Drug use among HIV+ adults aged 50 and older: findings from the GOLD II study

Abstract

Understanding the nexus of aging, HIV, and substance use is key to providing appropriate services and support for their aging, HIV seropositive patients. The proportion of PLWHA aged 50 and older is growing due to a variety of factors like decreases in mortality due to highly active retroviral therapy and non-negligible HIV incidence. We describe prevalence of alcohol, tobacco, and other drug use and participation in substance use treatment and 12-steps programs among 95 HIV-positive patients aged 50 and older engaged in care. Most (73.7%) smoked cigarettes in their lifetime and 46.3% were current smokers. Most were at medium (81.1%) or high risk (13.7%) for an alcohol use disorder. With respect to illicit drug use, 48.4% had used marijuana, cocaine, crack, methamphetamines, heroin, and/or prescription opiates without a prescription in the last 12 months; 23.2% met criteria for drug dependence. Marijuana was the most commonly reported illicit drug (32.6%) followed by cocaine and crack (10.5% each), heroin and prescription opiates (7.4% each), and methamphetamines (6.3%). Among those who had not used drugs in the past 12 months, 36.7% had been in a substance use treatment program and 26.5% had participated in a 12-step program in their lifetime; 8.2% were currently in treatment and 16.3% were currently participating in a 12-step program. Among those who had used an illicit drug in the past 12 months, 37.0% had never been in treatment, 34.8% had been in treatment in their lifetime, and 28.3% were currently in treatment. With respect to 12-step programs, 27.3% of those meeting dependence criteria had never participated, 45.5% had participated in their lifetimes, and 27.3% were currently participating. Our findings suggest that older adults in HIV care settings could benefit from Screening, Brief Intervention, and Referral to Treatment (SBIRT) interventions and/or integrated services for substance abuse and medical treatment.

Cannabis Use is Associated with Lower Odds of Prescription Opioid Analgesic Use Among HIV-Infected Individuals with Chronic Pain

“…The potential benefit of medical cannabis in the treatment of patients with HIV has a long history (Werner, 2001) and up to 62% of people with HIV infection report cannabis use (Mimiaga et al, 2013; Okafor et al, 2017; Ompad et al, 2016). Cannabis use could improve HIV outcomes by improving pain and anxiety (both are associated with poor HIV outcomes) or could worsen HIV outcomes, as suggested by pre-clinical studies which show that cannabis negatively impacts immune function (Friedman, Klein, Newton, & Daaka, 1995; Hollister, 1992).…”

Patterns of drug use and HIV infection among adults in a nationally representative sample

“…This study is of particular importance as few studies have estimated drug usage among HIV-infected populations in comparison to the general population. The majority of epidemiologic studies report on HIV infection rates among injection drug users in comparison to non-injection drug users [11, 12] or on the prevalence of drug use among a population with HIV [13, 14]. …”

“…Existing studies on HIV and drug use in the United States primarily report on HIV infection rates among injection drug users in comparison to non-injection drug users [11, 12] or on the prevalence of drug use among a population with HIV [13, 14]. Few studies, however, have specifically compared drug use patterns among people living with HIV to people without HIV in the general United States population.…”

Addressing treatment and care needs of older adults living with HIV who use drugs

“…Unlike substance use patterns observed among the general population, previous research has suggested that substance use among PLHIV does not decline with age [9]. In one study from the United States (US), 10.5% of OALHIV were found to have used cocaine, 10.5% used crack cocaine, 6.3% used methamphetamines, 7.4% used heroin and 7.4% used prescription opioids without a prescription in the past 12 months [10]. Furthermore, close to a quarter of OALHIV were found to meet the DSM-IV criteria for a substance use disorder [10].…”

“…In one study from the United States (US), 10.5% of OALHIV were found to have used cocaine, 10.5% used crack cocaine, 6.3% used methamphetamines, 7.4% used heroin and 7.4% used prescription opioids without a prescription in the past 12 months [10]. Furthermore, close to a quarter of OALHIV were found to meet the DSM-IV criteria for a substance use disorder [10]. Understanding drug use patterns of OALHIV is relevant to improving the health and wellbeing of this population, particularly as drug use has been found to be associated with sub-optimal HIV treatment outcomes, including ART adherence [11].…”