Older Adults with HIV Face Higher Opioid Risks, Rutgers Study Finds

New research reveals that older Americans living with HIV are prescribed opioids more often — and at higher-risk levels — than those without the virus.

A new study from Rutgers Health has found that older adults diagnosed with HIV are prescribed opioid medications at significantly higher rates and are more likely to show signs of opioid use disorder (OUD) compared to their HIV-negative peers.

The study, published in The Lancet Primary Care, represents the first long-term, nationally representative analysis of opioid-related risks among U.S. adults aged 65 and older living with HIV. The findings raise urgent questions about how healthcare providers can better balance pain management with addiction prevention in this aging population.

A Closer Look at the Findings

The Rutgers research team, led by Dr. Stephanie Shiau, an associate professor at the Rutgers School of Public Health, analyzed data from more than 650,000 Medicare beneficiaries between 2008 and 2021. The goal: to understand how opioid prescribing patterns and related disorders differ between older adults with and without HIV.

Their results were striking.

More than one in three older adults with HIV had received at least one opioid prescription — a rate notably higher than that of those without HIV. But the concern goes deeper than prescription frequency.

“We found that older adults with HIV were more likely to receive high-risk opioid prescriptions — including higher doses, overlapping prescriptions, and longer durations of use,” said Dr. Shiau. “These practices significantly increase the potential for opioid-related harm in an already medically vulnerable population.”

A Hidden Layer of the Opioid Crisis

The study also revealed that, between 2008 and 2016, older adults with HIV were more than twice as likely to show indicators of opioid use disorder — including formal OUD diagnoses, treatments, or hospital visits linked to opioid complications.

Researchers say these patterns likely reflect the complex health challenges faced by people aging with HIV. Advances in antiretroviral therapy have transformed HIV into a chronic, manageable condition, allowing patients to live well into their 60s and beyond. But with longevity comes new challenges: persistent pain, polypharmacy, and greater exposure to medications with dependency risks, including opioids.

“This is a health disparity that warrants serious attention,” said Dr. Shiau. “Older adults with HIV face a unique intersection of chronic pain, mental health concerns, and long-term medication use — all of which can amplify vulnerability to opioid misuse and overdose.”

The Need for Tailored Care

As the U.S. population of older adults with HIV grows, so too does the need for tailored pain management strategies. Traditional approaches to prescribing may not fully account for the physiological and psychosocial complexities of living with HIV while aging.

Experts say the findings underscore the importance of:

• Reevaluating opioid prescribing practices among older HIV patients.

• Expanding access to Naloxone, a life-saving medication that reverses opioid overdoses caused by FYL, XYL, or other synthetic opioids.

• Integrating addiction treatment into HIV care, ensuring that patients with OUD receive compassionate, coordinated treatment without stigma.

• Training healthcare providers to recognize the signs of opioid dependency and understand the potential drug interactions between opioids and antiretroviral therapies.

Looking Ahead: Research and Policy Implications

While this study shines a light on prescribing trends, researchers emphasize that more work is needed to understand the drivers behind opioid use in this population. Future studies will need to explore how opioids interact with HIV medications, how chronic pain is assessed and managed, and what long-term outcomes — including overdose and mortality — look like for these patients.

“As the HIV population ages, we must address their unique vulnerabilities within the broader opioid crisis,” said Shiau. “Developing safer, non-opioid pain management options and expanding access to evidence-based OUD treatments are essential steps toward improving their quality of life.”

A Call for Awareness and Action

The Rutgers findings serve as both a warning and a call to action. Older adults living with HIV are often invisible in discussions about the opioid epidemic, yet they represent a growing group at elevated risk.

By combining responsible prescribing, preventive education, and ready access to Naloxone, healthcare providers and policymakers can help prevent avoidable harm — and ensure that older adults with HIV receive compassionate, evidence-based care that meets their complex needs.

Source: Rutgers