Assessment of Chronic Opioid Therapy in People Living With HIV
Approximately one-third of participants with HIV in the Veterans Aging Cohort Study were prescribed opioids for pain.
No association was found between the risk of opioid misuse and receipt of or satisfaction with chronic opioid therapy (COT) in people living with HIV (PLHIV), according to findings from a recently published study in Clinical Infectious Diseases.
The use of prescription opioids within the United States has increased dramatically over the past 2 decades. As a result, the number of drug overdose deaths has more than tripled, with 63% of overdose deaths related to opioids as of 2015 and half of all opioid-related deaths involving a prescription opioid.
Chronic pain has been reported in 30% to 90% of HIV-infected adults. In the Veterans Aging Cohort Study, 31% of HIV-infected patients were prescribed opioids for pain during a 12-month period. Guidelines from the Infectious Diseases Society of America highlight the importance of appropriate monitoring practices among PLHIV receiving COT. However, little is known about opioid monitoring practices among this population or patients' perceptions of those monitoring practices, when applied. Therefore, this study assessed opioid risk behaviors, perceptions of risk, opiod monitoring, and associated Current Opioid Misuse Measure (COMM™) scores of PLHIV receiving COT (ClinicalTrials.gov Identifier: NCT02525731).
A total of 166 participants (median age, 55 years) receiving COT from 2 HIV clinics in Boston and Atlanta were included in this study. COT was defined as at least 3 opioid prescriptions written at least 21 days apart in the past 6 months. Demographics, substance use history, COMM™ score, and perceptions of and satisfaction with COT monitoring were assessed. The COMM™ is a 17-question patient self-report of aberrant behavior related to opioids (behavior concerning for addiction or taking the medication other than how it was prescribed) in the past 30 days. A COMM™ score ≥9 was considered a good measure of prior 30-day prescription opioid misuse, and a score of ≥13 has shown high sensitivity and specificity for predicting those patients with a prescription drug use disorder.
With reference to their current clinic at the time of assessment, 30% of participants reported having an opioid treatment agreement in place, 66% reported undergoing urine drug testing, and 12% reported having a pill count. However, fewer than 5% of participants reported undergoing all 3 types of monitoring, and 24% of participants did not receive any type of monitoring. Median satisfaction levels (1-10, 10=highest) were 10 for opioid treatment agreements, 9.5 for pill counts, and 10 for urine drug testing. Participants reported a perceived danger of pain medications, with 89.8% responding affirmatively to a question about the addiction potential of opioids.
Assessment of opioid misuse showed that 4.8% of participants reported illicit opioid use in the prior 12 months, while 26.1% reported any history of illicit opioid use. Assessment of risk of misuse with COMM™ showed that many participants met criteria for being at high risk for opioid use with 43% scoring ≥9 and 22.9% scoring ≥13. No association was found between a higher COMM™ score and receipt of or satisfaction with COT monitoring.
Overall, the study authors concluded that “Risk of opioid misuse was not associated with receiving monitoring practice nor satisfaction with that monitoring.”
Colasanti J, Lira MC, Cheng DM, et al. Chronic opioid therapy in HIV-infected patients: patients' perspectives on risks, monitoring and guidelines [published online May 31, 2018]. Clin Infect Dis. doi: 10.1093/cid/ciy452/5025878