Stephanie Parent1, Seonaid Nolan2, Nadia Fairbairn2, Monica Ye1, Anthony Wu1, Julio Montaner3, Rolando Barrios4, Lianping Ti5. 1. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. 2. British Columbia Centre on Substance Use, 400-1045 HOwe Street, Vancouver, BC, V6Z 2A9. 3. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. 4. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Vancouver Coastal Health, 520 West 6(th)Avenue, Vancouver, BC V6Z 4H5, Canada. 5. British Columbia Centre on Substance Use, 400-1045 HOwe Street, Vancouver, BC, V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: lianping.ti@bccsu.ubc.ca.
Abstract
BACKGROUND: Co-prescribing benzodiazepines and opioids is relatively contraindicated due to the possible overdose risk. However, people living with HIV (PLWH) may have concurrent psychiatric and/or chronic pain diagnoses that may lead to the use of opioids and/or benzodiazepines for symptomatic treatment. Consequently, some PLWH may be at-risk for the health harms associated with the co-prescribing of these medications. Given this, the objectives of this study were to first examine the prevalence of opioids and benzodiazepines co-prescribing, and second, to characterize patient factors associated with the co-prescribing of opioids and benzodiazepines among PLWH in British Columbia (BC), Canada. METHODS: Using data derived from a longitudinal BC cohort, we used bivariable and multivariable generalized estimating equation models to establish the prevalence of a benzodiazepine and opioid co-prescription and determine factors associated with this practice. RESULTS: Between 1996 and 2015, 14 484 PLWH were included in the study and were followed for the entire study period. At baseline, 548 people (4%) were co-prescribed opioids and benzodiazepines, 6593 (46%) were prescribed opioids only, 2887 (20%) were prescribed benzodiazepines only, and 4456 (31%) were prescribed neither medication. A total of 3835 (27%) participants were prescribed both medications at least once during the study period. Factors positively associated with concurrent opioid and benzodiazepine prescribing included: depression/mood disorder [adjusted odds ratio (AOR) = 1.32; 95% confidence interval (CI) = 1.22-1.43] and anxiety disorder (AOR = 1.45; 95% CI = 1.27-1.66), whereas female sex (AOR = 0.76; 95% CI = 0.64-0.91) and substance use disorder (SUD) (AOR = 0.82; 95% CI = 0.74-0.90) were negatively associated with the outcome. CONCLUSION: Our findings indicate that co-prescription of opioids and benzodiazepines was seen at some point during study follow-up in over a quarter of PLWH. Given the known risks associated with this prescribing practice, future research can focus on the outcomes of co-prescribing among this patient population and the development of strategies to reduce the co-prescribing of opioids and benzodiazepines.
BACKGROUND: Co-prescribing benzodiazepines and opioids is relatively contraindicated due to the possible overdose risk. However, people living with HIV (PLWH) may have concurrent psychiatric and/or chronic pain diagnoses that may lead to the use of opioids and/or benzodiazepines for symptomatic treatment. Consequently, some PLWH may be at-risk for the health harms associated with the co-prescribing of these medications. Given this, the objectives of this study were to first examine the prevalence of opioids and benzodiazepines co-prescribing, and second, to characterize patient factors associated with the co-prescribing of opioids and benzodiazepines among PLWH in British Columbia (BC), Canada. METHODS: Using data derived from a longitudinal BC cohort, we used bivariable and multivariable generalized estimating equation models to establish the prevalence of a benzodiazepine and opioid co-prescription and determine factors associated with this practice. RESULTS: Between 1996 and 2015, 14 484 PLWH were included in the study and were followed for the entire study period. At baseline, 548 people (4%) were co-prescribed opioids and benzodiazepines, 6593 (46%) were prescribed opioids only, 2887 (20%) were prescribed benzodiazepines only, and 4456 (31%) were prescribed neither medication. A total of 3835 (27%) participants were prescribed both medications at least once during the study period. Factors positively associated with concurrent opioid and benzodiazepine prescribing included: depression/mood disorder [adjusted odds ratio (AOR) = 1.32; 95% confidence interval (CI) = 1.22-1.43] and anxiety disorder (AOR = 1.45; 95% CI = 1.27-1.66), whereas female sex (AOR = 0.76; 95% CI = 0.64-0.91) and substance use disorder (SUD) (AOR = 0.82; 95% CI = 0.74-0.90) were negatively associated with the outcome. CONCLUSION: Our findings indicate that co-prescription of opioids and benzodiazepines was seen at some point during study follow-up in over a quarter of PLWH. Given the known risks associated with this prescribing practice, future research can focus on the outcomes of co-prescribing among this patient population and the development of strategies to reduce the co-prescribing of opioids and benzodiazepines.
Authors: Kathleen W Saunders; Michael Von Korff; Cynthia I Campbell; Caleb J Banta-Green; Mark D Sullivan; Joseph O Merrill; Constance Weisner Journal: J Pain Date: 2012-01-29 Impact factor: 5.820
Authors: Kalysha Closson; Chuck Osborne; Danielle M Smith; Sarah Kesselring; Oghenowede Eyawo; Kiffer Card; Paul Sereda; Shahab Jabbari; Conrado Franco-Villalobos; Tareq Ahmed; Karyn Gabler; Thomas Patterson; Mark Hull; Julio S G Montaner; Robert S Hogg Journal: AIDS Behav Date: 2018-05
Authors: Kate Heath; Hasina Samji; Bohdan Nosyk; Guillaume Colley; Mark Gilbert; Robert S Hogg; Julio Sg Montaner Journal: Int J Epidemiol Date: 2014-04-02 Impact factor: 7.196
Authors: Constance M Weisner; Cynthia I Campbell; Thomas G Ray; Kathleen Saunders; Joseph O Merrill; Caleb Banta-Green; Mark D Sullivan; Michael J Silverberg; Jennifer R Mertens; Denise Boudreau; Michael Von Korff Journal: Pain Date: 2009-07-05 Impact factor: 6.961
Authors: Daniel F Weisberg; Kirsha S Gordon; Declan T Barry; William C Becker; Stephen Crystal; Eva J Edelman; Julie Gaither; Adam J Gordon; Joseph Goulet; Robert D Kerns; Brent A Moore; Janet Tate; Amy C Justice; David A Fiellin Journal: J Acquir Immune Defic Syndr Date: 2015-06-01 Impact factor: 3.771