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Barriers to Obtaining Waivers to Prescribe Buprenorphine for Opioid Addiction Treatment Among HIV Physicians

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Abstract

Background

Illicit drug use is common among HIV-infected individuals. Buprenorphine enables physicians to simultaneously treat HIV and opioid dependence, offering opportunities to improve health outcomes. Despite this, few physicians prescribe buprenorphine.

Objective

To examine barriers to obtaining waivers to prescribe buprenorphine.

Design

Cross-sectional survey study.

Participants

375 physicians attending HIV educational conferences in six cities in 2006.

Approach

Anonymous questionnaires were distributed and analyzed to test whether confidence addressing drug problems and perceived barriers to prescribing buprenorphine were associated with having a buprenorphine waiver, using chi-square, t tests, and logistic regression.

Results

25.1% of HIV physicians had waivers to prescribe buprenorphine. In bivariate analyses, physicians with waivers versus those without waivers were less likely to be male (51.1 vs 63.7%, p < .05), more likely to be in New York (51.1 vs 29.5%, p < .01), less likely to be infectious disease specialists (25.5 vs 41.6%, p < .05), and more likely to be general internists (43.6 vs 33.5%, p < .05). Adjusting for physician characteristics, confidence addressing drug problems (adjusted odds ratio [AOR] = 2.05, 95% confidence interval [95% CI] = 1.08–3.88) and concern about lack of access to addiction experts (AOR = 0.56, 95% CI = 0.32–0.97) were significantly associated with having a buprenorphine waiver.

Conclusions

Among HIV physicians attending educational conferences, confidence addressing drug problems was positively associated with having a buprenorphine waiver, and concern about lack of access to addiction experts was negatively associated with it. HIV physicians are uniquely positioned to provide opioid addiction treatment in the HIV primary care setting. Understanding and remediating barriers HIV physicians face may lead to new opportunities to improve outcomes for opioid-dependent HIV-infected patients.

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Acknowledgments

We would like to thank Donna Jacobsen and the staff of the IAS-USA, as well as Alexandra Bobadilla for their assistance with this project. This study was supported by the Center for AIDS Research at the Albert Einstein College of Medicine and Montefiore Medical Center funded by the National Institutes of Health (NIH AI-51519) and the Health Resources and Services Administration, HIV/AIDS Bureau, Special Projects of National Significance, Grant no. 6H97HA00247-04-03. Dr. Cunningham is supported by the Robert Wood Johnson Foundation’s Harold Amos Medical Faculty Development Program.

Conflict of interest statement

None disclosed.

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Authors and Affiliations

  1. Montefiore Medical Center/Albert Einstein College of Medicine, 111 E. 210th Street, Bronx, NY, 10467, USA

    Chinazo O. Cunningham MD, Hillary V. Kunins MD, MPH, MS, Robert J. Roose MD, MPH & Rashiah T. Elam MD

  2. City University of New York Medical School, New York, NY, USA

    Nancy L. Sohler PhD, MPH

Authors
  1. Chinazo O. Cunningham MD
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  2. Hillary V. Kunins MD, MPH, MS
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  3. Robert J. Roose MD, MPH
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  4. Rashiah T. Elam MD
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  5. Nancy L. Sohler PhD, MPH
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Correspondence to Chinazo O. Cunningham MD.

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Cunningham, C.O., Kunins, H.V., Roose, R.J. et al. Barriers to Obtaining Waivers to Prescribe Buprenorphine for Opioid Addiction Treatment Among HIV Physicians. J GEN INTERN MED 22, 1325–1329 (2007). https://doi.org/10.1007/s11606-007-0264-7

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  • DOI: https://doi.org/10.1007/s11606-007-0264-7

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