Polypharmacy and risk of non-fatal overdose for patients with HIV infection and substance dependence

Abstract

Introduction People living with HIV (PLWH) are at risk of both polypharmacy and unintentional overdose yet there are few data on whether polypharmacy increases risk of overdose. The study objective was to determine if the number and type of medication (e.g., sedating) were associated with non-fatal overdose (OD) among PLWH with past-year substance dependence or a lifetime history of injection drug use. Materials and Methods This was a longitudinal study of adults recruited from two urban, safety-net HIV clinics. Outcomes were i) lifetime and ii) past-year non-fatal OD assessed at baseline and a 12-month follow-up. We used logistic regression to examine the association between each outcome and the number of medications (identified from the electronic medical record) in the following categories: i) overall medications, ii) non-antiretroviral (non-ARV), iii) sedating, iv) non-sedating, as well as any vs. no opioid medication and any vs. no non-opioid sedating medication. Covariates included demographics, medical comorbidities, depressive and anxiety symptoms, and substance use. Results Among 250 participants, 80% were prescribed a sedating medication, 50% were prescribed an opioid; 51% exceeded risky drinking limits. In the past month, 23% reported illiict opioid use and 9% illicit opioid sedative use; 37% reported lifetime non-fatal OD and 7% past-year non-fatal OD. The median number (interquartile range) of total medications was 10 (7, 14) and 2 (1, 3) sedating. The odds of lifetime non-fatal OD were significantly higher with each additional sedating medication (OR 1.26, 95% CI 1.08, 1.46) and any opioid medication (OR 2.31; 95% CI 1.37, 3.90), but not with each overall, non-ARV, or non-sedating medication. The odds of past year non-fatal OD were greater with each additional sedating medication (OR 1.18; 95% CI 1.00, 1.39, p=0.049), each additional non-ARV medication (OR 1.07; 95% CI 1.00, 1.15, p=0.048), and non-significantly for any opioid medication (OR 2.23; 95% CI 0.93, 5.35). Conclusions In this sample of PLWH with substance dependence and/or injection drug use, number of sedating medications and any opioid were associated with non-fatal overdose; sedating medications were prescribed to the majority of patients. Polypharmacy among PLWH and substance dependence warrants further research to determine whether reducing sedating medications, including opioids, lowers overdose risk.

A conceptual model for understanding post-release opioid-related overdose risk

“…Among PRJP in East England, psychotropic medication prescribing was 5.5 times higher among men and 5.9 times higher among women relative to community prescribing rates after adjusting for age. When sedating medications, especially benzodiazepines or multiple medications, are combined with opioids, overdose risk increases [137, 138]. In another cohort of people supervised by a community corrections program in Alabama, more than 10% had both opioids and benzodiazepines present upon urine drug testing, and concurrent use was associated with having a drug-related offense [139].…”

Chronic Opioid Therapy in People Living With Human Immunodeficiency Virus: Patients’ Perspectives on Risks, Monitoring, and Guidelines

“…The following domains were assessed in the survey: demographics; HIV transmission risk and date of diagnosis; antiretroviral therapy use; hepatitis C virus testing; education level [22]; housing instability and financial insecurities (adapted from Kim et al [23]); food insecurity [24]; depressive symptoms (Center for Epidemiologic Studies Depression Scale [CES-D]) [25]; medications with medical record reconciliation (HIV, opioids, nonopioid pain relievers, psychiatric medications); anxiety (State-Trait Anxiety Inventory) [26]; posttraumatic stress disorder (PTSD) scores (PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) [27]; substance use (Addiction Severity Index and Texas Christian University Drug Screen II) [28,29]; opioid misuse (COMM) [19]; and perceptions of COT, satisfaction with COT monitoring, and receipt of naloxone [30,31]. Research assistants entered data from the survey-based interviews directly into REDCap (Research Electronic Data Capture).…”

Polypharmacy-associated risk of hospitalisation among people ageing with and without HIV: an observational study

“…Polypharmacy is the simultaneous use of multiple medications (often five or more) 1 and is widespread among older adults in North America and Europe. 2,3 Polypharmacy is associated with non-adherence, 4 adverse drug events, 5 falls, 6 opioid overdose, 7 and adds substantial complexity to medical regimens, thereby contributing to inappropriate prescribing. 8 It is also associated with admission to hospital (hereafter referred to as hospitalisation) 9 and mortality 1 in a dose-response manner.…”