People living with HIV are at increased risk of both polypharmacy — the prescription of multiple medications to treat HIV and other health conditions — and non-fatal overdose, studies have shown.
Now, a team of researchers from the School of Medicine, Boston University School of Public Health (BUSPH) and Boston Medical Center has found that the elevated risk from polypharmacy is not due to more medications overall, but is largely due to a higher number of sedating medications, including prescribed opioids.
The study, published in the Journal of Substance Abuse Treatment, examined the effect of the number and type of medication on non-fatal overdose risk among individuals with HIV infection and substance dependence. It found that each additional sedating medication was associated with an approximately 25 percent increase in the odds of lifetime non-fatal overdose.
The study — part of the Boston ARCH Cohort Study — found that the median number of prescription medications was 10 and that 80 percent of patients were prescribed at least one sedating medication. The researchers said their findings suggested that the lifetime risk of non-fatal overdose from more sedating medications was mostly driven by prescription opioids versus other kinds of medications. Co-prescribed opioid and non-opioid sedating drugs also were associated with a higher risk of non-fatal overdose.
“Steps to address polypharmacy-related overdose risks could include treatment of addiction, addressing health conditions with non-medication options when relevant, reviewing medications regularly to assure prescription of those with efficacy, and elimination of combinations known to be potentially harmful,” said co-author Dr. Richard Saitz, professor and chair of community health sciences at BUSPH and principal investigator of the Boston ARCH cohort study.