Chronic Opioid Therapy in People Living With Human Immunodeficiency Virus: Patients’ Perspectives on Risks, Monitoring, and Guidelines

Colasanti, Jonathan; Lira, Marlene C.; Cheng, Debbie M.; Liebschutz, Jane M.; Tsui, Judith I.; Forman, Leah S; Sullivan, Meg; Walley, Alexander Y.; Bridden, Carly; Root, Christin; Podolsky, Melissa C; Abrams, Catherine; Outlaw, Kishna; Harris, Catherine; Armstrong, Wendy S.; Samet, Jeffrey H.; Rı́o, Carlos del

doi:10.1093/cid/ciy452

Cited by 20 publications

(24 citation statements)

References 33 publications

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“…Furthermore, the intended purposes of these instruments are fairly transparent, and higher risk patients responding in a manner suggesting lower-than-actual risk has been documented 28. Although early studies of the COMM15,16,29 substantiated the validity of the measure through significant relationships with UDT results, both the current study and another 2019 investigation30 of HIV-positive patients taking opioids did not find a significant relationship. These more recent findings may be reflective of the changes in opioid prescribing and monitoring occurring over the past few years.…”

Section: Discussioncontrasting

confidence: 50%

<p>Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety</p>

DiBenedetto¹,

Wawrzyniak²,

Schatman³

et al. 2019

JPR

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Objective To determine the average amount of time required to detect opioid aberrancy based upon varying frequencies of urine drug testing (UDT) in a community-based, tertiary care pain management center. Subjects This study was a retrospective analysis of 513 consecutive patients enrolled in a medication management program, receiving chronic opioid therapy between January 1, 2018 and December 31, 2018. Methods Data were extracted from medical records including age at start of the study period, sex, ethnicity, marital status, and smoking status. UDT was performed at each prescribing visit via semi-quantitative immunoassay, and at the discretion of the clinician, a sample was sent for external confirmation using gas chromatography or mass spectrometry testing to clarify questions of inconsistency with patients’ reports or prescribed medications. For purposes of the study, “opioid aberrancy” was defined through inconsistent UDT. Results One hundred and fifteen patients (22.4%) had at least one inconsistent UDT during the study period, and 160 (2.8%) of all UDTs were inconsistent. At this rate of inconsistency, it was determined that with monthly screening, it would require up to 36 months to detect a single aberrancy, and semi-annual testing would require as long as 216 months to detect an aberrancy. Conclusions More frequent UDT can be helpful in terms of earlier detection of opioid aberrancy. This has significant implications for helping avoid misuse, overdose, and potential diversion. Furthermore, early detection will ideally result in earlier implementation of treatment of the emotional and behavioral factors causing aberrancy. Such early intervention is more likely to be successful in terms of reducing substance misuse in a chronic pain population, providing a higher degree of patient adherence and safety, as well as producing superior overall patient outcomes. Finally, economic benefits may include substantial savings through avoidance of the necessity for drug rehabilitation and the empirically established higher costs of treating opioid misuse comorbidities.

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Section: Discussioncontrasting

confidence: 50%

<p>Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety</p>

DiBenedetto¹,

Wawrzyniak²,

Schatman³

et al. 2019

JPR

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“…That social awareness may, ironically, encourage greater use of LTOT out of an interest in reducing racial disparities and/or encouraging economically vulnerable patients to stay in care (Knight et al 2017). Further, the physicians in this study served as primary care providers for patients living with HIV-a disease with its own robust legacies of racial disparity (Parker et al 2019), and which presents its own imperatives to keep patients in care (Colasanti et al 2018). On the one hand, Dr. Harris's perspective on LTOT is shaped by a clear awareness of the role his safety net hospital plays for his patients.…”

Section: Scalar Situationsmentioning

confidence: 95%

Painful Subjects: Treating Chronic Pain among People Living with HIV in the Age of Opioid Risk

et al. 2020

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Public narratives often attribute the opioid overdose epidemic in the United States to liberal prescribing practices by health care providers. Consequently, new monitoring guidelines for the management of opioid prescriptions in patients with chronic pain have become recognized as key strategies for slowing this tide of overdose deaths. This article examines the social and ontological terrain of opioid-based pain management in an HIV clinic in the context of today's opioid overdose epidemic. We engage with anthropological analyses of contemporary drug policy and the

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“…11 Despite these concerns, until recently, there have been insufficient efforts to promote more judicious opioid prescribing for chronic pain and attention to addressing unsafe patterns of opioid use in HIV clinical settings. [12][13][14][15][16][17][18][19][20] Prior studies of opioid use among PWH lack comprehensive assessment of self-reported opioid use regardless of source of opioid and reason for use; they generally focused on prescribed opioid use (i.e., based on pharmacy data), 6,8,21 self-reported extramedical opioid use , [22][23][24][25][26] or the relationship between prescribed opioids and extra-medical opioid use. 9,27 Moreover, these prior studies did not have self-reported data linked with pharmacy data to robustly evaluate the impact of prescribed opioids or psychoactive medications for common comorbidities associated with opioid use (i.e., prescribed benzodiazepines, gabapentinoids, and antidepressants).…”

Section: Introductionmentioning

confidence: 99%

Trajectories of Self-Reported Opioid Use Among Patients With HIV Engaged in Care: Results From a National Cohort Study

Edelman

Liu

Barry

et al. 2020

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Background: No prior studies have characterized long-term patterns of opioid use regardless of source or reason for use among patients with HIV (PWH). We sought to identify trajectories of selfreported opioid use and their correlates among a national sample of PWH engaged in care. Setting: Veterans Aging Cohort Study, a prospective cohort including PWH receiving care at eight US Veterans Health Administration (VA) sites. Methods: Between 2002 and 2018, we assessed past year opioid use frequency based on selfreported "prescription painkillers" and/or heroin use at baseline and follow-up. We used groupbased trajectory models to identify opioid use trajectories and multinomial logistic regression to determine baseline factors independently associated with escalating opioid use compared to stable, infrequent use. Results: Among 3,702 PWH, we identified four opioid use trajectories: 1) no lifetime use (25%); 2) stable, infrequent use (58%); 3) escalating use (7%); and 4) de-escalating use 11%). In bivariate analysis, anxiety; pain interference; prescribed opioids, benzodiazepines and gabapentinoids; and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. In multivariable analysis, illness severity, pain interference, receipt of prescribed benzodiazepine medications and marijuana use were associated with escalating opioid group membership compared to stable, infrequent use. Conclusion: Among PWH engaged in VA care, one in 15 reported escalating opioid use. Future research is needed to understand the impact of psychoactive medications and marijuana use on opioid use and whether enhanced uptake of evidence-based treatment of pain and psychiatric symptoms can prevent escalating use among PWH.

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Chronic Opioid Therapy in People Living With Human Immunodeficiency Virus: Patients’ Perspectives on Risks, Monitoring, and Guidelines

Cited by 20 publications

References 33 publications

<p>Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety</p>

<p>Increased frequency of urine drug testing in chronic opioid therapy: rationale for strategies for enhancing patient adherence and safety</p>

Painful Subjects: Treating Chronic Pain among People Living with HIV in the Age of Opioid Risk

Trajectories of Self-Reported Opioid Use Among Patients With HIV Engaged in Care: Results From a National Cohort Study

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