Skip to main content

Advertisement

SpringerLink
Log in

Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Opioids are often prescribed for chronic pain, and opioid risks such as overdose and death are heightened when opioids are co-prescribed with other sedating medications. We investigated factors associated with chronic opioid prescription, alone and in combination with benzodiazepines and muscle relaxants, in a clinical cohort of individuals with HIV. We used multivariable logistic regression models to determine participant clinical and demographic characteristics that are associated with chronic prescription of opioids or chronic co-prescription of opioids with sedating medications. Among 1474 participants, chronic prescription of opioids occurred in 253 individuals (17.2 %), and chronic co-prescription occurred in 90 individuals (6.1 %). Age >50, public insurance as compared to private insurance, and symptoms of depression and anxiety were significantly associated with chronic opioid prescription and chronic co-prescription. Our findings raise concern that opioid prescription and co-prescription of sedating medications occurs disproportionately in patients for whom use is riskier.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Collaboration ATC. Life expectancy of individuals on combination antiretroviral therapy in high-income countries: a collaborative analysis of 14 cohort studies. Lancet. 2008;372(9635):293–9.

    Article  Google Scholar 

  2. Balderson BH, Grothaus L, Harrison RG, McCoy K, Mahoney C, Catz S. Chronic illness burden and quality of life in an aging HIV population. AIDS Care. 2013;25(4):451–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Edelman EJ, Gordon KS, Glover J, McNicholl IR, Fiellin DA, Justice AC. The next therapeutic challenge in HIV: polypharmacy. Drugs Aging. 2013;30(8):613–28.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Daubresse M, Chang HY, Yu Y, Viswanathan S, Shah ND, Stafford RS, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000–2010. Med Care. 2013;51(10):870–8.

    Article  PubMed  Google Scholar 

  5. Miaskowski C, Penko JM, Guzman D, Mattson JE, Bangsberg DR, Kushel MB. Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection. J Pain. 2011;12(9):1004–16.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Merlin JS, Cen L, Praestgaard A, Turner M, Obando A, Alpert C, et al. Pain and physical and psychological symptoms in ambulatory HIV patients in the current treatment era. J Pain Symptom Manage. 2012;43(3):638–45.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Merlin JS, Westfall AO, Raper JL, Zinski A, Norton WE, Willig JH, et al. Pain, Mood, and Substance Abuse in HIV: Implications for Clinic Visit Utilization, ART Adherence, and Virologic Failure. J Acquir Immune Defic Syndr. 2012;61(2):164–70.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Newshan G, Bennett J, Holman S. Pain and other symptoms in ambulatory HIV patients in the age of highly active antiretroviral therapy. J Assoc Nurses AIDS Care. 2002;13(4):78–83.

    Article  PubMed  Google Scholar 

  9. Aouizerat BE, Miaskowski CA, Gay C, Portillo CJ, Coggins T, Davis H, et al. Risk factors and symptoms associated with pain in HIV-infected adults. J Assoc Nurses AIDS Care. 2010;21(2):125–33.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Cervia LD, McGowan JP, Weseley AJ. Clinical and demographic variables related to pain in HIV-infected individuals treated with effective, combination antiretroviral therapy (cART). Pain Med. 2010;11(4):498–503.

    Article  PubMed  Google Scholar 

  11. Edelman EJ, Gordon K, Becker WC, Goulet JL, Skanderson M, Gaither JR, et al. Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients. J Gen Intern Med. 2012;28(1):82–90.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Silverberg MJ, Ray GT, Saunders K, Rutter CM, Campbell CI, Merrill JO, et al. Prescription long-term opioid use in HIV-infected patients. Clin J Pain. 2012;28(1):39–46.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Noble M, Treadwell JR, Tregear SJ, Coates VH, Wiffen PJ, Akafomo C, et al. Long-term opioid management for chronic noncancer pain. Cochrane Database Syst Rev. 2010;1:CD006605.

    PubMed  Google Scholar 

  14. Bohnert AS, Valenstein M, Bair MJ, Ganoczy D, McCarthy JF, Ilgen MA, et al. Association between opioid prescribing patterns and opioid overdose-related deaths. JAMA. 2011;305(13):1315–21.

    Article  CAS  PubMed  Google Scholar 

  15. Dunn KM, Saunders KW, Rutter CM, Banta-Green CJ, Merrill JO, Sullivan MD, et al. Opioid prescriptions for chronic pain and overdose: a cohort study. Ann Intern Med. 2010;152(2):85–92.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Johnson EM, Lanier WA, Merrill RM, Crook J, Porucznik CA, Rolfs RT, et al. Unintentional prescription opioid-related overdose deaths: description of decedents by next of kin or best contact, Utah, 2008–2009. J Gen Intern Med. 2012;. doi:10.1007/s11606-012-2225-z.

    Google Scholar 

  17. Kuehn BM. Methadone overdose deaths rise with increased prescribing for pain. JAMA. 2012;308(8):749–50.

    Article  CAS  PubMed  Google Scholar 

  18. Webster LR, Cochella S, Dasgupta N, Fakata KL, Fine PG, Fishman SM, et al. An analysis of the root causes for opioid-related overdose deaths in the United States. Pain Med. 2011;12(Suppl 2):S26–35.

    Article  PubMed  Google Scholar 

  19. Webster LR. Considering the risks of benzodiazepines and opioids together. Pain Med. 2010;11(6):801–2.

    Article  PubMed  Google Scholar 

  20. Skurtveit S, Furu K, Bramness J, Selmer R, Tverdal A. Benzodiazepines predict use of opioids–a follow-up study of 17,074 men and women. Pain Med. 2010;11(6):805–14.

    Article  PubMed  Google Scholar 

  21. Paulozzi LJ, Kilbourne EM, Shah NG, Nolte KB, Desai HA, Landen MG, et al. A history of being prescribed controlled substances and risk of drug overdose death. Pain Med. 2012;13(1):87–95.

    Article  PubMed  Google Scholar 

  22. Oliver P, Keen J. Concomitant drugs of misuse and drug using behaviours associated with fatal opiate-related poisonings in Sheffield, UK, 1997–2000. Addiction. 2003;98(2):191–7.

    Article  PubMed  Google Scholar 

  23. Jones JD, Mogali S, Comer SD. Polydrug abuse: a review of opioid and benzodiazepine combination use. Drug Alcohol Depend. 2012;125(1–2):8–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Gudin JA, Mogali S, Jones JD, Comer SD. Risks, management, and monitoring of combination opioid, benzodiazepines, and/or alcohol use. Postgrad Med. 2013;125(4):115–30.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Merlins JS, Tucker RO, Saag MS, Selwyn PA. The role of palliative care in the current HIV treatment era in developed countries. Top Antivir Med. 2013;21(1):20–6.

    PubMed  Google Scholar 

  26. Starrels JL PD, Fox AD, Merlin J, Arnsten JH, Cunningham CO. HIV Treatment providers’ perspectives on opioid prescribing for chronic pain: the overriding concern to retain patients in care [oral abstract presentation]. Paper presented at: Association of Medical Education and Research in Substance Abuse, November 8, 2013, Bethesda.

  27. Burkholder GA, Tamhane AR, Appell LE, Willig JH, Saag MS, Raper JL, et al. Short Communication: Viral Suppression Is Associated with Increased Likelihood of Colorectal Cancer Screening Among Persons Living with HIV/AIDS. AIDS Res Hum Retroviruses. 2015;31(5):519–24.

    Article  CAS  PubMed  Google Scholar 

  28. Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Mathews WC, May S. EuroQol (EQ-5D) measure of quality of life predicts mortality, emergency department utilization, and hospital discharge rates in HIV-infected adults under care. Health Qual Life Outcomes. 2007;5:5.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Newcombe DA, Humeniuk RE, Ali R. Validation of the world health organization alcohol, smoking and substance involvement screening test (ASSIST): report of results from the Australian site. Drug Alcohol Rev. 2005;24(3):217–26.

    Article  PubMed  Google Scholar 

  31. Bush K, Kivlahan DR, McDonell MB, Fihn SD, Bradley KA. The AUDIT alcohol consumption questions (AUDIT-C): an effective brief screening test for problem drinking. Ambulatory Care Quality Improvement Project (ACQUIP). Alcohol Use Disorders Identification Test. Arch Intern Med. 1998;158(16):1789–95.

    Article  CAS  PubMed  Google Scholar 

  32. P. A. Logistic regression using the SAS system. Publisher: SAS Institute Inc. Edition: August 2003.

  33. Weisberg DF, Gordon KS, Barry DT, Becker WC, Crystal S, Edelman EJ, et al. Long-term Prescription of Opioids and/or Benzodiazepines and Mortality Among HIV-Infected and Uninfected Patients. J Acquir Immune Defic Syndr. 2015;69(2):223–33.

    Article  CAS  PubMed  Google Scholar 

  34. Gomes T, Mamdani MM, Dhalla IA, Paterson JM, Juurlink DN. Opioid dose and drug-related mortality in patients with nonmalignant pain. Arch Intern Med. 2011;171(7):686–91.

    Article  CAS  PubMed  Google Scholar 

  35. Paulozzi LJ, Mack KA, Hockenberry JM. Division of Unintentional Injury Prevention NtCfIPaC, C. D. C. Vital signs: variation among States in prescribing of opioid pain relievers and benzodiazepines—United States, 2012. MMWR Morb Mortal Wkly Rep. 2014;63(26):563–8.

    PubMed  Google Scholar 

  36. Gaither JR, Goulet JL, Becker WC, Crystal S, Edelman EJ, Gordon K, et al. Guideline-concordant management of opioid therapy among human immunodeficiency virus (HIV)-infected and uninfected veterans. J Pain. 2014;. doi:10.1016/j.jpain.2014.08.004.

    PubMed  PubMed Central  Google Scholar 

  37. Dobscha SK, Morasco BJ, Duckart JP, Macey T, Deyo RA. Correlates of prescription opioid initiation and long-term opioid use in veterans with persistent pain. Clin J Pain. 2013;29(2):102–8.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Dobscha SK. Prescription opioids and benzodiazepines: moving beyond “just say no”. Pain Med. 2013;14(10):1447–9.

    Article  PubMed  Google Scholar 

  39. Cropsey KL, Stevens EN, Valera P, Brendan Clark C, Bulls HW, Nair P, et al. Risk factors for concurrent use of benzodiazepines and opioids among individuals under community corrections supervision. Drug Alcohol Depend. 2015;. doi:10.1016/j.drugalcdep.2015.06.038.

    PubMed  Google Scholar 

  40. Richards BL, Whittle SL, van der Heijde DM, Buchbinder R. The efficacy and safety of muscle relaxants in inflammatory arthritis: a cochrane systematic review. J Rheumatol Suppl. 2012;90:34–9.

    Article  CAS  PubMed  Google Scholar 

  41. Sullivan MD, Howe CQ. Opioid therapy for chronic pain in the United States: promises and perils. Pain. 2013;154(Suppl 1):S94–100.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Rogers KD, Kemp A, McLachlan AJ, Blyth F. Adverse selection? A multi-dimensional profile of people dispensed opioid analgesics for persistent non-cancer pain. PLoS One. 2013;8(12):e80095.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Sullivan MD, Edlund MJ, Zhang L, Unützer J, Wells KB. Association between mental health disorders, problem drug use, and regular prescription opioid use. Arch Intern Med. 2006;166(19):2087–93.

    Article  PubMed  Google Scholar 

  44. Sullivan MD, Edlund MJ, Steffick D, Unützer J. Regular use of prescribed opioids: association with common psychiatric disorders. Pain. 2005;119(1–3):95–103.

    Article  PubMed  Google Scholar 

  45. Edlund MJ, Martin BC, Devries A, Fan MY, Braden JB, Sullivan MD. Trends in use of opioids for chronic noncancer pain among individuals with mental health and substance use disorders: the TROUP study. Clin J Pain. 2010;26(1):1–8.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Parsells Kelly J, Cook SF, Kaufman DW, Anderson T, Rosenberg L, Mitchell AA. Prevalence and characteristics of opioid use in the US adult population. Pain. 2008;138(3):507–13.

    Article  PubMed  Google Scholar 

  47. Simoni-Wastila L, Ritter G, Strickler G. Gender and other factors associated with the nonmedical use of abusable prescription drugs. Subst Use Misuse. 2004;39(1):1–23.

    Article  PubMed  Google Scholar 

  48. Calcaterra S, Glanz J, Binswanger IA. National trends in pharmaceutical opioid related overdose deaths compared to other substance related overdose deaths: 1999–2009. Drug Alcohol Depend. 2013;131(3):263–70.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Lum PJ, Little S, Botsko M, Hersh D, Thawley RE, Egan JE, et al. Opioid-prescribing practices and provider confidence recognizing opioid analgesic abuse in HIV primary care settings. J Acquir Immune Defic Syndr. 2011;56(Suppl 1):S91–7.

    Article  PubMed  Google Scholar 

  50. Perry BA, Westfall AO, Molony E, Tucker R, Ritchie C, Saag MS, et al. Characteristics of an ambulatory palliative care clinic for HIV-infected patients. J Palliat Med. 2013;. doi:10.1089/jpm.2012.0451.

    PubMed  PubMed Central  Google Scholar 

  51. Önen NF, Barrette EP, Shacham E, Taniguchi T, Donovan M, Overton ET. A review of opioid prescribing practices and associations with repeat opioid prescriptions in a contemporary outpatient HIV clinic. Pain Pract. 2012;12(6):440–8.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Johnson A, Condon KD, Mapas-Dimaya AC, Schrager J, Grossberg R, Gonzalez R, et al. Report of an HIV clinic-based pain management program and utilization of health status and health service by HIV patients. J Opioid Manag. 2012;8(1):17–27.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was supported by the University of Alabama at Birmingham (UAB) Center for AIDS Research, an NIH funded program (P30 A1027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, FIC, and OAR. JSM was supported by 1K12HS02169401 (AHRQ). JLS was supported by K23DA027719 (NIDA). Funding was also provided by the Mary Fisher CARE Fund at UAB.

Author information

Authors and Affiliations

  1. Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, BBRB 222, 1530 3rd Ave S, Birmingham, AL, 35294-2170, USA

    Jessica S. Merlin, Ashutosh Tamhane & Michael Saag

  2. Division of Gerontology, Geriatrics, and Palliative Care, University of Alabama at Birmingham, Birmingham, AL, USA

    Jessica S. Merlin

  3. Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, USA

    Joanna L. Starrels

  4. Birmingham VA Medical Center, Birmingham, AL, USA

    Stefan Kertesz

  5. Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA

    Stefan Kertesz

  6. Department of Psychiatry, University of Alabama at Birmingham, Birmingham, AL, USA

    Karen Cropsey

Authors
  1. Jessica S. Merlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashutosh Tamhane
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Joanna L. Starrels
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stefan Kertesz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Saag
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karen Cropsey
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jessica S. Merlin.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 34 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Merlin, J.S., Tamhane, A., Starrels, J.L. et al. Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV. AIDS Behav 20, 687–698 (2016). https://doi.org/10.1007/s10461-015-1178-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-015-1178-8

Keywords

Search

Navigation