From 2008 to 2021, Medicare beneficiaries aged 65 years and older with human immunodeficiency virus were more likely to receive prescription opioids and have indicators of opioid use disorder compared with matched beneficiaries without the virus, according to a Lancet Primary Care study involving 653,716 adult patients.
In the retrospective, repeated cross-sectional analysis, 163,429 beneficiaries with human immunodeficiency virus (HIV) were matched 1:3 with 490,287 patients without HIV by age, sex, race or ethnicity, US state, and dual eligibility status. During the study period, 35.1% (n = 57,373) of those with HIV and 28.3% (n = 138,547) of those without HIV received at least one opioid prescription.
Between 2008 and 2016, 3.1% (n = 2,408) of beneficiaries with HIV and 1.2% (n = 2,831) without HIV had an opioid use disorder (OUD) indicator, including a formal diagnosis, medication for OUD, or an opioid-related emergency department visit. The proportion of beneficiaries with HIV who had an indicator of OUD showed a twofold rise over the study period from 2.1% (n = 101) in 2008 to 4.7% (n = 613) in 2016.
Beneficiaries with HIV had a 1.38 times higher risk (95% confidence interval [CI] = 1.36–1.39) of receiving at least one opioid prescription and 2.61 times higher risk (95% CI = 2.47–2.76) of having OUD indicators compared with their counterparts. The risk of receiving high-dose opioid prescriptions (≥ 120 mg morphine milligram equivalents daily for ≥ 7 days) increased from 1.53 in 2008 to 2.46 in 2021. High-risk opioid use—including overlapping prescriptions, ≥ 90-day coverage, or daily doses ≥ 90 mg—was consistently more common among beneficiaries with HIV.
The cohort was predominantly male (72.7%) and either non-Hispanic White (46.8%) or Black (36.4%). Older adults with HIV had a greater comorbidity burden, with mean Elixhauser Comorbidity Index scores rising from 3.4 in 2008 to 4.6 in 2021.
The investigators noted that their results may not generalize beyond the United States because of reliance on Medicare data and possible selection bias. Excluding patients receiving hospice care and unmatched cases may have underrepresented older and minority adults. Prescription fills didn't confirm use, exposure outside Medicare was unmeasured, and opioid-related mortality wasn't assessed.
This study was funded by the US National Institute on Drug Abuse, the New Jersey Alliance for Clinical and Translational Science, and the National Center for Advancing Translational Sciences of the National Institutes of Health. The study authors declared no competing interests.
Source: The Lancet Primary Care
