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Correlates of opioid and benzodiazepine co-prescription among people living with HIV in British Columbia, Canada: A population-level cohort study.
Int J Drug Policy. 2019 May; 67:52-57.IJ

Abstract

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.

Authors+Show Affiliations

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.British Columbia Centre on Substance Use, 400-1045 HOwe Street, Vancouver, BC, V6Z 2A9.British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada; Vancouver Coastal Health, 520 West 6(th)Avenue, Vancouver, BC V6Z 4H5, Canada.British Columbia Centre on Substance Use, 400-1045 HOwe Street, Vancouver, BC, V6Z 2A9; Department of Medicine, University of British Columbia, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. Electronic address: lianping.ti@bccsu.ubc.ca.No affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30897373

Citation

Parent, Stephanie, et al. "Correlates of Opioid and Benzodiazepine Co-prescription Among People Living With HIV in British Columbia, Canada: a Population-level Cohort Study." The International Journal On Drug Policy, vol. 67, 2019, pp. 52-57.
Parent S, Nolan S, Fairbairn N, et al. Correlates of opioid and benzodiazepine co-prescription among people living with HIV in British Columbia, Canada: A population-level cohort study. Int J Drug Policy. 2019;67:52-57.
Parent, S., Nolan, S., Fairbairn, N., Ye, M., Wu, A., Montaner, J., Barrios, R., & Ti, L. (2019). Correlates of opioid and benzodiazepine co-prescription among people living with HIV in British Columbia, Canada: A population-level cohort study. The International Journal On Drug Policy, 67, 52-57. https://doi.org/10.1016/j.drugpo.2019.01.021
Parent S, et al. Correlates of Opioid and Benzodiazepine Co-prescription Among People Living With HIV in British Columbia, Canada: a Population-level Cohort Study. Int J Drug Policy. 2019;67:52-57. PubMed PMID: 30897373.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Correlates of opioid and benzodiazepine co-prescription among people living with HIV in British Columbia, Canada: A population-level cohort study. AU - Parent,Stephanie, AU - Nolan,Seonaid, AU - Fairbairn,Nadia, AU - Ye,Monica, AU - Wu,Anthony, AU - Montaner,Julio, AU - Barrios,Rolando, AU - Ti,Lianping, AU - ,, Y1 - 2019/03/18/ PY - 2018/8/13/received PY - 2019/1/9/revised PY - 2019/1/17/accepted PY - 2019/3/22/pubmed PY - 2020/2/29/medline PY - 2019/3/22/entrez KW - Benzodiazepines KW - Canada KW - Co-prescription KW - Opioids KW - People living with HIV KW - Polypharmacy SP - 52 EP - 57 JF - The International journal on drug policy JO - Int J Drug Policy VL - 67 N2 - 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. SN - 1873-4758 UR - https://www.unboundmedicine.com/medline/citation/30897373/Correlates_of_opioid_and_benzodiazepine_co_prescription_among_people_living_with_HIV_in_British_Columbia_Canada:_A_population_level_cohort_study_ DB - PRIME DP - Unbound Medicine ER -