"In our study, there was greater evidence for an association between substance use and chronic pain among inpatients than among MMTP [Methadone Maintenance Treatment Program] patients. Among inpatients, there were significant bivariate relationships between chronic pain and pain as a reason for first using drugs, multiple drug use, and drug craving. In the multivariate analysis, only drug craving remained significantly associated with chronic pain. Not surprisingly, inpatients with pain were significantly more likely than those without pain to attribute the use of alcohol and other illicit drugs, such as cocaine and marijuana, to a need for pain control. These results suggest that chronic pain contributes to illicit drug use behavior among persons who were recently using alcohol and/or cocaine. Inpatients with chronic pain visited physicians and received legitimate pain medications no more frequently than those without pain, raising the possibility that undertreatment or inability to access appropriate medical care may be a factor in the decision to use illicit drugs for pain."

"Other Highlights – Younger Heroin Users:
"• Eight CEWG area representatives noted either increases in primary heroin treatment admissions for young adults (age 18–25) or high proportions of admissions for this age group compared with other age groups. A younger heroin user population was reported in treatment data in Denver and Colorado, Detroit and Michigan, Los Angeles, Minneapolis/St. Paul, St. Louis, San Diego (based on 2012 treatment data), Seattle, and Texas. The area representative from Chicago reported an increase in heroin use by young suburbanites as a key finding for 2013.
"Other Highlights – Cross-Area Data Sources
"Treatment Admissions:
"• Primary heroin treatment admissions ranked first in proportions of total treatment admissions in 2013 in 6 of 17 CEWG reporting areas—Baltimore City, Boston, Detroit, Maryland, St. Louis, and San Francisco—and they ranked second in 2 areas: Cincinnati and Seattle (table 1). Boston (56.6 percent) and Baltimore City (49.5 percent) had the highest proportions of primary heroin treatment admissions in 2013; Atlanta had the lowest, at 6.1 percent (table 8; figure 5).
"• Injection was the most frequently reported mode of heroin administration in 12 of 16 reporting CEWG areas in 2013. Proportions of heroin admissions injecting the drug ranged from 15.0 percent in Atlanta to 87.1 percent in South Florida/Broward County (table 9). Inhalation or intranasal use was the most frequent mode of heroin administration reported by heroin admissions in 2 of 17 areas: Baltimore City, at 57.0 percent, and Detroit, at 59.8 percent. However, this mode was relatively rarely reported among treatment admissions in Phoenix and Denver (at 3.8 and 4.3 percent, respectively). Smoking was reported by less than 2.0 percent of the heroin admissions in 9 of 16 CEWG areas reporting. Phoenix had the highest proportion of heroin treatment admissions whose primary mode of administration was smoking, at 28.1 percent (table 9)."