• Paula J Lum, Sherri Little, Michael Botsko, David Hersh, Robert E Thawley, James E Egan, Jennifer Mitty, Joshua Boverman, David A Fiellin, and BHIVES Collaborative.
• Department of Medicine, HIV/AIDS Division, University of California, San Francisco, San Francisco, CA, USA. plum@php.ucsf.edu
• J. Acquir. Immune Defic. Syndr. 2011 Mar 1;56 Suppl 1:S91-7.

BackgroundPain syndromes are common in HIV-infected patients, who also are commonly affected by opioid-use disorders. Although opioids can treat pain, prescribers must consider the consequences of iatrogenic or missed addiction diagnoses.MethodsIn an anonymous online survey, we asked a national sample of HIV providers about their demographics, experience, and patients, and their practices and attitudes about chronic opioid therapy, addiction, and confidence recognizing opioid analgesic abuse.ResultsOne hundred six providers reported 28% of their patients had chronic pain; 21% received opioid analgesics; 37% were HIV infected by injecting drug use; and 12% were addicted to prescription opioids. Few providers followed recommended guidelines for chronic opioid therapy in nonmalignant pain. Mean provider confidence was 6.3 on a scale of 10. Higher confidence was associated with provider sex (P < 0.05), patient volume (P < 0.03), discussing substance use, (P < 0.05), urine toxicology (P < 0.01), prescribing longer acting opioids (P = 0.005), and prescribing buprenorphine (P = 0.009).ConclusionsHIV providers seldom follow recommended guidelines for opioid prescribing and have limited confidence in their ability to recognize opioid analgesic abuse. Clinical practices developed to reduce misuse and increase early detection and treatment of opioid dependence are associated with higher confidence. The implementation of guidelines to improve the quality of opioid prescribing in HIV clinics may aid in the diagnosis of addictive disorders and prevent their adverse outcomes.

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