Toward safer opioid prescribing: effects of the TOWER intervention on HIV care providers

ABSTRACT

Rates of opioid use disorder and associated deaths remain alarmingly high. Measures to address the epidemic have included reductions in opioid prescribing, in part guided by the Centers for Disease Control Opioid Prescribing Guideline (CDCG). While reductions in over-prescribing have occurred, these measures have also resulted in decreased access and adverse outcomes for some stable opioid-treated chronic pain patients. The TOWard SafER Opioid Prescribing (TOWER) intervention was designed to support HIV primary care providers in use of the CDCG and in decision-making and patient–provider communication regarding safe opioid prescribing. Eleven HIV primary care providers and 40 of their patients were randomized into intervention and control groups. Transcripts from 21 patient visits were analyzed, focusing on opioid and pain-related communications. Findings from this research indicate greater alignment with the CDCG among visits carried out with providers in the TOWER intervention group. However, control group visits were notably consistent with guideline recommendations in several key areas. Differences observed between the intervention and control group visits demonstrate intervention strengths, as well as areas where additional work needs to be done to ensure prescribing and communication consistent with the CDCG.

KEYWORDS:

• HIV/AIDS
• opioid prescribing Guidelines
• randomized control trial
• chronic pain

Acknowledgements

We would like to thank the providers and patients who participated in this study. We would also like to thank the numerous colleagues who have been involved in the different stages of this work. This research was supported by the Agency for Healthcare Research and Quality under Grant 1 R18 HS 02564 1.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Disclosures

The authors have no conflicts of interest to declare.

Additional information

Funding

This work was supported by Agency for Healthcare Research and Quality: [grant number 1 R18 HS 02564 1].