British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
British Columbia Centre on Substance Use, 400-1045 HOwe Street, Vancouver, BC, V6Z 2A9.
Int J Drug Policy. 2019 May;67:52-57. doi: 10.1016/j.drugpo.2019.01.021. Epub 2019 Mar 18.
BACKGROUND: Co-prescribing benzodiazepines and opioids is relatively contraindicated due to the possible overdose risk. However, people living with HIV (PLWH) may have concurrent psychiatric and/or chronic pain diagnoses that may lead to the use of opioids and/or benzodiazepines for symptomatic treatment. Consequently, some PLWH may be at-risk for the health harms associated with the co-prescribing of these medications. Given this, the objectives of this study were to first examine the prevalence of opioids and benzodiazepines co-prescribing, and second, to characterize patient factors associated with the co-prescribing of opioids and benzodiazepines among PLWH in British Columbia (BC), Canada. METHODS: Using data derived from a longitudinal BC cohort, we used bivariable and multivariable generalized estimating equation models to establish the prevalence of a benzodiazepine and opioid co-prescription and determine factors associated with this practice. RESULTS: Between 1996 and 2015, 14 484 PLWH were included in the study and were followed for the entire study period. At baseline, 548 people (4%) were co-prescribed opioids and benzodiazepines, 6593 (46%) were prescribed opioids only, 2887 (20%) were prescribed benzodiazepines only, and 4456 (31%) were prescribed neither medication. A total of 3835 (27%) participants were prescribed both medications at least once during the study period. Factors positively associated with concurrent opioid and benzodiazepine prescribing included: depression/mood disorder [adjusted odds ratio (AOR) = 1.32; 95% confidence interval (CI) = 1.22-1.43] and anxiety disorder (AOR = 1.45; 95% CI = 1.27-1.66), whereas female sex (AOR = 0.76; 95% CI = 0.64-0.91) and substance use disorder (SUD) (AOR = 0.82; 95% CI = 0.74-0.90) were negatively associated with the outcome. CONCLUSION: Our findings indicate that co-prescription of opioids and benzodiazepines was seen at some point during study follow-up in over a quarter of PLWH. Given the known risks associated with this prescribing practice, future research can focus on the outcomes of co-prescribing among this patient population and the development of strategies to reduce the co-prescribing of opioids and benzodiazepines.
背景：由于可能存在过量风险，同时开处苯二氮䓬类药物和阿片类药物是相对禁忌的。然而，艾滋病毒感染者（PLWH）可能同时存在精神科和/或慢性疼痛诊断，这可能导致为了对症治疗而使用阿片类药物和/或苯二氮䓬类药物。因此，一些 PLWH 可能面临与同时使用这些药物相关的健康危害风险。鉴于此，本研究的目的首先是检查在不列颠哥伦比亚省（BC）的 PLWH 中同时开处阿片类药物和苯二氮䓬类药物的流行情况，其次是描述与 PLWH 同时开处阿片类药物和苯二氮䓬类药物相关的患者因素。 方法：我们使用来自纵向 BC 队列的数据，使用双变量和多变量广义估计方程模型来确定苯二氮䓬类药物和阿片类药物同时开处的流行情况，并确定与这种做法相关的因素。 结果：在 1996 年至 2015 年期间，共有 14484 名 PLWH 被纳入研究，并在整个研究期间进行了随访。在基线时，有 548 人（4%）同时开处阿片类药物和苯二氮䓬类药物，6593 人（46%）仅开处阿片类药物，2887 人（20%）仅开处苯二氮䓬类药物，4456 人（31%）两者均未开处。共有 3835 名（27%）参与者在研究期间至少有一次同时开处两种药物。与同时开处阿片类药物和苯二氮䓬类药物相关的因素包括：抑郁/情绪障碍（调整后的优势比[OR] = 1.32；95%置信区间[CI] = 1.22-1.43）和焦虑障碍（OR = 1.45；95% CI = 1.27-1.66），而女性（OR = 0.76；95% CI = 0.64-0.91）和物质使用障碍（SUD）（OR = 0.82；95% CI = 0.74-0.90）与该结果呈负相关。 结论：我们的研究结果表明，在超过四分之一的 PLWH 中，在研究随访的某个时间点同时开处了阿片类药物和苯二氮䓬类药物。鉴于这种开处方式存在已知风险，未来的研究可以关注该患者群体中同时开处这两种药物的结果以及制定减少同时开处阿片类药物和苯二氮䓬类药物的策略。
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