184928 Opioid analgesic misuse in a large urban HIV clinic

Tuesday, October 28, 2008: 5:42 PM

Sherri Little, MPH , Community Behavioral Health Services, San Francisco Department of Public Health, San Francisco, CA
Alice Asher, RN, MSN , Positive Health Program, San Francisco General Hospital, University of San Francisco, San Francisco, CA
Paula Lum, MD, MPH , University of California, San Francisco, San Francisco, CA
     
Background: HIV/AIDS patients commonly report pain that is treated with prescription opioids. Opioid analgesic abuse is a growing public health concern. Identifying factors associated with opioid misuse may inform clinical practices to improve patient care.

Methods: 262 patients completed an anonymous waiting-room survey at a large HIV/AIDS clinic in San Francisco, 2007. We collected data about pain, pain management, substance use, and provider relationships. We used bivariate and multivariate analyses to examine factors associated with opioid analgesic misuse (“ever using opioid pain medications for reasons other than pain”).

Results: Respondents were 81% male, 46% white; mean age was 44 years. Among 234 (89%) patients ever prescribed opioids for pain, 80 reported misuse. Reasons included: to sleep better (78%), soothe anxiety (46%), prevent opiate withdrawal (33%), come off stimulants (31%), and keep from feeling sad (24%). Misuse was associated with heroin, cocaine, and benzodiazepine use in the last year; giving/selling pain medications, lost/stolen pain medications, current substance use treatment, less comfort talking to providers about pain, and less satisfaction with pain management. Gender, ethnicity, and age were not associated with misuse. Independent predictors of misuse were past year heroin use (AOR=3.5, p<.01); giving/selling pain medications (AOR=3.9, p<.01); and lost or stolen pain medications (AOR=2.3, p=.01).

Conclusions: Most HIV+ patients receiving opioids analgesics do not misuse their medications. Misuse is greater among heroin-using patients, who may be self-medicating unrecognized or untreated mental health symptoms and addictive disorders. Screening, brief intervention, referral, and treatment may reduce opioid analgesic misuse and improve overall care.

Learning Objectives:
1. Describe the prevalence of prescription opioids received for pain in an urban HIV/AIDS clinic population. 2. Estimate the prevalence of self-reported opioid analgesic misuse, defined as “ever using one’s opioid pain medications for reasons other than pain.” 3. List the most common reasons reported by HIV/AIDS patients for misuse of their opioid pain medications. . 4. Identify patient and physician factors that may be associated with the misuse of prescription opioids. 5. Discuss strategies that may be effective interventions for reducing opioid analgesic misuse, including integrated mental health and substance use evaluation and treatment in HIV primary care settings.

Keywords: Chemical Dependence, HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a researcher and evaluator of substance abuse and mental health programs in the community. This abstract stems from my work on a Buprenorphine and HIV multi-site grant.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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