From 2008–2021, Medicare beneficiaries ≥65 years old with HIV were more likely to receive opioids and show opioid use disorder (OUD) indicators than matched peers without HIV.

Study: Lancet Primary Care retrospective analysis of 653,716 adults (163,429 with HIV; 490,287 without).

Opioid prescriptions: 35.1% with HIV vs 28.3% without.

OUD indicators (2008–2016): 3.1% with HIV vs 1.2% without; rate among HIV group rose from 2.1% to 4.7%.

Relative risk: HIV group had 1.38× higher odds of opioid prescriptions and 2.61× higher odds of OUD indicators.

High-dose opioid use (≥120 mg MME/day for ≥7 days) increased from 1.53× risk in 2008 to 2.46× in 2021.

High-risk use (overlaps, ≥90 days, ≥90 mg/day) was consistently more common in HIV group.

Cohort: 72.7% male, 46.8% White, 36.4% Black.

Limitations: Medicare-only data, potential selection bias, missing mortality data.

Funding: NIDA, NJ ACTS, NCATS.