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

• 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
• Journal Title: Journal of the International Association of Providers of AIDS Care
• Volume: Volume 20
• Publisher: SAGE Publishing | 2021-01-01, Pages 23259582211010952-23259582211010952
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1177/23259582211010952
• Subjects: Health Sciences, Public Health
• Keywords: HIV infection; chronic opioids; chronic pain; emergency department utilization; Analgesics, Opioid; Antiretroviral Therapy, Highly Active; Chronic Pain; Cross-Sectional Studies; Emergency Service, Hospital; Female; HIV Infections; Humans; Male; Middle Aged; Opioid-Related Disorders; Prospective Studies

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.