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Opioid misuse prevalent among homeless adults with HIV

Indigent adults living in San Francisco who were infected with HIV reported high rates of opioid misuse, according to a research letter published in JAMA Internal Medicine. The findings raise questions about clinical guidelines for prescribing pain medications to high-risk patients to avoid misuse.

“Doctors should use caution when prescribing opioid analgesics to patients at high risk for misuse, including those who have substance abuse disorders, co-occurring depression, or tobacco use,” study researcher Margot Kushel, MD, of the division of internal medicine at the University of California, San Francisco, told Psychiatric Annals.

 

Margot Kushel

Kushel and colleagues interviewed 296 participants from the Research in Access to Care in the Homeless (REACH) study, a longitudinal cohort of indigent adults with HIV. For 2 years, participants reported on pain, treatment for pain, alcohol use, current smoking, illicit substance use and depression. Participants also reported on their reasons for misusing opioid prescriptions (ie, treating pain, getting high, both or neither). Major opioid misuse was defined in the study as behaviors posing imminent risk for overdose or legal peril.

At enrollment, 52% of all participants reported having received a prescription for an opioid analgesic in the past 90 days, despite having many risk factors for misuse. During the study period, 71.9% of participants reported any misuse, and 53.4% reported major misuse. The most commonly reported misuse behaviors were drinking alcohol or using street drugs to boost the effect (32.1%); using prescribed opioids to get high (25.3%); and buying medicines from another person (14.5%). Most participants reported that their reason for misuse was to get high.

Additional analysis indicated that current homelessness (adjusted OR=1.8; 95% CI, 1.1-3.1), regular drinking (AOR=1.8; 95% CI, 1.0-3.1), current smoking (AOR=1.8; 95% CI, 1.1-2.8), illicit substance use (AOR=2.3; 95% CI, 1.6-3.4), moderate to severe depression (AOR=1.6; 95% CI, 1.1-2.4), and being prescribed opioids by a health care provider (AOR=1.5; 95% CI, 1.1-2.2) were associated with major misuse.

“Several factors could have influenced health care providers’ decisions to prescribe opioids to high-risk individuals, including patients’ severity of pain, limited access to pain specialists, and health care providers’ limited ability to accurately assess for misuse,” the researchers wrote. “Our results suggest a need for strategies to assist health care providers with managing chronic pain in high-risk populations without increasing risk for misuse.”

Disclosure: The researchers report no relevant financial disclosures.