RWE-003 - IMPACT OF COMORBID PAIN, PSYCHIATRIC DIAGNOSES, AND SUBSTANCE USE DISORDERS ON OPIOID USE DISORDER TREATMENT IN PERSONS WITH AND WITHOUT HIV.

E. Miller¹, K. McGinnis², R. Kerns², K. Gordon², J. Edelman², A. Justice², T. Feinberg², M. McRae¹, J. Patterson¹; ¹Virginia Commonwealth University, Richmond, VA, USA, ²Yale University, New Haven, CT, USA.

Background: Opioid use disorder (OUD) in people with HIV (PWH) leads to negative health outcomes. OUD treatment improves HIV outcomes and mortality, however engagement is low (1,2) and is influenced by medical and psychiatric comorbidities (3). We examined the impact of patterns of co-occurring pain diagnoses, psychiatric conditions, and substance use disorders (SUDs) on OUD treatment initiation and retention in people with and without HIV.

Methods: Using data from the Veterans Aging Cohort Study, 7,875 patients (2,702 PWH and 5,173 without HIV) were identified with new OUD clinical encounters from Jan 2008 to Sept 2017. Buprenorphine (BUP) initiation and 6- and 12-month retention were examined. Comorbidities were determined from ICD-9 and -10 codes. We employed a latent class analysis (LCA) to identify patterns of co-occurring diagnoses and regression analyses to assess the effect of class membership on BUP initiation and retention.

Results: Of the 7,875 patients identified, the mean age was 55 years, 98% were male, 58% Black, 8% Hispanic, and only 8% initiated BUP. Four classes were identified: “Few Co-occurring Diagnoses” (45.3%); “Pain” (20.8%); “Pain + SUD” (19.8%); and “Pain + SUD + Psychiatric” (14.2%). Patients in the two highest comorbidity classes, “Pain + SUD” class and “Pain + SUD + Psychiatric” class, were significantly less likely to initiate BUP. Specifically, compared to those in the “Few Co-occurring Diagnoses” class, these two classes had 33% and 61% lower odds, respectively, of initiating BUP; this did not vary by HIV status. Treatment retention was not significantly associated with HIV status or class membership.

Conclusion: In conclusion, comorbidity burden may be most relevant when initiating OUD treatment. More research is warranted to determine other factors that influence treatment retention.

1. Fanucchi L, Springer SA, Korthuis PT. Medications for Treatment of Opioid Use Disorder among Persons Living with HIV. Curr. HIV/AIDS Rep. 2019;16(1):1-6. doi:10.1007/s11904-019-00436-7
2. Kraemer KL, McGinnis KA, Fiellin DA, et al. Low levels of initiation, engagement, and retention in substance use disorder treatment including pharmacotherapy among HIV-infected and uninfected veterans. J. Subst. Abuse Treat. 2019;103:23-32. doi:10.1016/j.jsat.2019.05.007
3. National Institute on Drug Abuse. Common Comorbidities with Substance Use Disorders Research Report. https://www.samhsa.gov/data/population-data-nsduh. Published April 14, 2020. Accessed September 9, 2022.