Opioid Misuse Among HIV-Positive Adults in Medical Care

Results From the Medical Monitoring Project, 2009-2014

Ansley Lemons, MPH; Nicholas DeGroote, MPH; Alejandro Peréz, MPH; Jason Craw, MPH; Margaret Nyaku, MPH; Dita Broz, PhD; Christine L. Mattson, PhD; Linda Beer, PhD


J Acquir Immune Defic Syndr. 2019;80(2):127-134. 

In This Article

Abstract and Introduction


Background: People living with HIV are prescribed opioids more often and at higher doses than people who do not have HIV, and disproportionately experience risk factors for substance use disorder, which suggests they could be at increased risk of the misuse of opioids. Researchers also suggest that opioid misuse negatively affects various HIV clinical outcomes, increasing the risk of transmission to partners with an HIV-negative status.

Methods: We calculated weighted percentages and 95% confidence intervals to estimate substance use characteristics among a probability sample of 28,162 HIV-positive adults receiving medical care in the United States who misused opioids (n = 975). Then, we used Rao-Scott χ 2 tests to assess bivariate associations between opioid misuse and selected characteristics.

Results: In all, 3.3% misused opioids. Misuse was more common among young adults, males, and non-Hispanic whites. Persons who misused opioids were less likely to: have been prescribed antiretroviral therapy (ART) (88.7%), report being adherent to ART medications in the past 3 days (78.1%), and have durable viral suppression (54.3%) than persons who did not misuse opioids (92.5%, 87.7%, and 64.7%, respectively). Persons who misused opioids were more likely to report condomless sex with partners of negative or unknown HIV status while not durably virally suppressed (11.7% vs 3.4%) than persons who did not misuse opioids.

Conclusions: Opioid misuse among adults receiving HIV medical care is associated with inadequate ART adherence, insufficient durable viral suppression, and higher risk of HIV transmission to sexual partners.


The opioid crisis in the United States has led to devastating health consequences. The Centers for Disease Control and Prevention (CDC) reported that 66.4% of drug overdose deaths in 2016 involved the use of an opioid.[1] The use of opioids, such as heroin, fentanyl, oxycodone, and hydrocodone, has been tied to increased death rates across the United States.[2] Evidence suggests the nonmedical use of prescription opioids is associated with the subsequent use of heroin[3] and injection drug use.[4] Injection drug use increases the risk of HIV and hepatitis C virus transmission and other blood borne infections.[5] Persons who misuse opioids tend to engage in risky behaviors, including condomless sex,[6,7] having multiple concurrent partners,[6,8] and syringe-sharing.[7]

Studies have shown that people living with HIV (PLWH) are more likely to be prescribed opioids than those not living with HIV[9] and at higher dosages,[9,10] in part because pain is a commonly reported symptom among patients with HIV infection.[11] PLWH are also more likely to experience mental health issues and substance use disorders,[12] which are known risk factors for opioid misuse.[13] Evidence suggests PLWH who misuse opioids are less likely to be prescribed antiretroviral therapy (ART),[14] adherent to ART, and engaged in regular HIV care,[15] which could decrease the likelihood of viral suppression and lead to adverse health outcomes and increase the risk of transmitting HIV to others. As networks of persons who misuse opioids expand to include people who inject opioids and PLWH, HIV transmission risks could increase. Keeping PLWH engaged in medical care and virally suppressed is a key strategy for preventing the transmission of HIV and an important part of national HIV prevention goals.[16]

Currently, there are no national data describing opioid misuse among PLWH. Given the increased risk of opioid misuse among PLWH and the links between misuse, poor health outcomes, and HIV transmission, these data are essential to inform and monitor an effective response and prevent the spread of HIV. This analysis is the first to provide nationally representative estimates of opioid misuse and associations with sociodemographic, clinical, and behavioral characteristics among HIV-positive adults receiving medical care in the United States.