Pain, Substance Use Disorders, Mental Health, and Buprenorphine Treatment among Patients With and Without HIV.

Autor: Miller EA; Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA., McGinnis KA; VA Connecticut Healthcare System, West Haven, CT, USA., Edelman EJ; Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA., Feinberg T; Kelly Government Solutions, Silver Spring, MD, USA.; Department of Biostatistics, Yale University School of Public Health, New Haven, CT, USA.; Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, USA., Gordon KS; VA Connecticut Healthcare System, West Haven, CT, USA.; Section of General Internal Medicine, Yale University School of Medicine, New Haven, CT, USA., Kerns RD; Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA., Marshall BDL; Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA., Patterson JA; Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA., McRae M; Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA, USA. mpmcrae@vcu.edu.; 410 North 12th Street, Richmond, VA, 23298, USA. mpmcrae@vcu.edu.
Jazyk: angličtina
Zdroj: AIDS and behavior [AIDS Behav] 2024 Dec; Vol. 28 (12), pp. 3994-4004. Date of Electronic Publication: 2024 Sep 12.
DOI: 10.1007/s10461-024-04494-w
Abstrakt: Treatment of opioid use disorder (OUD) with buprenorphine improves outcomes and mortality among people with HIV (PWH). However, engagement is low and is influenced by comorbidities. We examined the impact of patterns of co-occurring pain, substance use disorders (SUDs), and mental health diagnoses on buprenorphine initiation and retention in PWH. The Veterans Aging Cohort Study contained 7,875 patients (2,702 PWH and 5,173 without HIV) with new OUD clinical encounters (2008-2017). Buprenorphine initiation and retention were derived from prescription data. We identified patterns of co-occurring diagnoses (via ICD codes) and assessed the effects of class membership on both outcomes using latent class analysis and regression analyses. The mean age of patients was 55, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated buprenorphine within 12 months of OUD diagnosis. Four classes of co-occurring diagnoses were identified: "Few Co-occurring Diagnoses" (42.3%); "Multiple Pain Conditions" (21.3%); "Pain + SUD" (18.4%) and "Pain + SUD + Mental Health" (18.0%). Patients in the "Pain + SUD" class and "Pain + SUD + Mental Health" class were significantly less likely to initiate buprenorphine and had 59% and 45% lower odds, respectively, of initiating buprenorphine compared with patients in the "Few Co-occurring Diagnoses" class; this effect did not vary by HIV status. Buprenorphine retention was not significantly associated with HIV status or class membership. However, Black Veterans were less likely to initiate or be retained in buprenorphine treatment. Higher comorbidity burden was negatively associated with buprenorphine initiation but not with retention. More research is warranted to determine other factors that may influence treatment retention.
Competing Interests: Declarations. Competing Interests: Termeh Feinberg was supported as a contractor with the National Institutes of Health National Center for Complementary and Integrative Health. All other authors declare no potential conflicts of interest. Preliminary findings of this research study were presented at the American Society of Clinical Pharmacology and Therapeutics (ASCPT) Annual Meeting in Atlanta, GA in March 2023.
(© 2024. The Author(s).)
Databáze: MEDLINE
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