Appropriate and inappropriate prescribing of narcotics for ambulatory HIV-positive patients.
OBJECTIVE
To assess the appropriateness of narcotic-prescribing practices in an ambulatory clinic for patients infected with HIV.


METHODS
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.


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.
Morrison
R E
RE
Department of Medicine, University of Tennessee, Memphis 38103.
Brint
J M
JM
Smith
W R
WR
Arheart
K L
KL
Wray
D
D
Palte
S B
SB
Ackerman
T F
TF
D000386:AIDS-Related Complex / Q000150:complications; D000553:Ambulatory Care; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D009294:Narcotics / Q000008:administration & dosage*; D009293:Opioid-Related Disorders / Q000150:complications*; D012725:Sexual Behavior; D015819:Substance Abuse, Intravenous / Q000150:complications; D013714:Tennessee
D009294:Narcotics