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Abstract
Background: Chronic pain is common in people living with HIV or opioid use disorder and is complex to clinically manage. Opioid dependence treatment, such as Suboxone (combined buprenorphine and naloxone), is associated with improved adherence to antiretroviral therapy, reduced opioid use, and lower overdose risk. While evidence suggests Suboxone can treat opioid use disorder and chronic pain concomitantly, its use as an analgesic remains off-label. Patients with these co-morbidities, especially prevalent among People of Color, are often underdiagnosed and undertreated . This study explored clinicians’ experiences and opinions on managing chronic pain in (mostly Black) persons living with HIV who have a history of substance use disorder. The study focused on three clinically relevant themes with implications for improving patient-provider experiences and mutual understanding.
Methods: In January 2019–July 2020, we conducted in-depth interviews with 14 clinicians (including physicians and nurse practitioners specialized in internal medicine, infectious diseases, psychiatry, addiction medicine, and palliative care) who provide healthcare for patients with HIV and pain problems in outpatient settings in Baltimore, Maryland. The interviews were recorded, transcribed, and analyzed thematically, using a combination of inductive and deductive coding through an iterative coding process.
Results: Of major themes from our data, this paper explores: 1) clinical use of Suboxone by providers, 2) patient-provider trust and mutual understanding, and 3) stigma and other sociocultural factors impacting patient experiences. Providers who prescribed Suboxone found it an effective tool. One prescriber described it as a "safer alternative,” explaining, “[Suboxone] is a common medication that I use for people with opioid use disorder and chronic pain, because it has an indication for both.” Many prescribers encountered barriers to Suboxone, such as extensive training required for licensure; these can limit the number of licensed providers, and hinder patient access to treatment. Some providers reported patients who demonstrated mistrust and resistance to clinical advice. Providers who took time to build trusting relationships with patients reported positive experiences and successful management. One provider cited, “The person I was able to get off the opioids, I've been taking care of him for ten years. So, there's this trust... it takes time.” Finally, providers acknowledged the stigmas perpetuated by the healthcare system and sociocultural factors that negatively impact care. A provider recounted, “But since this guy was a 58-year-old man, African- American man from the neighborhood, who maybe wasn’t as articulate, didn’t dress as well, may have had a remote history of substance abuse … [he] was perceived as drug seeking. “
Conclusion: In this study, many providers licensed to prescribe Suboxone highlighted its effectiveness in managing chronic pain for patients with opioid use disorder and a serious chronic condition. However, some expressed frustration with licensing barriers that hinder patients’ access to Suboxone treatment. Our findings emphasize the importance of long-term fostering of patient relationships of trust, especially for successful chronic pain management and opioid titration. The results suggest that providers should understand the stigma patients face to advocate for them and foster a more equitable healthcare system.
Recommended Citation
Bhatia, Sonya A.; Iregui, Isabella; Knowlton, Amy; and Tseng, Tuo-Yen, "Provider perspectives on the challenges and opportunities in managing chronic pain among patients with HIV and a history of substance use disorder: a qualitative study" (2025). Research Symposium. 153.
https://scholarworks.utrgv.edu/somrs/2025/posters/153
Included in
Provider perspectives on the challenges and opportunities in managing chronic pain among patients with HIV and a history of substance use disorder: a qualitative study
Background: Chronic pain is common in people living with HIV or opioid use disorder and is complex to clinically manage. Opioid dependence treatment, such as Suboxone (combined buprenorphine and naloxone), is associated with improved adherence to antiretroviral therapy, reduced opioid use, and lower overdose risk. While evidence suggests Suboxone can treat opioid use disorder and chronic pain concomitantly, its use as an analgesic remains off-label. Patients with these co-morbidities, especially prevalent among People of Color, are often underdiagnosed and undertreated . This study explored clinicians’ experiences and opinions on managing chronic pain in (mostly Black) persons living with HIV who have a history of substance use disorder. The study focused on three clinically relevant themes with implications for improving patient-provider experiences and mutual understanding.
Methods: In January 2019–July 2020, we conducted in-depth interviews with 14 clinicians (including physicians and nurse practitioners specialized in internal medicine, infectious diseases, psychiatry, addiction medicine, and palliative care) who provide healthcare for patients with HIV and pain problems in outpatient settings in Baltimore, Maryland. The interviews were recorded, transcribed, and analyzed thematically, using a combination of inductive and deductive coding through an iterative coding process.
Results: Of major themes from our data, this paper explores: 1) clinical use of Suboxone by providers, 2) patient-provider trust and mutual understanding, and 3) stigma and other sociocultural factors impacting patient experiences. Providers who prescribed Suboxone found it an effective tool. One prescriber described it as a "safer alternative,” explaining, “[Suboxone] is a common medication that I use for people with opioid use disorder and chronic pain, because it has an indication for both.” Many prescribers encountered barriers to Suboxone, such as extensive training required for licensure; these can limit the number of licensed providers, and hinder patient access to treatment. Some providers reported patients who demonstrated mistrust and resistance to clinical advice. Providers who took time to build trusting relationships with patients reported positive experiences and successful management. One provider cited, “The person I was able to get off the opioids, I've been taking care of him for ten years. So, there's this trust... it takes time.” Finally, providers acknowledged the stigmas perpetuated by the healthcare system and sociocultural factors that negatively impact care. A provider recounted, “But since this guy was a 58-year-old man, African- American man from the neighborhood, who maybe wasn’t as articulate, didn’t dress as well, may have had a remote history of substance abuse … [he] was perceived as drug seeking. “
Conclusion: In this study, many providers licensed to prescribe Suboxone highlighted its effectiveness in managing chronic pain for patients with opioid use disorder and a serious chronic condition. However, some expressed frustration with licensing barriers that hinder patients’ access to Suboxone treatment. Our findings emphasize the importance of long-term fostering of patient relationships of trust, especially for successful chronic pain management and opioid titration. The results suggest that providers should understand the stigma patients face to advocate for them and foster a more equitable healthcare system.
