APPROPRIATE AND INAPPROPRIATE PRESCRIBING OF NARCOTICS FOR AMBULATORYHIV-POSITIVE PATIENTS

Objective: To assess the appropriateness of narcotic-prescribing pract ices in an ambulatory clinic for patients infected with HIV. Design, s etting, and patients: The medical records of 220 (190 HIV-positive) pa tients, seen in a clinic primarily designed for the long-term follow-u p of ambulatory HIV-infected patients and located in an inner-city, pu blic teaching hospital, were retrospectively reviewed to determine the prevalence and appropriateness of prescribing Drug Enforcement Admini stration schedule 2 narcotics. Appropriateness was based on published guidelines for the use of narcotics in the treatment of cancer patient s. 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 H IV-positive patients (CDC clinical class A). None of the HIV-negative patients seen in the clinic received narcotics. Narcotics were more li kely to be prescribed for patients with AIDS than for patients with AR C (p < 0.001) or for HIV-positive patients (p < 0.001). For the three CDC clinical classes, there was no significant difference among the pr oportions of patients receiving narcotics inappropriately (p = 0.108). Among the risk groups, intravenous drug abusers were more likely to b e prescribed narcotics inappropriately than were men who were homosexu al (p < 0.001) or individuals who were heterosexual (p = 0.013); trans fusion recipients were also more likely to be prescribed narcotics ina ppropriately 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 ca rinii 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 te nd to prescribe narcotics inappropriately to patients known to have pr eviously 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.