Prescription of High-Dose Opioids Among People Living with HIV in British Columbia, Canada

AbstractPeople living with HIV (PLHIV) often experience pain for which opioid medications may be prescribed. Thus, these individuals are particularly vulnerable to opioid-related harms, including overdose, misuse, and addiction, particularly when prescribed at high doses. We used a comprehensive linked population-level database of PLHIV in British Columbia (BC) to identify demographic and clinical characteristics associated with being prescribed any high-dose opioid analgesic, defined as  >  90 daily morphine milligram equivalents (MME/day). Among PLHIV who were prescribed opioids between 1996 and 2015 (n = 10,780), 28.2% received prescriptions of >  90 MME/day at least once during the study period. Factors positively associated with being prescribed high-dose opioid analgesics included: co-prescription of benzodiazepines (adjusted odds ratio [AOR] = 1.14; 95% confidence interval 1.11–1.17); presence of an AIDS-defining illness (ADI; AO R = 1.78; 95% CI 1.57–2.02); seen by an HIV specialist (AOR = 1.24; 95% CI 1.20–1.29); substance use disorder (AOR = 1.46; 95% CI 1.25–1.71); and more recent calendar year (AOR = 1.05; 95% CI 1.04–1.06). Given the known risks associated with high-dose opioid prescribing, futu re research efforts should focus on the clinical indication and outcomes associated with these prescribing practices.
Source: AIDS and Behavior - Category: Infectious Diseases Source Type: research

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Ryan R. Kelly1,2†, Lindsay T. McDonald1,2†, Nathaniel R. Jensen1,2, Sara J. Sidles1,2 and Amanda C. LaRue1,2* 1Research Services, Ralph H. Johnson VA Medical Center, Charleston, SC, United States 2Department of Pathology and Laboratory Medicine, Medical University of South Carolina, Charleston, SC, United States The significant biochemical and physiological effects of psychological stress are beginning to be recognized as exacerbating common diseases, including osteoporosis. This review discusses the current evidence for psychological stress-associated mental health disorders as risk factors for os...
Source: Frontiers in Psychiatry - Category: Psychiatry Source Type: research
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Source: blog.bioethics.net - Category: Medical Ethics Authors: Tags: Health Care syndicated Source Type: blogs
See something of interest? Please share our postings with colleagues in your institutions! Spotlight The MAReport: the Summer/Fall 2018 issue of the MAReport newsletter is now available! This quarter, Executive Director Kate Flewelling wrote about how the National Library of Medicine and National Network of Libraries of Medicine are responding to the opioid crisis, including details on a new class that will be offered for the first time on November 28. National Network of Libraries of Medicine News Funding Applications Due: NNLM MAR has funding available for two grants of $19,000. Libraries, community-based organizations, ...
Source: NN/LM Middle Atlantic Region Blog - Category: Databases & Libraries Authors: Tags: Weekly Postings Source Type: news
AbstractPurpose of ReviewIn light of the current crisis in opioid involved overdose deaths, the federal Department of Health and Human Services operating divisions are working together to implement a data-driven, research-based strategy to reduce opioid misuse and its consequences.Recent FindingsThe strategy has five elements: (1) strengthening public health data collection and reporting; (2) advancing the practice of pain management; (3) improving access to addiction prevention, treatment, and recovery support services; (4) increasing availability of overdose-reversing drugs; and (5) supporting cutting-edge research in tr...
Source: Current HIV/AIDS Reports - Category: Infectious Diseases Source Type: research
In early April 2018, Dr. Maria Oquendo, President of the American Psychiatric Association, and Dr. Nora Volkow, Director of the National Institute on Drug Abuse, published a thought-provoking article in the New England Journal of Medicine about the role of suicide in the opioid overdose epidemic, referring to the relationship between them as a “hidden tragedy.” Drs. Oquendo and Volkow drew our attention to the twinning of the opioid (and other drug) overdose and suicide epidemics, but these are not the first or only drug-related “twin epidemics.” Numerous other related conditions, including pain dis...
Source: Journal of Addictions Nursing - Category: Addiction Tags: Departments: Policy Watch Source Type: research
When it comes to the opioid epidemic, physicians are some of the best drug dealers around with almost unrestricted access to the purest substances. As the opioid epidemic spirals out of control, physicians continue to be able to provide their patients with a variety of options, including oxycodone, morphine and fentanyl. Many people would be surprised to know that physicians don’t need any additional training to prescribe opiates to their patients especially considering that 40 percent of opioid deaths last year involved a prescription medication. But paradoxically, if physicians want to treat opioid addiction, they ...
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Pain Management Primary Care Source Type: blogs
Psychosocial stress, defined here as socioenvironmental demands that tax the adaptive capacity of the individual (e.g., low socioeconomic status, childhood adversity, bullying), has repeatedly been linked to substance use disorders (SUDs). Neighborhood poverty and social support are shown to influence substance use patterns. Among smokers, multiple psychosocial stressors are associated with relapse, and acute psychosocial stress has been demonstrated to enhance cigarette craving and smoking behavior. Similarly, psychosocial stress has been associated with greater risk of relapse in individuals with alcohol and cocaine use ...
Source: Psychology of Pain - Category: Anesthesiology Source Type: blogs
On December 5, 2017, the Senate Appropriations Subcommittee on Labor, Health and Human Services, Education, and Related Agencies held a hearing to discuss the opioid epidemic and the possible role that Congress could play in the prevention, treatment, and recovery. Senator Roy Blunt, the Subcommittee Chairman, opened the hearing by discussing the fact that overdose related deaths outnumber the deaths at the peak of the AIDS/HIV epidemic. Overdose deaths have also overtaken automobile accident fatalities to become the number one cause of accidental death in the United States. Senator Blunt also spoke about the three propos...
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs
In 2015, the opioid crisis was escalating to emergency-level proportions, claiming as many lives as car accidents. As the daughter of a longtime drug addict, the current burgeoning opioid epidemic managed to be both familiar and strange to me at the same time. My mother developed her addictions during the height of drug epidemics that occurred in New York City in the mid-1980s. The timeframe also marked the infancy of the AIDS crisis and the height of Reagan-era “Just Say No” programs. Back then, addiction was treated and viewed more as a crime than a disease, supposedly committed by scoundrels and misfits. The...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Addiction Behavioral Health Source Type: blogs
In a new study of the leading causes of death in the U.S., researchers say that opioids have contributed to a shortening of life expectancy. Scientists from the Centers for Disease Control and Prevention report in JAMA that while life expectancy in the U.S. increased overall from 2000 to 2015, that improvement was blunted by deaths from opioid overdoses. (According to other recent research, deaths from opioid overdoses nearly doubled in the U.S. from 2009 to 2015.) The life expectancy for people born in 2015 increased by two years compared to people born in 2000, from 76 years to 78. Much of that gain was due to decreases ...
Source: TIME.com: Top Science and Health Stories - Category: Consumer Health News Authors: Tags: Uncategorized are opioids painkillers drug addiction Drugs leading causes of death opioid addiction opioid epidemic opioid overdose opioid overdoses opioid pain killers what are opioids what is the leading cause of death Source Type: news
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