Opioid Use Disorder Among Medicare Beneficiaries

By: Ranier Simons, ADAP Blog Guest Contributor

The United States has the highest levels of opioid consumption worldwide (Cornell et al., 2021). This consumption level is not solely attributed to recreational use but is also a product of prescription rates. United States healthcare providers prescribe opioids for pain more often and at earlier points in treatment, sometimes as first-line therapy (Cornell et al., 2021). This is especially concerning regarding people living with HIV/AIDS (PLWHA). Compounding the potential adverse effects of medically prescribed opioids, PLWHA also have a much higher prevalence of non-medical opioid use compared to the general population of HIV-negative individuals (West et al., 2023). A recent study examined opioid use among older PLWHA specifically.

Photo Source: Clinical Trials Arena

A recently published retrospective cross-sectional study analyzed opioid utilization and the prevalence of opioid use disorder (OUD) among Medicare beneficiaries. The study subjects were aged 65 and older and beneficiaries of Medicare fee-for-service with Part D prescription drug coverage. The study covered the period from January 1, 2008, to December 31, 2021 (Shiau et al., 2025). The researchers examined 163,429 PLWHA, comparing them to 490,287 individuals without HIV, matching based on demographic criteria. 

During the study timeline, 35% of PLWHA, compared to 28.3% of HIV-negative subjects, were prescribed at least one opioid annually (Shiau et al., 2025). PLWHA had a higher prevalence of being prescribed higher-risk prescriptions. High-risk opioid prescriptions are those with higher dosages and longer durations. Dosages are commonly measured in morphine milligram equivalents (MME). Dosages higher than 100 MMEs have twice the risk of misuse and overdose as lower doses, while dosages of 20-50 MME also carry risk (U.S. Dept of Labor, n.d.). In the study cohort, 5.3% of PLWHA received prescriptions with total daily MMEs higher than 90mg compared to 2.2% of those without HIV (Shiau et al., 2025). Additionally, 3.1% of PLWHA, compared to 1.6% of those without HIV, were prescribed opioids with MMEs higher than 120mg (Shiau et al., 2025). Regarding prescription duration, 6.1% of PLWHA, compared to 3.9% of individuals without HIV, were prescribed high-risk opioids with coverage of longer than 90 consecutive days of use (Shiau et al., 2025). 

Photo Source: AIDS Map

It is notable that among the study participants, there was a higher prevalence of OUD indicators in PLWHA compared to those who were HIV-negative. The data analyzed were administrative; thus, OUD indicators include formal diagnosis, OUD medication, and opioid-related emergency department visits (Shiau et al., 2025).  

PLWHA are prescribed opioids for chronic pain. That pain can have multiple causes, such as HIV-related nerve damage, pain from opportunistic infections acquired due to lowered immune response, antiretroviral treatment side effects, and more (Lutton, 2025; Madden et al., 2020). Opioid abuse is not only medically detrimental overall but also has HIV-specific adverse outcomes. PLWHA with OUD are more likely to have difficulty with ART adherence. This is especially true for PLWHA who are also living with mental health challenges. Gravely, ART, opioids, and drugs used to treat OUD are metabolized in the body via the same biochemical pathways (Cernasev et al., 2020). Thus, there can be adverse drug interactions. Moreover, ART medications can enhance or decrease the levels of opioids or OUD treatment drugs in the bloodstream (Cernasev et al., 2020). There are times when the interactions can increase the effectiveness of the ART, opioids, or OUD treatment medications (Cernasev et al., 2020). However, many times the result is often reduced effectiveness or even toxicity (Cernasev et al., 2020). All these potential adverse outcomes are compounded by the fact that many PLWHA have comorbidities.

Photo Source: Valley Spring Recovery Center

Studies indicate that over half of PLWHA will have nonmalignant chronic pain at points throughout their lives (Madden et al., 2020). As a result of medical advances in HIV treatment, PLWHA are living longer. Thus, the population of PLWHA over the age of 65 is going to continue to increase, as will chronic pain issues. The Shiau study indicates the importance of examining better ways to treat chronic pain in PLWHA that do not rely on high-risk opioids. A direct quote from the study text includes, “…clinicians treating older adults with HIV should consider alternative therapies for pain, and public health researchers and policy makers should consider screening and prevention programs for opioid use disorder in older adults living with HIV” (Shiau et al., 2025). 

It is essential to emphasize the holistic well-being of older PLWHA. Physical health, mental health, sexual health, and addiction are all realities that need to remain priorities for all medical professionals who give care to aging populations.

[1] Cernasev, A., Veve, M. P., Cory, T. J., Summers, N. A., Miller, M., Kodidela, S., & Kumar, S. (2020). Opioid Use Disorders in People Living with HIV/AIDS: A Review of Implications for Patient Outcomes, Drug Interactions, and Neurocognitive Disorders. Pharmacy (Basel, Switzerland), 8(3), 168. https://doi.org/10.3390/pharmacy8030168

[2] Cornell, A., Davis-Castro, C., Duff, H., Romero, P. (2021, June 2). Consumption of Prescription Opioids for Pain: A Comparison of Opioid Use in the United States and Other Countries. Retrieved from https://www.congress.gov/crs-product/R46805

[3] Lutton, L. (2025, October 7). Opioid Prescriptions, Addiction More Common in Older HIV Patients. Managedhealthcareexecutive.com; Managed Healthcare Executive. Retrieved from https://www.managedhealthcareexecutive.com/view/opioid-prescriptions-addiction-more-common-in-older-hiv-patients

[4] Madden, V. J., Parker, R., & Goodin, B. R. (2020). Chronic pain in people with HIV: a common comorbidity and threat to quality of life. Pain management, 10(4), 253–260. https://doi.org/10.2217/pmt-2020-0004. Retrieved from https://pmc.ncbi.nlm.nih.gov/articles/PMC7421257/#:~:text=Abstract,(e.g.%2C%20stigma)%20factors.

[5] Shiau, S., Drago, F., Kinkade, C. W., Getz, K., Bushnell, G., Samples, H., Bender, A. A., Bennett, L., Dave, C., Halkitis, P. N., Gerhard, T., Roy, J. A., Martins, S. S., Yin, M. T., & Crystal, S. (2025). Prescription opioid use and opioid use disorder among older adults with HIV in the USA from 2008 to 2021: a retrospective repeated cross-sectional study. 100017–100017. https://doi.org/10.1016/j.lanprc.2025.100017. Retrieved from https://www.thelancet.com/journals/lanprc/article/PIIS3050-5143(25)00017-2/fulltext

[6] West, B. S., Diaz, J. E., Philbin, M. M., & Mauro, P. M. (2023, April). Past-year medical and non-medical opioid use by HIV status in a nationally representative US sample: Implications for HIV and substance use service integration. Journal of Substance Use and Addiction Treatment, 147, 208976. https://doi.org/10.1016/j.josat.2023.208976. Retrieved from https://www.sciencedirect.com/science/article/abs/pii/S2949875923000267#:~:text=Conclusion,%2Drelated%20outcomes%2C%20including%20overdose.

[7] U.S. Department of Labor. (nd). Risk Factors for Opioid Misuse, Addiction, and Overdose. Retrieved from https://www.dol.gov/agencies/owcp/opioids/riskfactors

Disclaimer: Guest blogs do not necessarily reflect the views of the ADAP Advocacy Association, but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about public health-related issues and updates.