Author ORCID Identifier

Date Available


Year of Publication


Degree Name

Doctor of Philosophy (PhD)

Document Type

Doctoral Dissertation


Public Health


Epidemiology and Biostatistics

First Advisor

Dr. Daniela Moga

Second Advisor

Dr. David Fardo


Opioid-related negative health outcomes, such as substance use disorder, misuse, and overdose deaths, have risen as long-term opioid use has increased. The benefit of using long-term opioids for pain is yet to be established. The Centers for Disease Control and Prevention provides guidelines for opioid prescribing in chronic pain, but detailed recommendations on opioid prescribing for vulnerable populations are missing due to lack of evidence-based studies. The purpose of this dissertation is to describe patterns and predictors of opioid use and assess outcomes related to prescribing opioid medications in vulnerable populations, specifically older adults with various levels of cognitive function, as well as US adults enrolled in the Medicaid program.

The four projects included in this dissertation used existing data from the National Alzheimer’s Coordinating Center (2005 and 2017) for the first and second projects and the Center for Medicare and Medicaid Services––Medicaid enrollment and claims data (2002-2009), including four US states, Kentucky, Maryland, North Carolina, and Washington, for the third and fourth projects. The first research project, “Patterns and predictors of chronic opioid use in older adults: a retrospective cohort study,” shows that chronic opioid use is more prevalent in participants who are more vulnerable among participants with 65+ age. The second research project, “Comparing the patterns and predictors of opioid use in older adults with different cognitive status,” shows that the patterns and predictors of chronic opioid use vary across the cognitive status. The third research project, “An investigation of predictors of long-term opioid use in Medicaid beneficiaries with HIV who initiated antiretroviral therapy,” shows that comorbidities and polypharmacy was important predictors of long-term opioid use in patients with HIV. The fourth research project, “The effect of long-term opioid use on healthcare utilization in Medicaid beneficiaries with HIV who initiated antiretroviral therapy” shows long-term opioid use is associated with increased emergency department admissions and HIV-related hospitalization and decreased discontinuation of standard antiretroviral therapy in HIV-diagnosed Medicaid beneficiaries.

The results from this dissertation provide a better understanding of utilization patterns and effects of opioid use in vulnerable populations needed to improve the risk-benefit assessment for opioid use in these populations.

Digital Object Identifier (DOI)