142nd APHA Annual Meeting and Exposition

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Chronic pain disparities and addiction: Medical and nonmedical prescription opioid use among people with substance use disorder ageing with HIV, cancer, and diabetes

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014

Traci Green, PhD, MSc , Inflexxion, Inc, Newton, MA
Steven Passik, PhD , Millennium Research Institute, San Diego, CA
Kenneth Kirsh, PhD , Millennium Research Institute, San Diego, CA
Stephen Butler, PhD , Inflexxion, Inc, Newton, MA
Background: As people live longer with HIV, chronic pain is becoming a critical focal point, and nonmedical prescription opioid use (NMPU) an attendant risk. We explored age-related differences (>50 vs. <50) in prescription opioid use among people being assessed for substance use disorder, comparing across self-reported HIV and other chronic diseases.

Methods: Analyses of 53,303 assessments from 550 treatment centers in the Addiction Severity Index Multimedia Version surveillance system from January 1, 2009 to March 30, 2013. Bivariate analyses (Χ2, median tests) compared age and NMPU across diagnoses and, among >50 with HIV/AIDS, cancer, or diabetes (n=5217), explored disparities in prescription opioid use by addiction severity composites, according to diagnosis.

Results: Younger age correlated with NMPU for all diagnoses except HIV/AIDS, where NMPU did not differ by age (p=.40). Among 1636 aged >50 with HIV, diabetes or cancer, 31.4% reported recent prescription opioid use and those with HIV indicated higher NMPU (72.2% vs. 53.8% cancer, 52.4% diabetes, p<.001). Compared to cancer or diabetes patients of similar age, people with HIV had lower prescription opioid use (25.5% vs. 39.0% cancer, 30.9% diabetes, p<.001), even in the presence of pain problems (35.5% vs. 45.6% cancer, 43.2% diabetes, p<.001). Older adults with HIV had higher drug and employment problem composites but similar alcohol, legal, family, and psychological problem composites compared to peers with cancer or diabetes.

Conclusions: For older adults with substance use histories, disparities in use of prescription opioids among HIV+ may explain differences in NMPU, with critical implications for successful treatment.

Learning Areas:

Chronic disease management and prevention
Epidemiology
Public health or related research

Learning Objectives:
Describe differences by age in prescription opioid use among adults being assessed for substance abuse treatment need who self-report a diagnosis of HIV/AIDS, cancer, diabetes, epilepsy, chronic obstructive pulmonary disease (COPD), cardiovascular disease (CVD), or asthma. Explain how people over 50 with HIV/AIDS differ in their medical and nonmedical use of prescription opioids Discuss possible reasons for and treatment, adherence and prevention implications of the under treatment of chronic pain among people 50 and over living with HIV

Keyword(s): Chronic Disease Management and Care, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a drug abuse epidemiologist whose federally funded research focuses on HIV/AIDS, chronic pain, and abuse and misuse of prescription and non-prescription drugs.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
Inflexxion drug abuse research Employment (includes retainer)

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5057.0: Substance Use and HIV/AIDS