HIV providers’ opioid prescribing practice and their belief on whether chronic opioid therapy helps keep people living with HIV (PLWHIV) engaged with care may be associated with differences in these practices, according to a study published in AIDS Care.

Chronic pain is a common clinical problem in PLWHIV, and it is estimated that one-fifth of PLWHIV are prescribed chronic opioid therapy. However, over time, the consequences of opioid overprescribing have meant that PLWHIV face an increased risk for overdose mortality and high rates of prescription opioid misuse. As a consequence, the Centers for Disease Control and Prevention has recently released guidelines for appropriate opioid prescribing to mitigate these risks, which include monitoring measures with urine drug tests and using prescription drug monitoring programs, written treatment agreements, pill counts, and counselling on risks and overdose. However, some HIV providers believe chronic opioid therapy helps PLWHIV stay engaged in care for their HIV infection, which is at odds with the strict adherence to guidelines for monitoring chronic opioid therapy. Therefore, this study aimed to describe opioid prescribing practices in HIV providers who prescribe chronic opioid therapy.

A total of 41 providers were included: 11 from Boston, Massachusetts, and 30 from Atlanta, Georgia. Twenty-eight were attending physicians, 4 were physicians in infectious diseases fellowships, 6 were nurse practitioners, and 3 were physician assistants. All participants had at least 1 adult patient with HIV receiving chronic opioid therapy, who had no plans to leave the clinic within 9 months. Chronic opioid therapy was defined as prescribing opioids continuously for at least 3 months. Participants completed a baseline assessment that included demographics, training and practice characteristics, substance use among PLWHIV, and practices for assessing pain, treating pain, and managing prescribed opioids.

More than half of providers (54%) agreed that chronic opioid therapy for pain helps keep patients engaged in care for their HIV infection. The providers who agreed with this belief were more likely to be older (median age, 45 vs 39 years), nonwhite (45% vs 26%), and female (68% vs 58%). Of the providers who believed chronic opioid therapy helps keep PLWHIV engaged in care, 59% reported routine use of at least 1 of the key components of recommended chronic opioid therapy care compared with 37% of providers who did not have that belief. The relative odds for routinely practicing key components of chronic opioid therapy care were higher in providers who believed chronic opioid therapy helped keep PLWHIV engaged in care, although results were not statistically significant. Further, when each component was examined separately, positive odds ratios were observed for each individual component of recommended chronic opioid therapy care with keeping PLWHIV engaged in care; however, results were only statistically significant for urine drug test (odds ratio = 5.33).

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Overall, the study authors concluded that, “These results are reassuring that the desire to retain patients in HIV care and achieve viral suppression does not appear to adversely compete with HIV providers’ willingness to provide guideline-concordant [chronic opioid therapy].”

Reference

Tsui JI, Walley AW, Cheng DM, et al. Provider opioid prescribing practices and the belief that opioids keep people living with HIV engaged in care: a cross-sectional study [published online January 11, 2019]. AIDS Care. 2019. doi: 10.1080/09540121.2019.1566591