by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

April 6, 2021

Featured Literature:

Scherer M, Kamler A, Weiss L, et al. Toward safer opioid prescribing: effects of the TOWER intervention on HIV care providers. AIDS Care. 2021 March 9; 1-6. doi: 10.1080/09540121.2021.1887444. PMID: 33719775.

Recent shifts in opioid prescribing practices, although well-intentioned and necessary at times, have also led to decreased access and adverse outcomes for some stable, opioid-treated patients experiencing chronic pain. TOWard SafER Opioid Prescribing (TOWER) is a provider-facing intervention designed to support HIV primary care providers’ adherence to CDC Opioid Prescribing Guidelines. TOWER includes three components: prescription opioid management training including patient-recommended communication strategies; access to patient-reported risk-benefit data via an app; and a medical encounter note template. This study describes qualitative findings of a randomized trial examining outcomes among TOWER-trained providers vs. usual care. Review of visit content demonstrated greater guidelines alignment among intervention provider encounters: topic areas with greatest discrepancies included discussions of treatment goals and progress assessment, opioid medication adherence review, and evaluation (and discussion) of harms/risk factors.

Author’s Commentary:

Opioid use disorder, overdose deaths, and safer prescribing remain challenging issues for many providers and communities. These findings suggest that interventions such as TOWER are feasible and may help facilitate guidelines-concordant opioid prescribing and management. Further implementation and evaluation regarding intervention effectiveness and patient-oriented outcomes are important. Additionally, this information may motivate HIV providers to consider modifications to their patient interviewing and counseling styles/habits to include regular, collaborative discussions of benefits/harms of long-term prescription opioid use and reassessment of individual treatment goals and progress toward those goals.

The author has no conflicts of interest to disclose.

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