Department of Medicine, Stroger Hospital of Cook County, Chicago, Illinois, USA.
Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, USA.
J Womens Health (Larchmt). 2022 Aug;31(8):1188-1196. doi: 10.1089/jwh.2021.0231. Epub 2022 Feb 28.
To examine predictors and consequences of prescription opioid use among a cohort of women living with HIV (WLWH) and women without HIV from 2000 to 2019. The Women's Interagency HIV Study is a multisite, prospective cohort study. Cumulative proportion of visits with prescription opioid use was categorized as follows: minimal (0%-9%), intermediate (10%-39%), and chronic (>40%). Logistic regression examined independent predictors, and proportional hazards regression estimated unadjusted and adjusted hazards of all-cause mortality, comparing intermediate and chronic prescription opioid use with minimal use. Annual prevalence of prescription opioid use significantly increased from 12.6% to 19.3% from 2000 to 2019 ( < 0.0001). Prescription opioid use was minimal in 75%, intermediate in 16%, and chronic in 9% of women. WLWH had 56% higher odds of chronic prescription opioid use compared with women without HIV. Even after adjusting for quality-of-life scores including ratings of pain, women with intermediate and chronic prescription opioid use had greater odds of being sexual minorities (lesbian or bisexual), unemployed, and were more likely to report benzodiazepine and nonprescription substance use compared with those with minimal use. Intermediate and chronic prescription opioid use were each associated with an almost 1.5-fold increased risk of all-cause mortality. Despite federally mandated opioid prescribing guidelines, prescription opioid use and related mortality significantly increased in women experiencing physical and psychosocial vulnerabilities. The higher mortality rate found among prescription opioid users may reflect the many underlying chronic medical and psychosocial conditions for which these opioids were prescribed, as well as complications of opioids themselves. Findings underscore the need for non-opioid and nonpharmacological interventions for chronic pain, particularly in sexual minorities and WLWH. Avoiding concurrent use of opioids with benzodiazepines and nonprescription drugs might reduce mortality. Clinical Trial Registration Number: NCT00000797.
调查 2000 年至 2019 年期间，生活在 HIV（艾滋病毒）的女性（WLWH）和没有 HIV 的女性队列中处方类阿片使用的预测因素和后果。妇女间艾滋病毒研究是一个多地点、前瞻性队列研究。处方类阿片使用的就诊累积比例分为以下几类：最小（0%-9%）、中等（10%-39%）和慢性（>40%）。逻辑回归检验了独立的预测因素，比例风险回归估计了全因死亡率的未经调整和调整的风险，将中等和慢性处方类阿片使用与最小使用进行了比较。从 2000 年到 2019 年，处方类阿片使用的年患病率从 12.6%显著增加到 19.3%（<0.0001）。75%的女性使用处方类阿片最小，16%的女性使用处方类阿片中等，9%的女性使用处方类阿片慢性。与没有 HIV 的女性相比，WLWH 使用慢性处方类阿片的可能性高 56%。即使在调整了包括疼痛评分在内的生活质量评分后，使用中等和慢性处方类阿片的女性也更有可能是性少数群体（女同性恋或双性恋）、失业，并且更有可能报告苯二氮卓类药物和非处方药物的使用，与使用最小剂量的女性相比。中等和慢性处方类阿片使用与全因死亡率增加近 1.5 倍相关。尽管有联邦授权的阿片类药物处方指南，但在经历身体和心理社会脆弱的女性中，处方类阿片的使用和相关死亡率显著增加。在处方类阿片使用者中发现的更高死亡率可能反映了这些阿片类药物用于治疗的许多潜在慢性医疗和心理社会状况，以及阿片类药物本身的并发症。研究结果强调需要为慢性疼痛提供非阿片类和非药物干预，特别是在性少数群体和 WLWH 中。避免同时使用阿片类药物与苯二氮卓类药物和非处方药物可能会降低死亡率。临床试验注册号：NCT00000797。
