Medicaid trends in prescription opioid and non-opioid use by HIV status

Research output: Contribution to journalArticle

Abstract

Background: Pain is more common among people living with HIV (PLWH) than their counterparts; however, it is unclear whether analgesic use differs by HIV status. Methods: We analyzed Medicaid pharmacy claims from adults in 14 US states from 2001 to 2009 to identify opioid and non-opioid analgesic prescriptions and compared prescribing trends by HIV status. We accounted for clinical and demographic differences by using inverse probability weights and by restricting the sample to a subgroup with a common comorbidity, diabetes, chosen for its high prevalence and association with lifestyle and chronic pain. We estimated the incidence of chronic opioid therapy (COT) (≥90 consecutive days with an opioid prescription) among opioid-naïve individuals. Results: Rates of opioid and non-opioid use increased approximately two-fold from 2001 to 2009. PLWH received approximately twice as many prescriptions as those without HIV. In an unadjusted Cox regression, PLWH were three times more likely to receive COT compared to those without HIV (hazard ratio (HR) = 3.06, 95% CI 2.76–3.39). When restricting to patients with diabetes and adjusting for age, sex, state, comorbidity score, depression, bipolar disorder, and schizophrenia, the HR decreased to 1.26 (95% CI 0.97–1.63). Conclusions: Higher opioid use among PLWH was largely a function of patients’ demographic characteristics and health status. The high incidence of COT among PLWH underscores the importance of practice guidelines that minimize adverse events associated with opioid use.

Original languageEnglish (US)
Pages (from-to)141-148
Number of pages8
JournalDrug and alcohol dependence
Volume197
DOIs
StatePublished - Apr 1 2019

Fingerprint

Medicaid
Opioid Analgesics
Prescriptions
HIV
Medical problems
Analgesics
Comorbidity
Hazards
Demography
Incidence
Bipolar Disorder
Practice Guidelines
Chronic Pain
Health Status
Life Style
Schizophrenia
Therapeutics
Health
Depression
Weights and Measures

Keywords

  • Chronic opioid therapy
  • HIV
  • Medicaid
  • Opioids
  • Prescription analgesics
  • Trends

ASJC Scopus subject areas

  • Toxicology
  • Pharmacology
  • Psychiatry and Mental health
  • Pharmacology (medical)

Cite this

Medicaid trends in prescription opioid and non-opioid use by HIV status. / Canan, Chelsea; Alexander, George Caleb; Moore, Richard D; Murimi, Irene B; Chander, Geetanjali; Lau, Bryan M.

In: Drug and alcohol dependence, Vol. 197, 01.04.2019, p. 141-148.

Research output: Contribution to journalArticle

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abstract = "Background: Pain is more common among people living with HIV (PLWH) than their counterparts; however, it is unclear whether analgesic use differs by HIV status. Methods: We analyzed Medicaid pharmacy claims from adults in 14 US states from 2001 to 2009 to identify opioid and non-opioid analgesic prescriptions and compared prescribing trends by HIV status. We accounted for clinical and demographic differences by using inverse probability weights and by restricting the sample to a subgroup with a common comorbidity, diabetes, chosen for its high prevalence and association with lifestyle and chronic pain. We estimated the incidence of chronic opioid therapy (COT) (≥90 consecutive days with an opioid prescription) among opioid-na{\"i}ve individuals. Results: Rates of opioid and non-opioid use increased approximately two-fold from 2001 to 2009. PLWH received approximately twice as many prescriptions as those without HIV. In an unadjusted Cox regression, PLWH were three times more likely to receive COT compared to those without HIV (hazard ratio (HR) = 3.06, 95{\%} CI 2.76–3.39). When restricting to patients with diabetes and adjusting for age, sex, state, comorbidity score, depression, bipolar disorder, and schizophrenia, the HR decreased to 1.26 (95{\%} CI 0.97–1.63). Conclusions: Higher opioid use among PLWH was largely a function of patients’ demographic characteristics and health status. The high incidence of COT among PLWH underscores the importance of practice guidelines that minimize adverse events associated with opioid use.",
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AU - Alexander, George Caleb

AU - Moore, Richard D

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AU - Lau, Bryan M

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N2 - Background: Pain is more common among people living with HIV (PLWH) than their counterparts; however, it is unclear whether analgesic use differs by HIV status. Methods: We analyzed Medicaid pharmacy claims from adults in 14 US states from 2001 to 2009 to identify opioid and non-opioid analgesic prescriptions and compared prescribing trends by HIV status. We accounted for clinical and demographic differences by using inverse probability weights and by restricting the sample to a subgroup with a common comorbidity, diabetes, chosen for its high prevalence and association with lifestyle and chronic pain. We estimated the incidence of chronic opioid therapy (COT) (≥90 consecutive days with an opioid prescription) among opioid-naïve individuals. Results: Rates of opioid and non-opioid use increased approximately two-fold from 2001 to 2009. PLWH received approximately twice as many prescriptions as those without HIV. In an unadjusted Cox regression, PLWH were three times more likely to receive COT compared to those without HIV (hazard ratio (HR) = 3.06, 95% CI 2.76–3.39). When restricting to patients with diabetes and adjusting for age, sex, state, comorbidity score, depression, bipolar disorder, and schizophrenia, the HR decreased to 1.26 (95% CI 0.97–1.63). Conclusions: Higher opioid use among PLWH was largely a function of patients’ demographic characteristics and health status. The high incidence of COT among PLWH underscores the importance of practice guidelines that minimize adverse events associated with opioid use.

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