E Jennifer Edelman1,2, Yu Li3, Declan Barry4, Jennifer Brennan Braden5,6, Stephen Crystal7, Robert D Kerns4,8, Julie R Gaither9, Kirsha S Gordon1,8, Ajay Manhapra4,10, Jessica S Merlin11, Brent A Moore4,8, Benjamin J Oldfield1, Lesley S Park12, Christopher T Rentsch8,13, Melissa Skanderson8, Emily C Williams14,15, Amy C Justice1,8, Janet P Tate1,8, William C Becker1,8, Brandon D L Marshall3. 1. Department of Internal Medicine, Yale School of Medicine, New Haven, CT. 2. Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT. 3. Department of Epidemiology, Brown University School of Public Health, Providence, RI. 4. Department of Psychiatry, Yale School of Medicine, New Haven, CT. 5. Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA. 6. UW Medicine Valley Medical Center Psychiatry, Renton, WA. 7. Center for Health Services Research, Institute for Health, Rutgers University, Rutgers, NJ. 8. VA Connecticut Healthcare System, West Haven, CT. 9. Department of Pediatrics, Yale School of Medicine, New Haven, CT. 10. Hampton VA Medical Center, Hampton, VA. 11. Department of Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 12. Stanford Center for Population Health Sciences, Stanford University School of Medicine, Palo Alto, CA. 13. Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom. 14. Department of Health Services, University of Washington School of Public Health, Seattle, WA; and. 15. Seattle-Denver Center of Innovation for Veteran-Centered Value-Driven Care, VA Puget Sound Health Services Research Development, Seattle, WA.
Abstract
BACKGROUND: No prior studies have characterized long-term patterns of opioid use regardless of source or reason for use among patients with HIV (PWH). We sought to identify trajectories of self-reported opioid use and their correlates among a national sample of PWH engaged in care. SETTING: Veterans Aging Cohort Study, a prospective cohort including PWH receiving care at 8 US Veterans Health Administration (VA) sites. METHODS: Between 2002 and 2018, we assessed past year opioid use frequency based on self-reported "prescription painkillers" and/or heroin use at baseline and follow-up. We used group-based trajectory models to identify opioid use trajectories and multinomial logistic regression to determine baseline factors independently associated with escalating opioid use compared to stable, infrequent use. RESULTS: Among 3702 PWH, we identified 4 opioid use trajectories: (1) no lifetime use (25%); (2) stable, infrequent use (58%); (3) escalating use (7%); and (4) de-escalating use (11%). In bivariate analysis, anxiety; pain interference; prescribed opioids, benzodiazepines and gabapentinoids; and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. In multivariable analysis, illness severity, pain interference, receipt of prescribed benzodiazepine medications, and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. CONCLUSION: Among PWH engaged in VA care, 1 in 15 reported escalating opioid use. Future research is needed to understand the impact of psychoactive medications and marijuana use on opioid use and whether enhanced uptake of evidence-based treatment of pain and psychiatric symptoms can prevent escalating use among PWH.
BACKGROUND: No prior studies have characterized long-term patterns of opioid use regardless of source or reason for use among patients with HIV (PWH). We sought to identify trajectories of self-reported opioid use and their correlates among a national sample of PWH engaged in care. SETTING: Veterans Aging Cohort Study, a prospective cohort including PWH receiving care at 8 US Veterans Health Administration (VA) sites. METHODS: Between 2002 and 2018, we assessed past year opioid use frequency based on self-reported "prescription painkillers" and/or heroin use at baseline and follow-up. We used group-based trajectory models to identify opioid use trajectories and multinomial logistic regression to determine baseline factors independently associated with escalating opioid use compared to stable, infrequent use. RESULTS: Among 3702 PWH, we identified 4 opioid use trajectories: (1) no lifetime use (25%); (2) stable, infrequent use (58%); (3) escalating use (7%); and (4) de-escalating use (11%). In bivariate analysis, anxiety; pain interference; prescribed opioids, benzodiazepines and gabapentinoids; and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. In multivariable analysis, illness severity, pain interference, receipt of prescribed benzodiazepine medications, and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. CONCLUSION: Among PWH engaged in VA care, 1 in 15 reported escalating opioid use. Future research is needed to understand the impact of psychoactive medications and marijuana use on opioid use and whether enhanced uptake of evidence-based treatment of pain and psychiatric symptoms can prevent escalating use among PWH.
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