UCSF

Objectives: To determine associations between dose changes in opioids prescribed for chronic non-cancer pain and HIV care outcomes. Methods: Using medical record data from January 1, 2012, to June 30, 2019, for 300 publicly insured HIV-positive primary care patients prescribed opioids for chronic non-cancer pain in San Francisco, we examined associations between opioid dose changes and both time to disengagement from HIV care and having a detectable viral load using logistic regression models. Models controlled for time-dependent confounding and informative censoring using inverse probability of treatment and retention weights, respectively. Results: Discontinuation of prescribed opioids was associated with increased odds of disengagement in care at 3 months (OR: 2.21, 95% CI: 1.19-4.12), 6 months (3.66, 1.94-6.93), and 9 months (3.75, 1.76-7.97) after discontinuation. An increased opioid dose was associated with lower odds of having a detectable viral load (0.64, 0.43-0.95). Conclusions: Discontinuation of opioids prescribed for chronic pain is associated with disengagement from HIV care. Policy Implications: Providers and policymakers must consider the unintended consequences of opioid stewardship and its potential impacts on retention in care.