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Journal of General Internal Medicine

, Volume 28, Issue 1, pp 82–90 | Cite as

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

  • E. Jennifer EdelmanEmail author
  • Kirsha Gordon
  • William C. Becker
  • Joseph L. Goulet
  • Melissa Skanderson
  • Julie R. Gaither
  • Jennifer Brennan Braden
  • Adam J. Gordon
  • Robert D. Kerns
  • Amy C. Justice
  • David A. Fiellin
Original Research

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.

KEY WORDS

opioid pain HIV narcotics veterans 

Notes

Acknowledgements

This work was generously supported by the Society of General Internal Medicine’s Lawrence Linn Award, the Robert Wood Johnson Foundation Clinical Scholars Program, the Department of Veterans Affairs and the Veterans Aging Cohort study, funded by the National Institute on Alcohol Abuse and Alcoholism (U10 AA 13566).

This work was presented as oral presentations in earlier versions at the Veterans Aging Cohort Study Scientific Meeting, October 13th, 2011, Washington, D.C. and the Society of General Internal Medicine 35th National Annual Meeting, May 12th, 2012, Orlando, FL.

Disclosures

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Copyright information

© Society of General Internal Medicine 2012

Authors and Affiliations

  • E. Jennifer Edelman
    • 1
    • 2
    Email author
  • Kirsha Gordon
    • 3
  • William C. Becker
    • 1
    • 3
  • Joseph L. Goulet
    • 3
    • 4
    • 9
  • Melissa Skanderson
    • 3
    • 8
  • Julie R. Gaither
    • 5
  • Jennifer Brennan Braden
    • 6
  • Adam J. Gordon
    • 7
    • 8
  • Robert D. Kerns
    • 4
    • 9
    • 10
  • Amy C. Justice
    • 1
    • 2
    • 3
    • 9
  • David A. Fiellin
    • 1
    • 2
  1. 1.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  2. 2.Center for Interdisciplinary Research on AIDSYale University School of Public HealthNew HavenUSA
  3. 3.VA Connecticut Healthcare SystemWest HavenUSA
  4. 4.Department of PsychiatryYale University School of MedicineNew HavenUSA
  5. 5.Yale University School of Public HealthNew HavenUSA
  6. 6.Department of PsychiatryUniversity of WashingtonSeattleUSA
  7. 7.Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  8. 8.VA Pittsburgh Healthcare SystemPittsburghUSA
  9. 9.Pain Research, Informatics, Medical Comorbidities and Education (PRIME) CenterVA Connecticut Healthcare SystemWest HavenUSA
  10. 10.Departments of Neurology and PsychologyYale University School of MedicineNew HavenUSA

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