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 Robert Beil and Uriel Felsen and Judith Aberg and Antonio Urbina and Korthuis, {P. Todd} and Nijhawan, {Ank E} 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

AU - Felsen, Uriel

AU - Aberg, Judith

AU - Urbina, Antonio

AU - Korthuis, P. Todd

AU - Nijhawan, Ank E

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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