Prescription Long-term Opioid Use in HIV-infected Patients : The Clinical Journal of Pain (original) (raw)

Original Articles

Silverberg, Michael J. PhD, MPH*; Ray, Gary Thomas MBA*; Saunders, Kathleen JD†; Rutter, Carolyn M. PhD†; Campbell, Cynthia I. PhD*; Merrill, Joseph O. MD, MPH‡; Sullivan, Mark D. MD, PhD§; J. Banta-Green, Caleb PhD, MPH, MSW∥; Von Korff, Michael ScD†; Weisner, Constance DrPH, MSW*,¶

*Kaiser Permanente Northern California, Oakland, CA

†Group Health Research Institute, Seattle, WA

Departments of ‡Medicine

§Psychiatry and Behavioral Sciences

∥Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA

¶Department of Psychiatry, University of California, San Francisco

Supported by grant numbers R01 DA022557 (PI: Michael Von Korff at Group Health Cooperative, Seattle, WA) and R37 DA 10572 (PI: Constance Weisner at University of California at San Francisco and Kaiser Permanente Northern California, Oakland, CA) from NIDA and K01AI071725 from NIAID (PI: Michael J. Silverberg at Kaiser Permanente Northern California, Oakland, CA). The authors declare no conflict of interest.

Reprints: Michael J. Silverberg, PhD, MPH, Kaiser Permanente Division of Research, 2000 Broadway, 2nd floor, Oakland, CA, 94612 (e-mail: [email protected]).

Received April 3, 2010

Accepted April 17, 2011

Abstract

Objectives

To examine changes the in use of prescription opioids for the management of chronic noncancer pain in human immunodeficiency virus (HIV)-infected patients and to identify patient characteristics associated with long-term use.

Methods

Long-term prescription opioid use (ie, 120+ days supply or 10+ prescriptions during a year) was assessed between 1997 and 2005 among 6939 HIV-infected Kaiser Permanente members and HIV-uninfected persons in the general health plan memberships.

Results

In 2005, 8% of HIV+ individuals had prevalent long-term opioid use, more than double the prevalence among HIV-uninfected individuals. However, the large increases in use from 1997 to 2005 in the general population were not observed for HIV-infected individuals. The strongest associations with prevalent use among HIV-infected individuals were female sex with a prevalence ratio (PR) of 1.8 (95% CI=1.3, 2.5); Charlson comorbidity score of 2 or more (compared with a score of 0) with a PR of 1.9 (95% CI=1.4, 2.8); injection drug use history with a PR of 1.8 (95% CI=1.3, 2.6); and substance use disorders with a PR of 1.8 (95% CI=1.3, 2.5). CD4, HIV viral load, and acquired immunodeficiency syndrome diagnoses were associated with prevalent opioid use early in the antiretroviral therapy era (1997), but not in 2005.

Conclusions

Long-term opioid use for chronic pain has remained stable over time for HIV patients, whereas its use increased in the general population. The prevalence of prescribed opioids in HIV patients was highest for certain subgroups, including women, and those with a comorbidity and substance abuse history.