A Review of Opioid Prescribing Practices and Associations with Repeat Opioid Prescriptions in a Contemporary Outpatient HIV Clinic

Önen, Nur F.; Barrette, Ernie-Paul; Shacham, Enbal; Taniguchi, Toshibumi; Donovan, Michael; Overton, Edgar Turner

doi:10.1111/j.1533-2500.2011.00520.x

Cited by 42 publications

(41 citation statements)

References 43 publications

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“…These data are consistent with a prior study, which found that only 57 % of HIV-infected patients initiating opioid treatment had a documented indication for opioids. 7 Our finding that HIV-infected patients were more likely to receive any and high-dose opioids, and less likely to receive long-term opioids are unlikely to be explained by differences in pain-related diagnoses alone. In fact, recent data from our group found that HIV-infected patients were less likely to report moderate or severe pain than uninfected patients (34 % vs. 49 %, p<0.05).…”

Section: Discussionmentioning

confidence: 75%

“…Consistent with previous literature, patients receiving opioids had a greater prevalence of HCV, major depression, alcohol and drug use disorders and pain-related diagnoses. 4,7,12,[38][39][40][41] Unique to our cohort, we demonstrated that these conditions were more common among HIV-infected patients who were prescribed opioids in comparison to their age/sex/race/ ethnicity/site-matched controls. Generally, non-schedule II short-acting medications were the most common types of opioids received.…”

Section: Discussionmentioning

confidence: 85%

“…22 There are limited recent data examining factors associated with opioid prescribing to HIV-infected patients. Existing studies focus on long-term therapy; 12,14 lack an uninfected comparison group; 7,14,15 and do not consider opioid indication. 12,14 Furthermore, some of these studies were conducted within a single site, 7,15 which may limit their generalizability.…”

Section: Introductionmentioning

confidence: 99%

“…Existing studies focus on long-term therapy; 12,14 lack an uninfected comparison group; 7,14,15 and do not consider opioid indication. 12,14 Furthermore, some of these studies were conducted within a single site, 7,15 which may limit their generalizability. 23 Therefore, we conducted a crosssectional study to: 1) describe opioid analgesic receipt in a large sample of HIV-infected and uninfected patients; 2) determine whether opioid receipt varies by HIV status; and 3) identify factors associated with receipt of any opioid analgesics, high-dose opioids and long-term opioids.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6] This has occurred despite limited evidence demonstrating opioid efficacy for chronic, non-cancer pain 7,8 and evidence of their risks, including side effects, 3 and potential for abuse and dependence. 9,10 Guidelines recommend careful consideration of risks and benefits of treatment when initiating opioids for pain, especially for populations with a history of substance use disorders.…”

Section: Introductionmentioning

confidence: 99%

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Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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BACKGROUND: Opioids are increasingly prescribed, but there are limited data on opioid receipt by HIV status. OBJECTIVES: To describe patterns of opioid receipt by HIV status and the relationship between HIV status and receiving any, high-dose, and long-term opioids. DESIGN: Cross-sectional analysis of the Veterans Aging Cohort Study. PARTICIPANTS: HIV-infected (HIV+) patients receiving Veterans Health Administration care, and uninfected matched controls. MAIN MEASURES: Pain-related diagnoses were determined using ICD-9 codes. Any opioid receipt was defined as at least one opioid prescription; high-dose was defined as an average daily dose ≥120 mg of morphine equivalents; long-term opioids was defined as ≥90 consecutive days, allowing a 30 day refill gap. Multivariable models were used to assess the relationship between HIV infection and the three outcomes. KEY RESULTS: Among the HIV+ (n = 23,651) and uninfected (n=55,097) patients, 31 % of HIV+ and 28 % of uninfected (p<0.001) received opioids. Among patients receiving opioids, HIV+ patients were more likely to have an acute pain diagnosis (7 % vs. 4 %), but less likely to have a chronic pain diagnosis (53 % vs. 69 %). HIV+ patients received a higher mean daily morphine equivalent dose than uninfected patients (41 mg vs. 37 mg, p=0.001) and were more likely to receive high-dose opioids (6 % vs. 5 %, p<0.001). HIV+ patients received fewer days of opioids than uninfected patients (median 44 vs. 60, p<0.001), and were less likely to receive long-term opioids (31 % vs. 34 %, p< 0.001). In multivariable analysis, HIV+ status was associated with receipt of any opioids (AOR 1.40, 95 % CI 1.35, 1.46) and high-dose opioids (AOR 1.22, 95 % CI 1.07, 1.39), but not long-term opioids (AOR 0.94, 95 % CI 0.88, 1.01). CONCLUSIONS:Patients with HIV infection are more likely to be prescribed opioids than uninfected individuals, and there is a variable association with pain diagnoses. Efforts to standardize approaches to pain management may be warranted in this highly complex and vulnerable patient population.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

et al. 2012

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Potential benefits and harms of prescription opioids in HIV

Becker

Edelman

2016

Chronic Pain and HIV

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Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV

et al. 2015

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Opioids are often prescribed for chronic pain, and opioid risks such as overdose and death are heightened when opioids are co-prescribed with other sedating medications. We investigated factors associated with chronic opioid prescription, alone and in combination with benzodiazepines and muscle relaxants, in a clinical cohort of individuals with HIV. We used multivariable logistic regression models to determine participant clinical and demographic characteristics that are associated with chronic prescription of opioids or chronic co-prescription of opioids with sedating medications. Among 1,474 participants, chronic prescription of opioids occurred in 253 individuals (17.2%), and chronic co-prescription occurred in 90 individuals (6.1%). Age >50, public insurance as compared to private insurance, and symptoms of depression and anxiety were significantly associated with chronic opioid prescription and chronic co-prescription. Our findings raise concern that opioid prescription and co-prescription of sedating medications occurs disproportionately in patients for whom use is riskier.

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A Review of Opioid Prescribing Practices and Associations with Repeat Opioid Prescriptions in a Contemporary Outpatient HIV Clinic

Cited by 42 publications

References 43 publications

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

Receipt of Opioid Analgesics by HIV-Infected and Uninfected Patients

Potential benefits and harms of prescription opioids in HIV

Factors Associated with Prescription of Opioids and Co-prescription of Sedating Medications in Individuals with HIV

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