TY - JOUR
T1 - A Review of Opioid Prescribing Practices and Associations with Repeat Opioid Prescriptions in a Contemporary Outpatient HIV Clinic
AU - Önen, Nur F.
AU - Barrette, Ernie Paul
AU - Shacham, Enbal
AU - Taniguchi, Toshibumi
AU - Donovan, Michael
AU - Overton, Edgar T.
N1 - Funding Information:
This publication was partially supported by Grant Number UL1 RR024992 , specifically KL2RR024994 from the National Center for Research Resources (NCRR) , a component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. ETO has received research grants from Merck, GlaxoSmithKline, Gilead, Abbott, Tibotec, and Boehinger Ingelheim through Washington University, served as a consultant for Tibotec and GlaxoSmithKline, and served on speakers' bureau or received honoraria from Merck, Tibotec, GlaxoSmithKline, Bristol–Myers Squibb, Monogram Sciences, and Gilead. EPB has stock options for The Natural Standard, and TT received a Bristol–Myers Squibb Virology Fellow's Grant in 2009.
PY - 2012/7
Y1 - 2012/7
N2 - Objectives: Among persons in current HIV outpatient care, data on opioid prescribing are lacking. This study aims to evaluate predictors of repeat opioid prescribing and to characterize outpatient opioid prescribing practices. Methods: Retrospective cross-sectional study of persons ≥18years in HIV outpatient care who completed an annual behavioral assessment between June 2008 and June 2009. Persons were grouped by ≤1 and ≥2 opioid prescriptions (no-repeat-opioid and repeat-opioids, respectively). Independent predictors for repeat-opioids were evaluated. Opioid prescribing practices were characterized in a sub-study of persons prescribed any opioid. Results: Overall, 659 persons were included, median age 43years, 70% men, and 68% African American. Independent predictors of repeat-opioids (88 [13%] persons) included opportunistic illnesses (both current and previous), depression, peripheral neuropathy, and hepatitis C coinfection (P<0.05). In the subgroup, 140 persons received any opioid prescription (96% short-acting, 33% tramadol). Indications for opioid prescribing were obtained in 101 (72%) persons, with 97% for noncancer-related pain symptoms. Therapeutic response was documented on follow-up in 67 (48%) persons, with no subjective relief of symptoms in 63%. Urine drug screens were requested in 6 (4%) persons, and all performed were positive for illicit drugs. Conclusions: Advanced HIV disease and greater medical and neuropsychiatric comorbidity predict repeat opioid prescribing, and these findings reflect the underlying complexities in managing pain symptoms in this population. We also highlight multiple deficiencies in opioid prescribing practices and nonadherence to guidelines, which are of concern as effective and safe pain management for our HIV-infected population is an optimal goal.
AB - Objectives: Among persons in current HIV outpatient care, data on opioid prescribing are lacking. This study aims to evaluate predictors of repeat opioid prescribing and to characterize outpatient opioid prescribing practices. Methods: Retrospective cross-sectional study of persons ≥18years in HIV outpatient care who completed an annual behavioral assessment between June 2008 and June 2009. Persons were grouped by ≤1 and ≥2 opioid prescriptions (no-repeat-opioid and repeat-opioids, respectively). Independent predictors for repeat-opioids were evaluated. Opioid prescribing practices were characterized in a sub-study of persons prescribed any opioid. Results: Overall, 659 persons were included, median age 43years, 70% men, and 68% African American. Independent predictors of repeat-opioids (88 [13%] persons) included opportunistic illnesses (both current and previous), depression, peripheral neuropathy, and hepatitis C coinfection (P<0.05). In the subgroup, 140 persons received any opioid prescription (96% short-acting, 33% tramadol). Indications for opioid prescribing were obtained in 101 (72%) persons, with 97% for noncancer-related pain symptoms. Therapeutic response was documented on follow-up in 67 (48%) persons, with no subjective relief of symptoms in 63%. Urine drug screens were requested in 6 (4%) persons, and all performed were positive for illicit drugs. Conclusions: Advanced HIV disease and greater medical and neuropsychiatric comorbidity predict repeat opioid prescribing, and these findings reflect the underlying complexities in managing pain symptoms in this population. We also highlight multiple deficiencies in opioid prescribing practices and nonadherence to guidelines, which are of concern as effective and safe pain management for our HIV-infected population is an optimal goal.
KW - HIV
KW - Opioid prescribing
KW - Outpatient care
UR - http://www.scopus.com/inward/record.url?scp=84863546540&partnerID=8YFLogxK
U2 - 10.1111/j.1533-2500.2011.00520.x
DO - 10.1111/j.1533-2500.2011.00520.x
M3 - Article
C2 - 22103269
AN - SCOPUS:84863546540
SN - 1530-7085
VL - 12
SP - 440
EP - 448
JO - Pain Practice
JF - Pain Practice
IS - 6
ER -