Prescription Analgesic Use and Misuse among People Living with HIV in the United States
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Date
2017-10-06
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Johns Hopkins University
Abstract
Background: Opioid misuse is a growing public health issue in the United States and is particularly concerning among people living with HIV (PLWH). Though PLWH are at high risk for opioid misuse, little research is available to describe or quantify risk factors for their elevated risk. Describing the trends in opioid prescribing among PLWH and identifying characteristics of PLWH at highest risk for opioid misuse can help to guide the treatment of chronic pain while minimizing potential harms.
Methods: We examined trends in opioid and non-opioid oral analgesic prescribing among PLWH compared to individuals without HIV. Next, we identified factors associated with high-risk opioid use by analyzing prescription claims from individuals attending HIV clinics in the United States. Finally, we applied an indirect questioning technique to estimate the prevalence of opioid diversion in the absence of social desirability bias.
Results: We found an increasing trend in prevalence for both opioid and non-opioid analgesics between 2001-2009 regardless of HIV status. In all years, PLWH received more analgesic prescriptions compared to individuals without HIV. PLWH had a higher incidence of chronic opioid therapy (COT), defined as ≥90 consecutive days of opioid use, but the increased hazard for COT was explained by differences in co-morbidities. High-risk opioid use was common among PLWH, with approximately one third of PLWH who had received an opioid prescription meeting high-risk use criteria. Nearly half of all high-risk opioid use occurred within one year of receiving an opioid prescription. Using an indirect questioning technique, we found that 11.5% of patients at an urban HIV clinic had ever given away or sold their opioid prescriptions. This prevalence of opioid diversion was twice as high as the prevalence obtained by directly asking patients if they had ever diverted opioids.
Conclusion: High rates of opioid prescribing and COT among PLWH are concerning because they may lead to opioid misuse; high-risk use patterns and opioid diversion were both common in our study. Applying our results to assess patients’ risk for opioid misuse and carefully monitoring prescribing patterns to avoid over-prescribing may help to mitigate adverse consequences of opioid misuse and reduce opioid diversion.
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HIV, PLWH, prescription opioids, opioid misuse, opioid diversion, indirect questioning