Prescription of High-Dose Opioids Among People Living with HIV in British Columbia, Canada.
Jessica ClarkNadia FairbairnSeonaid NolanTian LiAnthony WuRolando BarriosJulio MontanerLianping Tinull nullPublished in: AIDS and behavior (2020)
People living with HIV (PLHIV) often experience pain for which opioid medications may be prescribed. Thus, these individuals are particularly vulnerable to opioid-related harms, including overdose, misuse, and addiction, particularly when prescribed at high doses. We used a comprehensive linked population-level database of PLHIV in British Columbia (BC) to identify demographic and clinical characteristics associated with being prescribed any high-dose opioid analgesic, defined as > 90 daily morphine milligram equivalents (MME/day). Among PLHIV who were prescribed opioids between 1996 and 2015 (n = 10,780), 28.2% received prescriptions of > 90 MME/day at least once during the study period. Factors positively associated with being prescribed high-dose opioid analgesics included: co-prescription of benzodiazepines (adjusted odds ratio [AOR] = 1.14; 95% confidence interval 1.11-1.17); presence of an AIDS-defining illness (ADI; AOR = 1.78; 95% CI 1.57-2.02); seen by an HIV specialist (AOR = 1.24; 95% CI 1.20-1.29); substance use disorder (AOR = 1.46; 95% CI 1.25-1.71); and more recent calendar year (AOR = 1.05; 95% CI 1.04-1.06). Given the known risks associated with high-dose opioid prescribing, future research efforts should focus on the clinical indication and outcomes associated with these prescribing practices.
Keyphrases
- chronic pain
- high dose
- pain management
- low dose
- stem cell transplantation
- primary care
- antiretroviral therapy
- healthcare
- hiv infected
- hiv aids
- human immunodeficiency virus
- hiv positive
- palliative care
- emergency department
- physical activity
- adipose tissue
- human health
- quality improvement
- current status
- anti inflammatory
- metabolic syndrome