When HIV Treatment Goals Conflict with Guideline-Based Opioid Prescribing: A Qualitative Study of HIV Providers
BACKGROUND:
HIV-infected
patients have high prevalence of chronic pain and opioid use, making HIV care a
critical setting for improving the safety of opioid prescribing. Little is
known about HIV treatment providers' perspectives about opioid prescribing to
patients with chronic pain.
METHODS:
We
administered a questionnaire and conducted semi-structured telephone interviews
with 18 HIV treatment providers (infectious disease specialists, general
internists, family medicine physicians, nurse practitioners, and physician
assistants) in Bronx, NY. Open-ended interview questions focused on providers'
experiences, beliefs, and attitudes about opioid prescribing and about use of
guideline-based opioid prescribing practices (conservative prescribing, and
monitoring for and responding to misuse). Transcripts were thematically
analyzed using a modified grounded theory approach.
RESULTS:
Eighteen
HIV treatment providers included 13 physicians, 4 nurse practitioners, and 3
physician assistants. They were 62% female, 56% white, and practiced as HIV
providers for a mean of 14.6 years. Most reported always or almost always using
opioid treatment agreements (56%) and urine drug testing (61%) with their
patients on long-term opioid therapy. HIV treatment providers tended to view
opioid prescribing for chronic pain within the "HIV paradigm," a set
of priorities and principles defined by three key themes: 1) primacy of HIV
goals, 2) familiarity with substance use, and 3) the clinician as ally. The HIV
paradigm sometimes supported, and sometimes conflicted with guideline-based
opioid prescribing practices. For HIV treatment providers, perceived alignment
with the HIV paradigm determined whether and how guideline-based opioid
prescribing practices were adopted. For example, the primacy of HIV goals
superseded conservative opioid prescribing when providers prescribed opioids
with the goal of retaining patients in HIV care.
CONCLUSION:
Our
findings highlight unique factors in HIV care that influence adoption of
guideline-based opioid prescribing practices. These factors should be
considered in future research and initiatives to address opioid prescribing in
HIV care.
- 1 Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , NY , USA.
- 2 Center for Alcohol Studies, Rutgers University , New York , NY , USA.
- 3 University of Alabama at Birmingham , Birmingham , AL , USA.
- Subst Abus. 2016 Feb 9:0.
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