Becker William C, Gordon Kirsha, Edelman E Jennifer, Kerns Robert D, Crystal Stephen, Dziura James D, Fiellin Lynn E, Gordon Adam J, Goulet Joseph L, Justice Amy C, Fiellin David A
Internal Medicine, West Haven VA Medical Center, VA Connecticut Healthcare System, Mail Stop 151B, 950 Campbell Avenue, West Haven, CT, 06516, USA.
Internal Medicine, Yale University School of Medicine, New Haven, CT, USA.
AIDS Behav. 2016 Mar;20(3):679-86. doi: 10.1007/s10461-015-1197-5.
Harms of opioid analgesics, especially high-dose therapy among individuals with comorbidities and older age, are increasingly recognized. However, trends in opioid receipt among HIV-infected patients are not well characterized. We examined trends, from 1999 to 2010, in any and high-dose (≥120 mg/day) opioid receipt among patients with and without HIV, by age strata, controlling for demographic and clinical correlates. Of 127,216 patients, 64 % received at least one opioid prescription. Opioid receipt increased substantially among HIV-infected and uninfected patients over the study; high-dose therapy was more prevalent among HIV-infected patients. Trends in high-dose receipt stratified by three age groups revealed an increasing trend in each age strata, higher among HIV-infected patients. Correlates of any opioid receipt included HIV, PTSD and major depression. Correlates of high-dose receipt included HIV, PTSD, major depression and drug use disorders. These findings suggest a need for appropriate balance of risks and benefits, especially as these populations age.
阿片类镇痛药的危害,尤其是在患有合并症的个体和老年人中进行高剂量治疗的危害,越来越受到人们的认识。然而,HIV感染患者中阿片类药物使用的趋势尚未得到很好的描述。我们研究了1999年至2010年期间,按年龄分层,在有和没有HIV的患者中,使用任何剂量和高剂量(≥120毫克/天)阿片类药物的趋势,并控制了人口统计学和临床相关因素。在127216名患者中,64%接受了至少一张阿片类药物处方。在研究期间,HIV感染和未感染患者的阿片类药物使用量大幅增加;高剂量治疗在HIV感染患者中更为普遍。按三个年龄组分层的高剂量使用趋势显示,每个年龄层都呈上升趋势,在HIV感染患者中更高。使用任何阿片类药物的相关因素包括HIV、创伤后应激障碍和重度抑郁症。高剂量使用的相关因素包括HIV、创伤后应激障碍、重度抑郁症和药物使用障碍。这些发现表明需要适当平衡风险和益处,尤其是随着这些人群年龄的增长。