British Columbia’s (BC’s) overdose crisis has had devastating impacts on the general population, but little is known on how it has affected People living with HIV (PLWH). We therefore characterized the annual crude mortality rates for overdose-related deaths, and examined potential risk and protective factors for overdose-related mortality in our population.
Using the BC STOP HIV/AIDS database, we examined overdose-related deaths among PLWH in BC, Canada who were followed for >6 months between April 1, 2009-March 31, 2017 in BC, Canada. Overdose-related deaths were ascertained using ICD-10 codes in the Vital Statistics registry. Confounder-adjusted logistic regression models examined whether opioid use disorder (OUD) diagnoses (defined as an ever-recorded OAT dispensation, ever ? 3 physician claims, or 1 hospital admission) and opioid agonist therapy (OAT)s prescriptions were associated with overdose-related mortality.
Of 9594 PLWH in BC during the study period, 166 (18%) died of overdose-related causes. The crude period mortality rate was 2.89 deaths per 1,000 person-years (PY), with women experiencing 1.81 times higher rates of overdose-related mortality. Annual mortality rates began increasing in 2012/13 to a high of 5.1 deaths per 1,000 PY in 2016/17. Of those who died from overdose, 75% met the prescription criteria for OAT, while 51% did not receive an OAT prescription. Women were significantly more likely to be prescribed neuropathic pain relievers (NPRs), selective serotonin reuptake inhibitors (SSRIs), serotonin–norepinephrine reuptake inhibitors (SNRIs), and sedatives. After adjustment for health authority, gender, HCV co-infection status, diagnosis of a mental health illness, date of most recent OAT prescription, and age at death, people who were diagnosed with OUD has 3.48x the odds of dying of overdose compared to all causes of death, while the absence of OAT was non-significantly associated with risk of overdose deaths (AOR: 1.09, 95% CI: 0.70-1.7).
Overdose-related mortality among PLWH, which has been increasing amid the opioid crisis, is significantly correlated to chronic prescription trends and OUD, and non-significantly associated with the absence of OAT. Further research into these factors, particularly as mediated by OAT, may shed light on vulnerabilities related to prescription practices, drug interactions with OAT medications, and missed opportunities for OAT.