Mardge H Cohen1, Lorie Benning2, Kathleen M Weber3, Anjali Sharma4, Michael Plankey5, Mirjam-Colette Kempf6, Tracey E Wilson7, Brad Aouizerat8, Joel Milam9, Adaora A Adimora10, Gina Wingood11,12, Adam W Carrico12. 1. Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA. 2. Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA. 3. Hektoen Institute of Medicine, Cook County Health and Hospitals System, Chicago, Illinois, USA. 4. Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA. 5. Division of General Medicine, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA. 6. Departments of Family, Community and Health Systems, Health Behavior, Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA. 7. Department of Community Health Sciences, School of Public Health, SUNY Downstate Health Sciences University, Brooklyn, New York, USA. 8. Department of Oral and Maxillofacial Surgery, Bluestone Center for Clinical Research, College of Dentistry, New York University, New York, New York, USA. 9. Department of Epidemiology, School of Population Health, University of California at Irvine, Irvine, California, USA. 10. Department of Medicine, University of North Carolina School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA. 11. Department of Sociomedical Sciences, Mailman School of Public Health, Lerner Center for Public Health Promotion, New York, New York, USA. 12. Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, Florida, USA.
Abstract
Objective: To examine predictors and consequences of prescription opioid use among a cohort of women living with HIV (WLWH) and women without HIV from 2000 to 2019. Materials and Methods: The Women's Interagency HIV Study is a multisite, prospective cohort study. Cumulative proportion of visits with prescription opioid use was categorized as follows: minimal (0%-9%), intermediate (10%-39%), and chronic (>40%). Logistic regression examined independent predictors, and proportional hazards regression estimated unadjusted and adjusted hazards of all-cause mortality, comparing intermediate and chronic prescription opioid use with minimal use. Results: Annual prevalence of prescription opioid use significantly increased from 12.6% to 19.3% from 2000 to 2019 (p < 0.0001). Prescription opioid use was minimal in 75%, intermediate in 16%, and chronic in 9% of women. WLWH had 56% higher odds of chronic prescription opioid use compared with women without HIV. Even after adjusting for quality-of-life scores including ratings of pain, women with intermediate and chronic prescription opioid use had greater odds of being sexual minorities (lesbian or bisexual), unemployed, and were more likely to report benzodiazepine and nonprescription substance use compared with those with minimal use. Intermediate and chronic prescription opioid use were each associated with an almost 1.5-fold increased risk of all-cause mortality. Conclusions: Despite federally mandated opioid prescribing guidelines, prescription opioid use and related mortality significantly increased in women experiencing physical and psychosocial vulnerabilities. The higher mortality rate found among prescription opioid users may reflect the many underlying chronic medical and psychosocial conditions for which these opioids were prescribed, as well as complications of opioids themselves. Findings underscore the need for non-opioid and nonpharmacological interventions for chronic pain, particularly in sexual minorities and WLWH. Avoiding concurrent use of opioids with benzodiazepines and nonprescription drugs might reduce mortality. Clinical Trial Registration Number: NCT00000797.
Objective: To examine predictors and consequences of prescription opioid use among a cohort of women living with HIV (WLWH) and women without HIV from 2000 to 2019. Materials and Methods: The Women's Interagency HIV Study is a multisite, prospective cohort study. Cumulative proportion of visits with prescription opioid use was categorized as follows: minimal (0%-9%), intermediate (10%-39%), and chronic (>40%). Logistic regression examined independent predictors, and proportional hazards regression estimated unadjusted and adjusted hazards of all-cause mortality, comparing intermediate and chronic prescription opioid use with minimal use. Results: Annual prevalence of prescription opioid use significantly increased from 12.6% to 19.3% from 2000 to 2019 (p < 0.0001). Prescription opioid use was minimal in 75%, intermediate in 16%, and chronic in 9% of women. WLWH had 56% higher odds of chronic prescription opioid use compared with women without HIV. Even after adjusting for quality-of-life scores including ratings of pain, women with intermediate and chronic prescription opioid use had greater odds of being sexual minorities (lesbian or bisexual), unemployed, and were more likely to report benzodiazepine and nonprescription substance use compared with those with minimal use. Intermediate and chronic prescription opioid use were each associated with an almost 1.5-fold increased risk of all-cause mortality. Conclusions: Despite federally mandated opioid prescribing guidelines, prescription opioid use and related mortality significantly increased in women experiencing physical and psychosocial vulnerabilities. The higher mortality rate found among prescription opioid users may reflect the many underlying chronic medical and psychosocial conditions for which these opioids were prescribed, as well as complications of opioids themselves. Findings underscore the need for non-opioid and nonpharmacological interventions for chronic pain, particularly in sexual minorities and WLWH. Avoiding concurrent use of opioids with benzodiazepines and nonprescription drugs might reduce mortality. Clinical Trial Registration Number: NCT00000797.
Authors: Bryan Hartzler; Julia C Dombrowski; Heidi M Crane; Joseph J Eron; Elvin H Geng; W Christopher Mathews; Kenneth H Mayer; Richard D Moore; Michael J Mugavero; Sonia Napravnik; Benigno Rodriguez; Dennis M Donovan Journal: AIDS Behav Date: 2017-04