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

R. E. Morrison, J. M. Brint, W. R. Smith, Kristopher Arheart, D. Wray, S. B. Palte, T. F. Ackerman

Research output: Contribution to journalArticle

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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
Pages (from-to)301-305
Number of pages5
JournalJournal of General Internal Medicine
Volume9
Issue number6
StatePublished - Jan 1 1994
Externally publishedYes

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Inappropriate Prescribing
Narcotics
HIV
Centers for Disease Control and Prevention (U.S.)
AIDS-Related Complex
Heterosexuality
Dementia
Drug Administration Schedule
Acquired Immunodeficiency Syndrome
Physicians
Histoplasmosis

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Morrison, R. E., Brint, J. M., Smith, W. R., Arheart, K., 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.

Appropriate and inappropriate prescribing of narcotics for ambulatory HIV- positive patients. / Morrison, R. E.; Brint, J. M.; Smith, W. R.; Arheart, Kristopher; Wray, D.; Palte, S. B.; Ackerman, T. F.

In: Journal of General Internal Medicine, Vol. 9, No. 6, 01.01.1994, p. 301-305.

Research output: Contribution to journalArticle

Morrison, RE, Brint, JM, Smith, WR, Arheart, K, Wray, D, Palte, SB & Ackerman, TF 1994, 'Appropriate and inappropriate prescribing of narcotics for ambulatory HIV- positive patients', Journal of General Internal Medicine, vol. 9, no. 6, pp. 301-305.
Morrison RE, Brint JM, Smith WR, Arheart K, Wray D, Palte SB et al. Appropriate and inappropriate prescribing of narcotics for ambulatory HIV- positive patients. Journal of General Internal Medicine. 1994 Jan 1;9(6):301-305.
Morrison, R. E. ; Brint, J. M. ; Smith, W. R. ; Arheart, Kristopher ; Wray, D. ; Palte, S. B. ; Ackerman, T. F. / Appropriate and inappropriate prescribing of narcotics for ambulatory HIV- positive patients. In: Journal of General Internal Medicine. 1994 ; Vol. 9, No. 6. pp. 301-305.
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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.",
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AU - Morrison, R. E.

AU - Brint, J. M.

AU - Smith, W. R.

AU - Arheart, Kristopher

AU - Wray, D.

AU - Palte, S. B.

AU - Ackerman, T. F.

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N2 - 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.

AB - 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.

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