Appropriate and inappropriate prescribing of narcotics for ambulatory HIV-positive patients

Robert E. Morrison, J. Mark Brint, Wally R. Smith, Kristopher L. Arheart, Debra Wray, Stephen B. Palte, Terrence F. Ackerman

Research output: Contribution to journalArticle

2 Scopus citations

Abstract

Objective: To assess the appropriateness of narcotic-prescribing practices in an ambulatory clinic for patients infected with HIV. Design, setting, and patients: The medical records of 220 (190 HIV-positive) patients, seen in a clinic primarily designed for the long-term follow-up of ambulatory HIV- infected patients and located in an inner city, public teaching hospital, were retrospectively reviewed to determine the prevalence and appropriateness of prescribing Drug Enforcement Administration schedule 2 narcotics. Appropriateness was based on published guidelines for the use of narcotics in the treatment of cancer patients. Measurements and main results: The prevalence of narcotic use among the HIV-positive patients was 15%. Narcotics were prescribed for 38% of the patients who died, 33% of those with AIDS [Centers for Disease Control and Prevention (CDC) clinical class C], 4% of those with AIDS-related complex (ARC) (CDC clinical class B), and 5% of asymptomatic HIV-positive patients (CDC clinical class A). None of the HIV- negative patients seen in the clinic received narcotics. Narcotics were more likely to be prescribed for patients with AIDS than for patients with ARC (p < 0.001) or for HIV-positive patients (p < 0.001). For the three CDC clinical classes, there was no significant difference among the proportions of patients receiving narcotics inappropriately (p = 0.108). Among the risk groups, intravenous drug abusers were more likely to be prescribed narcotics inappropriately than were men who were homosexual (p < 0.001) or individuals who were heterosexual (p = 0.013); transfusion recipients were also more likely to be prescribed narcotics inappropriately than were homosexual men (p = 0.026) or heterosexual men or women (p = 0.032). Narcotics were more likely to be prescribed for patients with disseminated histoplasmosis (p = 0.022). Pneumocystis carinii pneumonia (p = 0.001), candidal esophagitis (p = 0.020), Kaposi's sarcoma (p < 0.001), or wasted appearance (p = 0.043). Inappropriate prescriptions were more likely to be given to patients with dementia (p = 0.005) or wasted appearance (p = 0.019). Conclusions: Physicians tend to prescribe narcotics inappropriately to patients known to have previously abused drugs and to those who appear wasted or have dementia. Physicians have a duty to prescribe narcotics appropriately as guided by recognized medical indications and the patients' views concerning their current medical needs.

Original languageEnglish (US)
Pages (from-to)301-305
Number of pages5
JournalJournal of general internal medicine
Volume9
Issue number6
DOIs
StatePublished - Jun 1994

Keywords

  • AIDS
  • HIV-positive
  • narcotics
  • prescription guidelines

ASJC Scopus subject areas

  • Internal Medicine

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    Morrison, R. E., Brint, J. M., Smith, W. R., Arheart, K. L., Wray, D., Palte, S. B., & Ackerman, T. F. (1994). Appropriate and inappropriate prescribing of narcotics for ambulatory HIV-positive patients. Journal of general internal medicine, 9(6), 301-305. https://doi.org/10.1007/BF02599175