St. PETERsburg Pain and Alcohol Intervention With Naltrexone and Nalmefene

Inclusion Criteria: * 18 years or older * HIV-positive * Chronic pain (present ≥3 mo) of moderate to severe intensity * Heavy drinking past year (Based on NIAAA criteria: \> 14 standard drinks per week/ \> 4 drinks in a day for men; \> 7 drinks in the past week/ \> 3 drinks in a day for women) * If female, negative pregnancy test and willing to use adequate birth control * Provision of contact information for 2 contacts to assist with follow-up * Stable address within 100 kilometers of St. Petersburg * Possession of a telephone (home or cell) * Able and willing to comply with all study protocols and procedures Exclusion Criteria: * Not fluent in Russian * Cognitive impairment resulting in inability to provide informed consent based on research assessor (RA) assessment * Known active TB or current febrile illness * Breastfeeding * Uncontrolled psychiatric illness (such as active psychosis) (i.e., answered yes to any of the following: past three month active hallucinations; mental health symptoms prompting a visit to the ED or hospital) * History of hypersensitivity to naltrexone, nalmefene, or naloxone * Current use (past week) of illicit or prescribed opiates as documented by either self-report or positive urine drug test * Unwilling to abstain from opiates during the treatment period * Current use of neuroleptics * History of seizure disorder * Known liver failure * ALT/AST levels \>5x normal * History of Raynaud's Disease * Planned surgeries in the next three months * Enrolled in another HIV and/or substance use medication intervention study * Taking naltrexone in the past 30 days * Taking nalmefene in the past 30 days