Provider opioid prescribing practices and the belief that opioids keep people living with HIV engaged in care: a cross-sectional study

• Type of Material: Article
• Authors: Judith I. Tsui, University of Washington; Alexander Y. Walley, Boston University; Debbie M. Cheng, Boston University; Marlene C. Lira, Boston Medical Center; Jane M. Liebschutz, University of Pittsburgh; Leah S. Forman, Boston University; Margaret M. Sullivan, Boston University; Jonathan Colasanti, Emory University; Christin Root, Emory University; Kristen O'Connor, Boston Medical Center; Christopher W. Shanahan, Boston Medical Center; Carly L. Bridden, Boston Medical Center; Carlos del Rio, Emory University; Jeffrey H. Samet, Boston University
• Language: English
• Date: 2019-09-02
• Publisher: Taylor & Francos Ltd.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Informa UK Limited.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1080/09540121.2019.1566591
• Title of Journal or Parent Work: AIDS Care: Psychological and Socio-medical Aspects of AIDS/HIV
• Volume: 31
• Issue: 9
• Start Page: 1140
• End Page: 1144
• Grant/Funding Information: This work was supported by the National Institute on Drug Abuse [grant number R01DA037768] and the National Institute of Allergy, Immunology and Infectious Diseases [Emory CFAR, grant number P30AI050409].
• Keywords: Misuse; HIV; opioid-related disorders; physicians; Biomedical Social Sciences; analgesics; Health Care Sciences & Services; Community based cohort; pain; Social Sciences; opioids; Respiratory System; Health Policy & Services; Chronic pain; chronic pain; Guidelines; Public, Environmental & Occupational Health; Life Sciences & Biomedicine; Psychology; Psychology, Multidisciplinary; Therapy; Science & Technology; Social Sciences, Biomedical
• Research Categories: Biology, Biostatistics; Health Sciences, Medicine and Surgery; Health Sciences, Epidemiology; Health Sciences, Public Health

Abstract

We describe HIV providers’ opioid prescribing practices and assess whether belief that chronic opioid therapy (COT) keeps people living with HIV (PLWH) engaged in care is associated with differences in these practices among providers from two HIV clinics. We conducted logistic regression to evaluate the association between the belief that COT keeps PLWH engaged in care and at least one component of guideline-recommended care (i.e., urine drug tests, treatment agreements, and/or prescription monitoring program use). The sample included 41 providers with a median age of 42 years, 63% female, 37% non-white. Routine adherence to guideline-recommended practices was: 34% urine drug tests, 27% treatment agreements, and 17% prescription monitoring program. Over half [54%] agreed that COT keeps PLWH engaged in care. There was no significant association between belief that COT keeps PLWH engaged in care and routinely providing any recommended COT care component (aOR 2.38; 95% CI 0.65–8.73). Most HIV providers do not routinely follow guidelines for opioid prescribing. We observed a positive association between belief that COT keeps PLWH engaged in care and following any guideline-recommended prescribing practices, although the result was not statistically significant. Interventions are needed to improve guideline-concordant care for COT by HIV providers.