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High-Risk Prescription Opioid use Among People Living with Hiv.

High-Risk Prescription Opioid use Among People Living with Hiv.
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Canan CE, Chander G, Monroe AK, Gebo KA, Moore RD, Agwu AL, Alexander GC, Lau B,


Canan CE, Chander G, Monroe AK, Gebo KA, Moore RD, Agwu AL, Alexander GC, Lau B, (click to view)

Canan CE, Chander G, Monroe AK, Gebo KA, Moore RD, Agwu AL, Alexander GC, Lau B,

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Journal of acquired immune deficiency syndromes (1999) 2018 03 27() doi 10.1097/QAI.0000000000001690

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 (HIVRN) and prescribing data from Medicaid for non-cancer patients seeking HIV treatment at four urban clinics between 2006-2010.

METHODS
HIVRN patients were included in the analytic sample if they received at least one incident opioid prescription. We examined four measures of high-risk opioid use: 1) high daily dosage; 2) early refills; 3) overlapping prescriptions; and 4) multiple prescribers.

RESULTS
Of 4,605 eligible PLWH, 1,814 (39.4%) received at least one incident opioid prescription during follow-up. The sample was 61% male 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%; multiple prescribers: 19.7%). About half of the cumulative incidence of high-risk use occurred within one year of receiving an opioid prescription. After adjusting for study site, high-risk opioid use was greater among patients with IDU as an HIV risk factor (aHR=1.39, 95% CI 1.11-1.74), non-Hispanic whites (aHR=1.61, [1.21-2.14]), patients age 35-45 (aHR=1.94, [1.33-2.80]) and 45-55 (aHR=1.84, [1.27-2.67]) and patients with a diagnosis of chronic pain (aHR=1.32, [1.03-1.70]).

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.

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