HIV Physicians and Chronic Opioid Therapy: It’s Time to Raise the Bar

Abstract

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.

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Acknowledgement

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.

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Correspondence to Jennifer J. Carroll.

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Carroll, J.J., Colasanti, J., Lira, M.C. et al. HIV Physicians and Chronic Opioid Therapy: It’s Time to Raise the Bar. AIDS Behav 23, 1057–1061 (2019). https://doi.org/10.1007/s10461-018-2356-2

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Keywords

  • HIV
  • Opioids
  • Pain
  • Safety
  • Prescribing