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M94A0246.TXT
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1994-10-08
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Document 0246
DOCN M94A0246
TI Appropriate and inappropriate prescribing of narcotics for ambulatory
HIV-positive patients.
DT 9412
AU Morrison RE; Brint JM; Smith WR; Arheart KL; Wray D; Palte SB; Ackerman
TF; Department of Medicine, University of Tennessee, Memphis 38103.
SO J Gen Intern Med. 1994 Jun;9(6):301-5. Unique Identifier : AIDSLINE
MED/94358799
AB OBJECTIVE: To assess the appropriateness of narcotic-prescribing
practices in an ambulatory clinic for patients infected with HIV.
DESIGN, SETTING, AND PATIENTS: 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. MEASUREMENTS AND MAIN 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.
DE Ambulatory Care Attitude of Health Personnel AIDS-Related
Complex/COMPLICATIONS Cross-Sectional Studies Female Follow-Up
Studies Human HIV Infections/*COMPLICATIONS Male Narcotic
Dependence/*COMPLICATIONS Narcotics/*ADMINISTRATION & DOSAGE
Prescriptions, Drug Sex Behavior Substance Abuse,
Intravenous/COMPLICATIONS Tennessee JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).