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