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. 2018 Jul 1;78(3):283-290.
doi: 10.1097/QAI.0000000000001690.

High-Risk Prescription Opioid Use Among People Living With HIV

Chelsea E Canan  1 , Geetanjali Chander  2 , Anne K Monroe  2 , Kelly A Gebo  2 , Richard D Moore  2 , Allison L Agwu  2 , G Caleb Alexander  1   2   3 , Bryan Lau  1 ; HIV Research Network
Affiliations

High-Risk Prescription Opioid Use Among People Living With HIV

Chelsea E Canan et al. J Acquir Immune Defic Syndr. .

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.

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Conflict of interest statement

Conflicts of interest: GCA is Chair of the FDA’s Peripheral and Central Nervous System Advisory Committee; serves as a paid consultant to QuintilesIMS; and is a member of OptumRx’s P&T Committee; this arrangement has been reviewed and approved by Johns Hopkins University in accordance with its conflict of interest policies.

Figures

Figure 1
Figure 1. Cumulative incidence of high-risk opioid use
The solid curve (the sum of Regions A through D) depicts the total cumulative incidence of any high-risk use pattern. The dashed lines depict the portion of the total cumulative incidence that each of the four high-risk use patterns contributes. Region A depicts the cumulative incidence contributed by high-daily dosage. Region B depicts the cumulative incidence contributed by overlapping prescriptions. Region C depicts the cumulative incidence contributed by early refills. Region D depicts the cumulative incidence contributed by multiple providers.
Figure 2
Figure 2. Time to recurrent early refills
The top panel shows the Kaplan-Meier survival function for first early refill, second early refill, and third early refill from the date of the first opioid prescription. The bottom panel depicts the Kaplan-Meier survival curves for the second and third early refills from the date of the first or second early refill, respectively.
See this image and copyright information in PMC

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