Background:
Despite growing concern that people living with HIV receive prescription opioids at elevated rates and experience a disproportionate burden of opioid use disorder (OUD) compared to their HIV- counterparts, few studies have described opioid prescription and OUD trends over time. Our objective was to evaluate these trends among older adults comparing those with HIV to their HIV- counterparts.
Methods:
We constructed annual cross-sectional cohorts (2008-2019) using a nationally representative sample of fee-for-service Medicare beneficiaries 65+ years in the US with Part D coverage. Beneficiaries with HIV (n=124,488) were matched to HIV- beneficiaries (n=373,464) using propensity scores based on age, sex, race/ethnicity, state, and dual eligibility status. Primary outcomes included receipt of 1+ opioid prescription and diagnosed OUD during that calendar year. Secondary outcomes included receipt of ‘high-risk’ opioid prescriptions [i.e., 2+ overlapping prescriptions >7 days, ≥90 mg total morphine milligram equivalent (MME) daily dose, and ≥90 consecutive days of coverage], use of medication for OUD, and opioid-related hospitalizations/emergency department (ED) visits. Logistic regression estimated the odds of each outcome comparing matched HIV and HIV- beneficiaries.
Results:
The cohort was predominantly male (68.5-74.3%) and White (39.7-49.0%) or African American (34.7-41.4%). Among beneficiaries with HIV, the prevalence of receiving 1+ opioid prescription (31.7-43.0%) and an OUD diagnosis (2.1-4.7%) was higher than their matched HIV- counterparts (24.9-35.6 and 0.6-2.3%, respectively). Consistent across all years, beneficiaries with HIV had significantly increased odds of receiving 1+ opioid prescription (OR=1.32-1.40) and diagnosed OUD (OR=2.08-3.84) compared to their matched HIV- counterparts (Figure 1). Similar trends were observed for all secondary outcomes, including receipt of 2+ overlapping prescriptions >7 days (OR=1.41-1.70), ≥90 mg total MME daily dose (OR=1.41-2.17), ≥90 consecutive days of coverage (OR=1.50-1.72), use of medication for OUD (OR=2.73-7.51), and opioid-related hospitalizations/ED visits (OR=2.48-3.60).
Conclusions:
Medicare beneficiaries with HIV have higher odds of receiving opioid prescriptions, diagnosed OUD, and receiving ‘high risk’ opioid prescriptions compared to matched HIV- beneficiaries. Trends are consistent across all years. Our findings may help guide opioid use management among this vulnerable population.
