Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

ABSTRACT

BACKGROUND

Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status.

OBJECTIVES

To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids.

DESIGN

Cross-sectional analysis of the Veterans Aging Cohort Study.

PARTICIPANTS

HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls.

MAIN MEASURES

Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥120 mg of morphine equivalents; long-term opioids was defined as ≥90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes.

KEY RESULTS

Among the HIV+ (n = 23,651) and uninfected (n = 55,097) patients, 31 % of HIV+ and 28 % of uninfected (p < 0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p = 0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p < 0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p < 0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p < 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01).

CONCLUSIONS

Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.

APPENDIX 1

We made the following assumptions to determine the milligram of morphine equivalents for each opioid: 1) If the quantity of pills was less than the intended days supply of the prescription, then days supply was considered equal to the quantity of pills as we assumed patients did not take less than one pill; 2) Each fentanyl patch was dispensed over 72 h, consistent with previous literature;30 3) Cough elixirs were prescribed to be taken as 7.5 mL (between 5 and 10 mL) every 4–6 h (37.5 mL per day) for 7 days; 4) We assumed that patients were taking no less than 10 mL per day of a opioid given solution (excluding cough elixirs); if a quantity of solution/days supply was less than 10 mL, then days supply was set equal to the quantity divided by 10 and we assumed that an equal amount was taken on each day. For a quantity of one, we assumed this was equal to one bottle of 500 mL of solution; and 5) For solutions (1 % of all formulations), we accounted for differences in concentration such that for XX mg opioid in YY mL solution, then quantity was divided by YY.