High-risk prescription opioid use among people living with HIV

HIV Research Network

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals. Setting: We analyzed clinical and demographic data from the HIV Research Network and prescribing data from Medicaid for noncancer patients seeking HIV treatment at 4 urban clinics between 2006 and 2010. Methods: HIV Research Network patients were included in the analytic sample if they received at least one incident opioid prescription. We examined 4 measures of high-risk opioid use: (1) high daily dosage; (2) early refills; (3) overlapping prescriptions; and (4) multiple prescribers. Results: Of 4605 eligible PLWH, 1814 (39.4%) received at least one incident opioid prescription during follow-up. The sample was 61% men and 62% African American with a median age of 44.5 years. High-risk opioid use occurred among 30% of incident opioid users (high daily dosage: 7.9%; early refills: 15.9%; overlapping prescriptions: 16.4%; and multiple prescribers: 19.7%). About half of the cumulative incidence of high-risk use occurred within 1 year of receiving an opioid prescription. After adjusting for study site, high-risk opioid use was greater among patients with injection drug use as an HIV risk factor [adjusted hazard ratio (aHR) = 1.39, 95% confidence interval: 1.11 to 1.74], non-Hispanic whites [aHR = 1.61, (1.21 to 2.14)], patients age 35–45 [aHR = 1.94, (1.33 to 2.80)] and 45–55 [aHR = 1.84, (1.27 to 2.67)], and patients with a diagnosis of chronic pain [aHR = 1.32, (1.03 to 1.70)]. Conclusions: A large proportion of PLWH received opioid prescriptions, and among these opioid recipients, high-risk opioid use was common. High-risk use patterns often occurred within the first year, suggesting this is a critical time for intervention.

Original languageEnglish (US)
Pages (from-to)283-290
Number of pages8
JournalJournal of Acquired Immune Deficiency Syndromes
Volume78
Issue number3
DOIs
StatePublished - Jan 1 2018
Externally publishedYes

Fingerprint

Opioid Analgesics
Prescriptions
HIV
Medicaid
Research
Chronic Pain
African Americans
Demography
Confidence Intervals
Injections
Incidence

Keywords

  • HIV
  • Medicaid
  • Opioid misuse
  • Prescription opioids

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

High-risk prescription opioid use among people living with HIV. / HIV Research Network.

In: Journal of Acquired Immune Deficiency Syndromes, Vol. 78, No. 3, 01.01.2018, p. 283-290.

Research output: Contribution to journalArticle

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title = "High-risk prescription opioid use among people living with HIV",
abstract = "Background: Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals. Setting: We analyzed clinical and demographic data from the HIV Research Network and prescribing data from Medicaid for noncancer patients seeking HIV treatment at 4 urban clinics between 2006 and 2010. Methods: HIV Research Network patients were included in the analytic sample if they received at least one incident opioid prescription. We examined 4 measures of high-risk opioid use: (1) high daily dosage; (2) early refills; (3) overlapping prescriptions; and (4) multiple prescribers. Results: Of 4605 eligible PLWH, 1814 (39.4{\%}) received at least one incident opioid prescription during follow-up. The sample was 61{\%} men and 62{\%} African American with a median age of 44.5 years. High-risk opioid use occurred among 30{\%} of incident opioid users (high daily dosage: 7.9{\%}; early refills: 15.9{\%}; overlapping prescriptions: 16.4{\%}; and multiple prescribers: 19.7{\%}). About half of the cumulative incidence of high-risk use occurred within 1 year of receiving an opioid prescription. After adjusting for study site, high-risk opioid use was greater among patients with injection drug use as an HIV risk factor [adjusted hazard ratio (aHR) = 1.39, 95{\%} confidence interval: 1.11 to 1.74], non-Hispanic whites [aHR = 1.61, (1.21 to 2.14)], patients age 35–45 [aHR = 1.94, (1.33 to 2.80)] and 45–55 [aHR = 1.84, (1.27 to 2.67)], and patients with a diagnosis of chronic pain [aHR = 1.32, (1.03 to 1.70)]. Conclusions: A large proportion of PLWH received opioid prescriptions, and among these opioid recipients, high-risk opioid use was common. High-risk use patterns often occurred within the first year, suggesting this is a critical time for intervention.",
keywords = "HIV, Medicaid, Opioid misuse, Prescription opioids",
author = "{HIV Research Network} and Canan, {Chelsea E.} and Geetanjali Chander and Monroe, {Anne K.} and Gebo, {Kelly A.} and Moore, {Richard D.} and Agwu, {Allison L.} and Alexander, {G. Caleb} and Bryan Lau and Howard Edelstein and Richard Rutstein and Amy Baranoski and Sara Allen and Stephen Boswell and Beil, {Robert S.} and Felsen, {Uriel R.} and Judith Aberg and Antonio Urbina and Korthuis, {P. Todd} and Ank Nijhawan and Muhammad Akbar and Aditya Gaur and Charurut Somboonwit and William Valenti and Mathews, {W. Christopher} and Fred Hellinger and John Fleishman and Irene Fraser and Robert Mills and Faye Malitz and Jeanne Keruly and Cindy Voss and Charles Collins and Rebeca Diaz-Reyes",
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T1 - High-risk prescription opioid use among people living with HIV

AU - HIV Research Network

AU - Canan, Chelsea E.

AU - Chander, Geetanjali

AU - Monroe, Anne K.

AU - Gebo, Kelly A.

AU - Moore, Richard D.

AU - Agwu, Allison L.

AU - Alexander, G. Caleb

AU - Lau, Bryan

AU - Edelstein, Howard

AU - Rutstein, Richard

AU - Baranoski, Amy

AU - Allen, Sara

AU - Boswell, Stephen

AU - Beil, Robert S.

AU - Felsen, Uriel R.

AU - Aberg, Judith

AU - Urbina, Antonio

AU - Korthuis, P. Todd

AU - Nijhawan, Ank

AU - Akbar, Muhammad

AU - Gaur, Aditya

AU - Somboonwit, Charurut

AU - Valenti, William

AU - Mathews, W. Christopher

AU - Hellinger, Fred

AU - Fleishman, John

AU - Fraser, Irene

AU - Mills, Robert

AU - Malitz, Faye

AU - Keruly, Jeanne

AU - Voss, Cindy

AU - Collins, Charles

AU - Diaz-Reyes, Rebeca

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Background: Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals. Setting: We analyzed clinical and demographic data from the HIV Research Network and prescribing data from Medicaid for noncancer patients seeking HIV treatment at 4 urban clinics between 2006 and 2010. Methods: HIV Research Network patients were included in the analytic sample if they received at least one incident opioid prescription. We examined 4 measures of high-risk opioid use: (1) high daily dosage; (2) early refills; (3) overlapping prescriptions; and (4) multiple prescribers. Results: Of 4605 eligible PLWH, 1814 (39.4%) received at least one incident opioid prescription during follow-up. The sample was 61% men and 62% African American with a median age of 44.5 years. High-risk opioid use occurred among 30% of incident opioid users (high daily dosage: 7.9%; early refills: 15.9%; overlapping prescriptions: 16.4%; and multiple prescribers: 19.7%). About half of the cumulative incidence of high-risk use occurred within 1 year of receiving an opioid prescription. After adjusting for study site, high-risk opioid use was greater among patients with injection drug use as an HIV risk factor [adjusted hazard ratio (aHR) = 1.39, 95% confidence interval: 1.11 to 1.74], non-Hispanic whites [aHR = 1.61, (1.21 to 2.14)], patients age 35–45 [aHR = 1.94, (1.33 to 2.80)] and 45–55 [aHR = 1.84, (1.27 to 2.67)], and patients with a diagnosis of chronic pain [aHR = 1.32, (1.03 to 1.70)]. Conclusions: A large proportion of PLWH received opioid prescriptions, and among these opioid recipients, high-risk opioid use was common. High-risk use patterns often occurred within the first year, suggesting this is a critical time for intervention.

AB - Background: Prescription opioid use is greater among people living with HIV (PLWH), yet little is known about the prevalence of specific types of high-risk use among these individuals. Setting: We analyzed clinical and demographic data from the HIV Research Network and prescribing data from Medicaid for noncancer patients seeking HIV treatment at 4 urban clinics between 2006 and 2010. Methods: HIV Research Network patients were included in the analytic sample if they received at least one incident opioid prescription. We examined 4 measures of high-risk opioid use: (1) high daily dosage; (2) early refills; (3) overlapping prescriptions; and (4) multiple prescribers. Results: Of 4605 eligible PLWH, 1814 (39.4%) received at least one incident opioid prescription during follow-up. The sample was 61% men and 62% African American with a median age of 44.5 years. High-risk opioid use occurred among 30% of incident opioid users (high daily dosage: 7.9%; early refills: 15.9%; overlapping prescriptions: 16.4%; and multiple prescribers: 19.7%). About half of the cumulative incidence of high-risk use occurred within 1 year of receiving an opioid prescription. After adjusting for study site, high-risk opioid use was greater among patients with injection drug use as an HIV risk factor [adjusted hazard ratio (aHR) = 1.39, 95% confidence interval: 1.11 to 1.74], non-Hispanic whites [aHR = 1.61, (1.21 to 2.14)], patients age 35–45 [aHR = 1.94, (1.33 to 2.80)] and 45–55 [aHR = 1.84, (1.27 to 2.67)], and patients with a diagnosis of chronic pain [aHR = 1.32, (1.03 to 1.70)]. Conclusions: A large proportion of PLWH received opioid prescriptions, and among these opioid recipients, high-risk opioid use was common. High-risk use patterns often occurred within the first year, suggesting this is a critical time for intervention.

KW - HIV

KW - Medicaid

KW - Opioid misuse

KW - Prescription opioids

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