Prescription of High-Dose Opioids Among People Living with HIV in British Columbia, Canada

  • Jessica Clark
  • Nadia Fairbairn
  • Seonaid Nolan
  • Tian Li
  • Anthony Wu
  • Rolando Barrios
  • Julio Montaner
  • Lianping TiEmail author
  • the STOP HIV/AIDS in BC Study Group
Original Paper


People living with HIV (PLHIV) often experience pain for which opioid medications may be prescribed. Thus, these individuals are particularly vulnerable to opioid-related harms, including overdose, misuse, and addiction, particularly when prescribed at high doses. We used a comprehensive linked population-level database of PLHIV in British Columbia (BC) to identify demographic and clinical characteristics associated with being prescribed any high-dose opioid analgesic, defined as > 90 daily morphine milligram equivalents (MME/day). Among PLHIV who were prescribed opioids between 1996 and 2015 (n = 10,780), 28.2% received prescriptions of > 90 MME/day at least once during the study period. Factors positively associated with being prescribed high-dose opioid analgesics included: co-prescription of benzodiazepines (adjusted odds ratio [AOR] = 1.14; 95% confidence interval 1.11–1.17); presence of an AIDS-defining illness (ADI; AOR = 1.78; 95% CI 1.57–2.02); seen by an HIV specialist (AOR = 1.24; 95% CI 1.20–1.29); substance use disorder (AOR = 1.46; 95% CI 1.25–1.71); and more recent calendar year (AOR = 1.05; 95% CI 1.04–1.06). Given the known risks associated with high-dose opioid prescribing, future research efforts should focus on the clinical indication and outcomes associated with these prescribing practices.


Prescription opioids Analgesics Pain People living with HIV 



We thank the participants that make up the Seek and Treat for Optimal Prevention of HIV/AIDS in BC cohort and the physicians, nurses, social workers and volunteers who support them. This study was funded by the British Colombia Ministry of Health (BCMoH), which-funded Seek and treat for optimal prevention of HIV & AIDS in BC pilot project, and an Avant-Garde Award (Number 1DP1DA026182) and Grant 1R01DA036307-01 from the National Institute of Drug Abuse, at the US National Institutes of Health. The funder had no direct role in the conduct of the analysis or the decision to submit the manuscript for publication. We thank BCMoH and Vancouver Coastal Health Decision support staff involved in data access and procurement, including Joleen Wright and Karen Luers, Vancouver Coastal Health decision support. We would also like to acknowledge Ciro Panessa, Nancy South, and Mark Gilbert for their contributions to the STOP HIV/AIDS in BC study group. LT and SN are supported by the Michael Smith Foundation for Health Research. NF is supported by a Michael Smith Foundation for Health Research/St. Paul’s Foundation Scholar Award. Dr. Montaner’s Treatment as Prevention (TasP) research, paid to institution, has received support from the Public Health Agency of Canada, BC-Ministry of Health and US NIH (NIDA R01DA036307 and CTN 248). Institutional grants have been provided by J&J, Merck and a Knowledge Translation Award from CIHR and he has served as an advisor to the federal and BC governments, UNAIDS, WHO in the last year.

The STOP HIV/AIDS in BC Study Group Rolando Barrios, MD, FRCPC, Senior Medical Director, VCH; Adjunct Professor, School of Population and Public Health, UBC. Patty Daly, MD, Vancouver Coastal Health Authority. Mark Gilbert, Clinical Prevention Services, BC Centre for Disease Control; School of Population and Public Health, University of British Columbia. Reka Gustafson, MD, Vancouver Coastal Health Authority. Perry R.W. Kendall, OBC, MBBS, MSc, FRCPC, Provincial Health Officer, British Columbia Ministry of Health; Clinical Professor, Faculty of Medicine UBC. Ciro Panessa, British Columbia Ministry of Health. Gina McGowan, British Columbia Ministry of Health. Nancy South, British Columbia Ministry of Health. Kate Heath, Robert S. Hogg, and Julio S.G. Montaner, BC Centre for Excellence in HIV/AIDS.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of MedicineUniversity of British ColumbiaVancouverCanada
  2. 2.British Columbia Centre on Substance Use, St. Paul’s HospitalVancouverCanada
  3. 3.British Columbia Centre for Excellence in HIV/AIDS, St. Paul’s HospitalVancouverCanada
  4. 4.Vancouver Coastal Health AuthorityVancouverCanada
  5. 5.British Columbia Centre on Substance UseVancouverCanada

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