HIV Physicians and Chronic Opioid Therapy: It’s Time to Raise the Bar
Clinical practice that utilizes chronic opioid therapy has been recognized as one major cause of the opioid crisis. Among patients living with HIV, the risks associated with chronic opioid therapy may be complicated by factors such as co-occurring mental health diagnoses, substance use, and economic marginalization. Improving opioid prescribing practices in HIV clinics requires attention to these and other characteristics common to HIV care. In the context of a randomized controlled trial testing an intervention to improve opioid prescribing practices in HIV outpatient clinics, we interviewed physicians about their perspectives on chronic opioid therapy. Overwhelmingly, physicians voiced ambivalence about their own knowledge and comfort with prescription opioids. They raised concerns about the impact of opioid prescribing on patient-provider relationships and the increasing workload associated with prescribing and monitoring patients. In this report, we explore these concerns and propose several strategies for improving clinical care in which chronic opioid therapy is addressed.
KeywordsHIV Opioids Pain Safety Prescribing
This work was supported by the National Institutes of Health/National Institutes of Drug Abuse [R01DA037768 to J.H.S and C.d.R.]. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health.
Compliance with Ethical Standards
Conflicts of interest
All authors declare that they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in this study.
- 1.Ahmad F, Rossen L, Spencer M, Warner M, Sutton P. Provisional drug overdose data [Internet]. National Center or Health Statistics; 2018. Available from: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm.
- 6.Colasanti J, Lira MC, Cheng DM, Liebschutz JM, Tsui JI, Forman LS, et al. Chronic opioid therapy in HIV-infected patients: patients’ perspectives on risks. Monitoring and Guidelines: Clin Infect Dis; 2018.Google Scholar
- 8.Sionean C, Le BC, Hageman K, Oster AM, Wejnert C, Hess KL, et al. HIV Risk, prevention, and testing behaviors among heterosexuals at increased risk for HIV infection–National HIV Behavioral Surveillance System, 21 U.S. cities, 2010. Morb Mortal Wkly Rep Surveill Summ Wash DC 2002. Morb Mortal Wkly Rep Surveill Summ. 2002;63(14):1–39.Google Scholar
- 14.Tsui JI, Walley AY, Lira MC, Chaisson CE, Forman LS, Colasanti JA, et al. Opioid Prescribing Attitudes and Risk Mitigation Practices in Two HIV Clinics. Conference presentation presented at: Annual Meeting of the College on Problems of Drug Dependence; 2017; Montreal.Google Scholar
- 15.Liebschutz JM, Xuan Z, Shanahan CW, LaRochelle M, Keosaian J, Beers D, et al. Improving adherence to long-term opioid therapy guidelines to reduce opioid misuse in primary care: a cluster-randomized clinical trial. JAMA Intern Med. 2017.Google Scholar