title: Problematic prescription opioid use in an HIV-infected cohort: the importance of universal toxicology testing.
abstract: BACKGROUND
  Providers treating chronic pain must attempt to relieve suffering, while minimizing problematic prescription opioid use, including addiction and diversion. Previously described risk factors for problematic use include history of substance use, younger age, male sex, psychiatric comorbidity, and lower education level.
  
  
  METHODS
  We examined these risk factors in HIV-infected individuals, using cross-sectional and longitudinal data from the Manhattan HIV Brain Bank. Problematic use was defined as illicit substance use (documented by urine toxicology or structured psychiatric interview), while receiving prescription opioids.
  
  
  RESULTS
  Among 173 participants prescribed opioids, 62% had problematic use, the majority of which was discovered by urine toxicology. Problematic use was associated with past substance use, current psychiatric disorder, and poorer adherence to antiretrovirals. However, when participants without problematic use at baseline were followed longitudinally, these factors were not predictive. Furthermore, the cumulative incidence of problematic use behaviors was no greater than in a similar group of participants who were not prescribed opioids.
  
  
  CONCLUSIONS
  Problematic prescription opioid use is common among HIV-infected individuals and is associated with history of substance use, current psychiatric disorder, and poor adherence to antiretrovirals. However, these factors do not predict future problematic use in those who are not currently using illicit substances, and the prescription of an opioid does not seem to predispose patients toward a future substance use disorder. Rather than attempting to assess risk for problematic prescription opioid use in HIV-infected individuals, we recommend baseline and follow-up urine toxicology.
authors: Department of Neurology, Mount Sinai School of Medicine, New York, NY 10029, USA. jessica.robinsonpapp@mssm.edu
authors: Jessica
authors: J
authors: Robinson-Papp
authors: Kathryn
authors: K
authors: Elliott
authors: David M
authors: DM
authors: Simpson
authors: Susan
authors: S
authors: Morgello
mesh_terms: D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D063487:Prescription Drug Misuse; D011446:Prospective Studies; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D014556:Urine / Q000737:chemistry
chemical_list: D000701:Analgesics, Opioid