High Prevalence of Inappropriate Urine Drug Tests in a Pain Clinic for Patients with HIV

Dear Editor, We read the article regarding compliance with opioid treatment guidelines for chronic noncancer pain by Sekhon et al. with interest [1]. Our clinic recently conducted a similar study in a primary care setting for persons with HIV and found similar results. The management of chronic pain in HIV-infected persons is particularly challenging as it is often complicated by comorbidities, addiction disorders, and mental illness. Universal precautions to mitigate the risk of substance misuse/abuse among individuals with chronic pain on chronic opioid therapy has been recommended; behavioral contracts, surveillance urine drug tests (UDTs), and review of prescription refills have been suggested to control potential misuse of opioids [2]. The HIV Outpatient Program (HOP) is a primary care clinic for persons with HIV who provide care to patients in New Orleans and surrounding areas in Louisiana. The clinic has had a specialized clinic dedicated for patients with chronic pain for several years. This clinic, held once a week, is staffed by a physician who specializes in physical medicine and rehabilitation. Treatment plans vary depending upon each condition, but include physical therapy referrals, corticosteroid injections, analgesics, opioids and adjuvant therapies. The pain clinic is open to all patients in the general HIV clinic, but requires a referral from the primary care provider. In 2011, …