Appropriate and inappropriate prescribing of narcotics for ambulatory HIV-positive patients

Morrison, Robert E.; Brint, J. M.; Smith, Wally R.; Arheart, Kristopher L.; Wray, Debra; Palte, Stephen B.; Ackerman, Terrence F.

doi:10.1007/bf02599175

Cited by 2 publications

(4 citation statements)

References 5 publications

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“…The association of drug abuse with prescription opioid use is consistent with earlier studies among HIV-infected individuals 8, 29-31 , as well as recent studies comparing prescription opioid use between those with and without substance use disorders in the general population 18, 32 . Those with diagnosed substance use disorders may have reduced pain tolerance 23, 33 , or perhaps increased prevalence of other comorbid illnesses 34 , resulting in more frequent use of prescription opioids at higher dosage levels.…”

Section: Discussionsupporting

confidence: 88%

“…Those with a history of drug abuse also persistently reported aberrant opioid use during follow-up. Another study of 190 HIV-infected individuals seen in a single U.S. medical clinic indicated that HIV-infected individuals with a history of IDU were more likely to have been prescribed narcotics inappropriately compared with other men who have sex with men or heterosexuals 8 .…”

Section: Discussionmentioning

confidence: 99%

“…Thus, effective chronic pain management is an important consideration for HIV-infected patients, and one option for chronic pain management that is increasingly common in the general population is long-term use of opioid analgesics 7 . However, long-term treatment of pain with opioid analgesics in HIV-infected patients is complex given concerns of possible drug misuse since many HIV-infected individuals have a prior drug abuse history 8 . Furthermore, there are known drug-drug interactions for all antiretroviral drug classes with methadone and buprenorphine 9-12 , and also for other opioid analgesics including meperidine 10 and fentanyl 13 coadministered with ritonavir-boosted antiretrovirals.…”

Section: Introductionmentioning

confidence: 99%

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Prescription Long-term Opioid Use in HIV-infected Patients

Silverberg

Ray

Saunders

et al. 2012

The Clinical Journal of Pain

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Objectives To examine changes in use of prescription opioids for the management of chronic non-cancer pain in HIV-infected patients and to identify patient characteristics associated with long-term use. Methods Long-term prescription opioid use (i.e. 120+ days supply or 10+ prescriptions during a year) was assessed between 1997 and 2005 among 6,939 HIV-infected Kaiser Permanente members and HIV-uninfected persons in the general health plan memberships. Results In 2005, 8% of HIV+ individuals had prevalent long-term opioid use, more than double the prevalence among HIV-uninfected individuals. However, the large increases in use from 1997 to 2005 in the general population were not observed for HIV-infected individuals. The strongest associations with prevalent use among HIV-infected individuals were female gender with a prevalence ratio [PR] of 1.8 (95% CI=1.3, 2.5); Charlson comorbidity score of 2 or more (compared with a score of 0) with a PR of 1.9 (95% CI=1.4, 2.8); injection drug use history with a PR of 1.8 (95% CI=1.3, 2.6); substance use disorders with a PR of 1.8 (95% CI=1.3, 2.5). CD4, HIV RNA, and AIDS diagnoses were associated with prevalent opioid use early in the antiretroviral therapy era (1997), but not in 2005. Conclusions Long-term opioid use for chronic pain has remained stable over time for HIV patients, while use increased in the general population. The prevalence of prescribed opioids in HIV patients was highest for certain subgroups, including women, and those with a comorbidity and substance abuse history.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Prescription Long-term Opioid Use in HIV-infected Patients

Silverberg

Ray

Saunders

et al. 2012

The Clinical Journal of Pain

View full text Add to dashboard Cite

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“…Specifically, providers and patients must manage OT in the context of the competing demands of medical, psychiatric and substance use comorbidities, and accordingly, polypharmacy. 7, 14, 18, 30, 38, 42, 46 Moreover, military veterans, in general, suffer from a high prevalence of chronic pain, particularly veterans returning from Afghanistan and Iraq (i.e., Operation Enduring Freedom and Operation Iraqi Freedom, respectively). 46 To date, no studies have examined the provision of OT guideline-concordant care.…”

mentioning

confidence: 99%

Guideline-Concordant Management of Opioid Therapy Among Human Immunodeficiency Virus (HIV)-Infected and Uninfected Veterans

Gaither

Goulet

Becker

et al. 2014

The Journal of Pain

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Whether patients receive guideline-concordant opioid therapy (OT) is largely unknown and may vary based on provider and patient characteristics. We assessed the extent to which HIV-infected and uninfected patients initiating long-term (≥90-days) OT received care concordant with American Pain Society/American Academy of Pain Medicine and Department of Veterans Affairs/Department of Defense guidelines by measuring receipt of 17 indicators during the first 6 months of OT. Of 20,753 patients, HIV-infected patients (n= 6,604) were more likely than uninfected patients to receive a primary care provider (PCP) visit within 1-month (52.0% vs. 30.9%) and 6-months (90.7% vs. 73.7%) and urine drug tests (UDTs) within 1-month (14.8% vs. 11.5%) and 6-months (19.5% vs. 15.4%; all p < .001). HIV-infected patients were also more likely to receive OT concurrent with sedatives (24.6% vs. 19.6%) and an untreated substance use disorder (SUD; 21.6% vs. 17.2%). Among both patient groups, only modest changes in guideline-concordance were observed over time: UDTs and OT concurrent with untreated SUDs increased, while sedative co-prescriptions decreased (all p for trend < .001). Over a 10-year period, on average, patients received no more than 40% of recommended indicators. OT guideline-concordant care is rare in primary care, varies by patient/provider characteristics, and has undergone few changes over time. Perspective The promulgation of OT clinical guidelines has not resulted in substantive changes over time in OT management, which falls well short of the standard recommended by leading medical societies. Strategies are needed to increase the provision of OT guideline-concordant care for all patients.

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Appropriate and inappropriate prescribing of narcotics for ambulatory HIV-positive patients

Cited by 2 publications

References 5 publications

Prescription Long-term Opioid Use in HIV-infected Patients

Prescription Long-term Opioid Use in HIV-infected Patients

Guideline-Concordant Management of Opioid Therapy Among Human Immunodeficiency Virus (HIV)-Infected and Uninfected Veterans

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