Primary care providers’ judgments of opioid analgesic misuse in a community-based cohort of HIV-infected indigent adults.
BACKGROUND
Primary care providers (PCPs) must balance treatment of chronic non-cancer pain with opioid analgesics with concerns about opioid misuse.


OBJECTIVE
We co-enrolled community-based indigent adults and their PCPs to determine PCPs’ accuracy of estimating opioid analgesic misuse and illicit substance use.


METHODS
Patient-provider dyad study.


METHODS
HIV-infected, community-based indigent adults (‘patients’) and their PCPs.


METHODS
Using structured interviews, we queried patients on use and misuse of opioid analgesics and illicit substances. PCPs completed patient- and provider-specific questionnaires. We calculated the sensitivity, specificity, and measures of agreement between PCPs’ judgments and patients’ reports of opioid misuse and illicit substance use. We examined factors associated with PCPs’ thinking that their patients had misused opioid analgesics and determined factors associated with patients’ misuse.


RESULTS
We had 105 patient-provider dyads. Of the patients, 21 had misused opioids and 45 had used illicit substances in the past year. The sensitivity of PCPs’ judgments of opioid analgesic misuse was 61.9% and specificity, 53.6% (Kappa score 0.09, p = 0.10). The sensitivity of PCPs’ judgments of illicit substance use was 71.1% and specificity, 66.7% (Kappa score 0.37, p <0.001). PCPs were more likely to think that younger patients (Adjusted odds ratio (AOR) 0.89, 95% CI 0.84-0.97), African American patients (AOR 2.53, 95% CI 1.05-6.07) and those who had used illicit substances in the past year (AOR 3.33, 95% CI 1.35-8.20) had misused opioids. Younger (AOR 0.94, 95% CI 0.86-1.02) and African American (AOR 0.71, 95% CI 0.25-1.97) patients were not more likely to report misuse, whereas persons who had used illicit substances were (AOR 3.01, 95% CI 1.04-8.76).


CONCLUSIONS
PCPs’ impressions of misuse were discordant with patients’ self-reports of opioid analgesic misuse. PCPs incorrectly used age and race as predictors of misuse in this high-risk cohort.
Division of General Internal Medicine/San Francisco General Hospital, University of California, San Francisco, Box 1364, San Francisco, CA 94143-1364, USA.
Maya
M
Vijayaraghavan
Joanne
J
Penko
David
D
Guzman
Christine
C
Miaskowski
Margot B
MB
Kushel
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007600:Judgment; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000209:etiology; D058007:Physicians, Primary Care / Q000523:psychology* / Q000592:standards; D011320:Primary Health Care / Q000592:standards; D012111:Residence Characteristics; D057566:Self Report / Q000592:standards; D011795:Surveys and Questionnaires; D017664:Uncompensated Care
D000701:Analgesics, Opioid