Clinical Addiction Research and Education (CARE) Unit (TWK, AYW, ASV, RS), Section of General Internal Medicine, Boston University School of Medicine (GBL, NM), Boston Medical Center, Boston, MA, United States.
Department of Biostatistics (TH), Data Coordinating Center (GJP), Department of Community Health Sciences (RS), Boston University School Public Health, Boston, MA, United States.
J Subst Abuse Treat. 2017 Oct;81:1-10. doi: 10.1016/j.jsat.2017.07.007. Epub 2017 Jul 14.
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.
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.
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 illicit 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).
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.
感染艾滋病毒的人（PLWH）面临着多种药物治疗和非故意用药过量的风险，但关于药物治疗是否会增加用药过量风险的数据很少。本研究的目的是确定过去一年有物质依赖或有注射毒品使用史的 PLWH 中，药物的数量和类型（例如镇静剂）是否与非致命性用药过量（OD）有关。
这是一项对从两家城市安全网 HIV 诊所招募的成年人进行的纵向研究。结果是：i）终身和 ii）过去一年的非致命性 OD，在基线和 12 个月随访时进行评估。我们使用逻辑回归来检查每个结果与以下类别的药物数量（从电子病历中识别）之间的关联：i）总体药物，ii）非抗逆转录病毒药物（非 ARV），iii）镇静剂，iv）非镇静剂，以及任何与无阿片类药物和任何与无非阿片类镇静剂的药物。协变量包括人口统计学、合并症、抑郁和焦虑症状以及物质使用情况。
在 250 名参与者中，80%服用镇静剂，50%服用阿片类药物；51%超过了危险饮酒限制。在过去一个月中，23%报告了非法阿片类药物使用，9%报告了非法阿片类镇静剂使用；37%报告了终身非致命性 OD，7%报告了过去一年的非致命性 OD。总药物的中位数（四分位距）为 10（7，14）和 2（1，3）镇静剂。每增加一种镇静剂（OR 1.26，95%CI 1.08，1.46）和任何阿片类药物（OR 2.31；95%CI 1.37，3.90），终身非致命性 OD 的可能性显著增加，但每增加一种总体药物、非 ARV 或非镇静剂药物均无此关联。每增加一种镇静剂（OR 1.18；95%CI 1.00，1.39，p=0.049），每增加一种非 ARV 药物（OR 1.07；95%CI 1.00，1.15，p=0.048），过去一年非致命性 OD 的可能性均增加，但阿片类药物的关联性不显著（OR 2.23；95%CI 0.93，5.35）。
在本研究中，有物质依赖和/或注射毒品使用史的 PLWH 中，镇静药物的数量和任何阿片类药物与非致命性 OD 有关；大多数患者都被开了镇静药物。PLWH 和物质依赖的多种药物治疗需要进一步研究，以确定减少镇静药物，包括阿片类药物，是否会降低用药过量的风险。
