Department of Medicine, Brown University, Providence, RI, USA.
Department of Sociology and Anthropology, Elon University, 2035 Campus Box, Elon, NC, 27244, USA.
AIDS Behav. 2019 Apr;23(4):1057-1061. doi: 10.1007/s10461-018-2356-2.
Clinical practice that utilizes chronic opioid therapy has been recognized as one major cause of the opioid crisis. Among patients living with HIV, the risks associated with chronic opioid therapy may be complicated by factors such as co-occurring mental health diagnoses, substance use, and economic marginalization. Improving opioid prescribing practices in HIV clinics requires attention to these and other characteristics common to HIV care. In the context of a randomized controlled trial testing an intervention to improve opioid prescribing practices in HIV outpatient clinics, we interviewed physicians about their perspectives on chronic opioid therapy. Overwhelmingly, physicians voiced ambivalence about their own knowledge and comfort with prescription opioids. They raised concerns about the impact of opioid prescribing on patient-provider relationships and the increasing workload associated with prescribing and monitoring patients. In this report, we explore these concerns and propose several strategies for improving clinical care in which chronic opioid therapy is addressed.
临床实践中，利用慢性阿片类药物治疗已被认为是阿片类药物危机的一个主要原因。在感染艾滋病毒的患者中，与慢性阿片类药物治疗相关的风险可能因共病精神健康诊断、药物使用和经济边缘化等因素而变得复杂。改善艾滋病毒诊所的阿片类药物处方实践需要关注这些以及艾滋病毒护理中常见的其他特征。在一项测试改善艾滋病毒门诊阿片类药物处方实践的干预措施的随机对照试验中，我们采访了医生，了解他们对慢性阿片类药物治疗的看法。医生们压倒性地对自己在开处方阿片类药物方面的知识和舒适度表示矛盾。他们对阿片类药物处方对医患关系的影响以及与处方和监测患者相关的工作量增加表示担忧。在本报告中，我们探讨了这些担忧，并提出了一些策略，以改善对慢性阿片类药物治疗的临床护理。
