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).