Justice and Research on Controlled Substances with HIV Persons

Abstract

Building the case for research improving pain management in HIV patients is an urgent matter. Interventional research with controlled substances may need to be complemented with other research strategies, given existing legal risks and barriers. These complementary strategies — along with the research discussed by Andreae and colleagues — require attention to the additional barriers we have explored in this comment. Ethical questions about this research must not be framed primarily as a binary choice between liberty and the need to solve a critical social problem. Considerations of justice must be at the fore, most notably risks to participants such as individuals newly infected with HIV who are among the most vulnerable of populations in the United States, in Europe, and elsewhere. Addressing these considerations of justice requires longer term strategies such a research on pain control in less vulnerable populations, noninterventional research, or other research methodologies that although not gold standard may still produce findings of value. Even partial or imperfect results may help build the case for reforming public policies that govern experimentation with controlled substances. There is value in the adoption of a risk‐averse approach to research on controlled substances with HIV‐infected patients so that these doubly vulnerable patients are not placed in legal harm's way.