Prescription and Non-Medical Use of Opioids, Benzodiazepines, Muscle Relaxants, and Stimulants Among People with HIV Infection Who Are Homeless

Non-medical use of prescription opioids is associated with overdose and is common in people with HIV infection. The impact of non-medical use of non-opioid psychotherapeutic medications in this population is not known. Researchers conducted a prospective cohort study among 296 homeless or marginally housed people with HIV to determine whether 90-day non-medical use of prescription opioids was associated with non-medical use of non-opioid psychotherapeutic medications.

• In the week prior to study enrollment, 52% of participants were prescribed opioids for chronic pain, 18% were prescribed benzodiazepines, and 8% were prescribed muscle relaxants.
• Over 2 years of observation, 53% reported non-medical use of prescription opioids, 25% reported non-medical use of benzodiazepines, 12% reported non-medical use of muscle relaxants, and 6% reported non-medical use of stimulants.
• Non-medical use of prescription benzodiazepines was associated with non-medical use of prescription opioids (odds ratio [OR], 3.5), as well as white race (OR, 2.1) and receipt of prescribed benzodiazepines (OR, 3.7).
• Non-medical use of prescription muscle relaxants was associated with non-medical use of prescription opioids (OR, 3.4), as well as receipt of prescribed opioids (OR, 2.6) and receipt of prescribed muscle relaxants (OR, 9.9). 
• Non-medical use of prescription stimulants was associated with non-medical use of prescription opioids (OR, 5.9).

Comments:

Among this cohort, both prescribed and non-medical use of psychotherapeutic medications were common, particularly opioids. People prescribed psychotherapeutics were more likely to misuse that psychotherapeutic and people who misused opioids were more likely to misuse other psychotherapeutics. Prescribers should monitor for and educate patients about the risks of polypharmacy and overdose from psychotherapeutic medications.

Alexander Y. Walley, MD, MSc

Reference:

Vijayaraghavan M, Freitas D, Bangsberg DR, et al. Non-medical use of non-opioid psychotherapeutic medications in a community-based cohort of HIV-infected indigent adults. Drug Alcohol Depend. 2014;143:263–267.