Test analysis revealed participants' adherence to safer injection practices fluctuated with changes in pain severity. When their pain was at its worst, participants reported they less often engaged in hand washing (Z -5.63, P < .001), cleaning the injection site (Z -5.29, P < .001), and waiting until in a clean safe place to inject (Z -3.94, P < .001). Additionally, they more often reused their own injection equipment (Z -2.55, P = .011), and injected faster, or at a higher dose (Z -2.71, P = .007) when in worse pain. CONCLUSIONS: This study provides initial evidence that pain is associated with reduced adherence to safer injection practices among people who inject opioids. Although all study participants received training in safer injection practices and cost-free sterile injection equipment, within-subject adherence to safer use practices varied significantly under conditions of best and worst pain.