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Persons with HIV (PWH) experience chronic pain and Post-Traumatic Stress Disorder (PTSD) at higher rates than the general population, and more often receive opioid medications to treat chronic pain. A known association exists between PTSD and substance use disorders, but less is known about the relationship between PTSD and risky opioid use among PWH taking prescribed opioid medications. In this observational study of PWH on long-term opioid medications for pain we examined associations between PTSD symptom severity based on the Post Traumatic Stress Disorder Checklist for DSM-5 (PCL-5, response range 0-80) and the following outcomes: 1) risk for opioid misuse (COMM score ≥13); 2) risky alcohol use (AUDIT score ≥8); 3) concurrent benzodiazepine prescription; and 4) morphine equivalent dose. Among 166 patients, 38 (23%) had a PCL-5 score over 38, indicating high PTSD symptom burden. Higher PCL-5 score (per 10 point difference) was associated with increased odds of opioid misuse (aOR 1.55; 95%CI: 1.31-1.83) and risky drinking (aOR: 1.28;1.07-1.52). No significant association was observed between PCL-5 score and benzodiazepine prescriptions or morphine equivalent dose. These findings suggest that when addressing alcohol and opioid use in PWH on long term opioid therapy, attention to PTSD symptoms is especially important given the higher risk for risky alcohol and opioid use among patients with this common comorbid condition. [ABSTRACT FROM AUTHOR]

Background: Buprenorphine is a partial mu opioid agonist medication that has been shown to decrease non-prescribed opioid use, cravings, and opioid related morbidity and mortality. There is an assumption that full adherence is needed to achieve ideal treatment outcomes, and that non-adherence is associated with ongoing opioid use. However, literature documenting the strength of that assertion is lacking. Objectives: Evaluate the association between daily buprenorphine adherence and illicit opioid use. Methods: Secondary analysis of a 12-week randomized controlled trial of adults with opioid use disorder who recently initiated buprenorphine. Weekly study visits included self-report of daily buprenorphine adherence over the past 7 days (Timeline Follow Back method) and urine drug tests (UDT). A log-linear regression model accounting for clustering by participant was used to assess the association between buprenorphine adherence and illicit opioid use. Buprenorphine adherence was measured as a continuous variable (0–7 days). Results: Among 78 participants (56 men, 20 women, 2 nonbinary) with 737 visits, full 7-day adherence was reported at 70% of visits. The predominant form of non-adherence was missed doses (92% of cases). Each additional day of adherence was associated with an 8% higher rate of negative UDT for illicit opioids (RR = 1.08; 95% CI:1.03–1.13, p =.0002). Conclusion: In this sample of participants starting buprenorphine, missed doses were not uncommon. Fewer missed days was significantly associated with a lower risk of illicit opioid use. These findings suggest that efforts to minimize the number of missed days of buprenorphine are beneficial for treatment outcomes. [ABSTRACT FROM AUTHOR]

This retrospective study examined mortality in an Opioid Treatment Program (OTP) with policies designed to admit and retain patients with as few barriers as possible. Methadone provided in the context of an OTP is known to decrease mortality and morbidity. Historically, patients have been discharged or turned away because of continued substance use. We examined patient deaths over three years in an OTP serving approximately 2400 patients daily. Demographics and causes of death were gathered from electronic health records and medical examiner reports. Pairwise comparisons were used to compare drug poisoning versus non-drug poisoning deaths. There were 155 deaths during the study period. The average age was 54, and half of the participants had positive results on their most recent drug screen. Forty one (26%) died from "drug poisoning." Drug poisoning deaths were more common among patients who: 1) had recent positive drug test results; 2) had documented alprazolam use; 3) were younger; 4) had shorter treatment durations; 5) were female. The majority of deaths were among long-term patients over 50 and were not caused by drug poisoning. These results support keeping patients in treatment despite ongoing drug use, and linking them to appropriate primary care. [ABSTRACT FROM AUTHOR]