Longitudinal analysis of the prevalence and correlates of heavy episodic drinking and self-reported opioid use among a national cohort of patients with HIV

Benjamin J. Oldfield, Yu Li, Rachel Vickers-Smith, Declan T. Barry, Stephen Crystal, Kirsha S. Gordon, Robert D. Kerns, Emily C. Williams, Brandon D.L. Marshall, E. Jennifer Edelman

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Heavy episodic drinking (HED) is a risk factor for opioid-related overdose and negatively impacts HIV disease progression. Among a national cohort of patients with HIV (PWH), we examined sociodemographic and clinical correlates of concomitant HED and self-reported opioid use. Methods: We used data collected from 2002 through 2018 from the Veterans Aging Cohort Study, a prospective cohort including PWH in care at eight US Veterans Health Administration sites. HED was defined as consuming six or more drinks at least once in the year prior to survey collection. We examined the relationship between HED and self-reported opioid use and created a 4-level composite variable of HED and opioid use. We used multinomial logistic regression to estimate odds of reporting concomitant HED and self-reported opioid use. Results: Among 3702 PWH, 1458 (39.4%) reported HED during the study period and 350 (9.5%) reported opioid use. In the multinomial model, compared to reporting neither HED nor opioid use, lifetime housing instability (adjusted odds ratio [aOR] 1.54, 95% confidence interval [CI] 1.01 to 2.35), Veterans Aging Cohort Study Index 2.0 (a measure of disease severity; aOR 1.14, 95% CI 1.02 to 1.28), depressive symptoms (aOR 2.27, 95% CI 1.42 to 3.62), past-year cigarette smoking (aOR 3.06, 95% CI 1.53 to 6.14), cannabis use (aOR 1.69, 95% CI 1.09 to 2.62), and cocaine/stimulant use (aOR 11.54, 95% CI 7.40 to 17.99) were independently associated with greater odds of concomitant HED and self-reported opioid use. Compared to having attended no college, having some college or more (aOR 0.39, 95% CI 0.26 to 0.59) was associated with lower odds of concomitant HED and self-reported opioid use. Conclusions: Among PWH, concomitant HED and self-reported opioid use are more common among individuals with depressive symptoms and substance use, structural vulnerabilities, and greater illness severity. Efforts to minimize opioid-related risk should address high-risk drinking as a modifiable risk factor for harm among these groups.

Original languageEnglish
Pages (from-to)600-613
Number of pages14
JournalAlcoholism: Clinical and Experimental Research
Volume46
Issue number4
DOIs
StatePublished - Apr 2022

Bibliographical note

Funding Information:
This work was supported by the National Institute on Drug Abuse (R01‐DA040471) and by the National Institute on Alcohol Abuse and Alcoholism (U01‐AA020790). The funding source was not involved in the design, conduct, or reporting of the work. No financial disclosures were reported by the authors of this article.

Publisher Copyright:
© 2022 by the Research Society on Alcoholism.

Keywords

  • alcohol-related disorders
  • cohort studies
  • drug overdose
  • human immunodeficiency virus
  • opioid-related disorders

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Toxicology
  • Psychiatry and Mental health

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