Emergency Department Utilization Among People Living With HIV on Chronic Opioid Therapy

• Type of Material: Article
• Authors: Kinna Thakarar, Maine Medical Center; Amoli Kulkarni, Boston University; Sara Lodi, Boston University; Alexander Y Walley, Boston University; Marlene C Lira, Boston University; Leah S Forman, Boston University; Jonathan Colasanti, Emory University; Carlos del Rio, Emory University; Jeffrey H Samet, Boston University
• Language: English
• Date: 2021-01-01
• Publisher: SAGE Publishing
• Publication Version: Final Published Version
• Copyright Statement: © The Author(s) 2021
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1177/23259582211010952
• Title of Journal or Parent Work: Journal of the International Association of Providers of AIDS Care
• Volume: 20
• Start Page: 23259582211010952
• End Page: 23259582211010952
• Grant/Funding Information: The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This study was funded by awards R01DA037768, P30AI050409, and P30AI042853. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
• Keywords: chronic pain; Prospective Studies; HIV infection; Humans; Chronic Pain; emergency department utilization; Middle Aged; Antiretroviral Therapy, Highly Active; chronic opioids; HIV Infections; Female; Emergency Service, Hospital; Cross-Sectional Studies; Opioid-Related Disorders; Analgesics, Opioid; Male
• Research Categories: Health Sciences, Public Health

Abstract

Chronic pain among people with HIV (PWH) is a driving factor of emergency department (ED) utilization, and it is often treated with chronic opioid therapy (COT). We conducted a cross-sectional analysis of a prospective observational cohort of PWH on COT at 2 hospital-based clinics to determine whether COT-specific factors are associated with ED utilization among PWH. The primary outcome was an ED visit within 12 months after study enrollment. We used stepwise logistic regression including age, gender, opioid duration, hepatitis C, depression, prior ED visits, and Charlson comorbidity index. Of 153 study participants, n = 69 (45%) had an ED visit; 25% of ED visits were pain-related. High dose opioids, benzodiazepine co-prescribing, and lack of opioid treatment agreements were not associated with ED utilization, but prior ED visits (p = 0.002), depression (p = 0.001) and higher Charlson comorbidity score (p = 0.003) were associated with ED utilization. COT-specific factors were not associated with increased ED utilization among PWH.