title: Barriers and facilitators to primary care or human immunodeficiency virus clinics providing methadone or buprenorphine for the management of opioid dependence.
abstract: BACKGROUND
  Federal initiatives aim to increase office-based treatment of opioid dependence, but, to our knowledge, factors associated with willingness to deliver this care have not been defined. The objective of this study was to describe clinics' willingness to provide methadone hydrochloride or buprenorphine hydrochloride for opioid dependence.
  
  
  METHODS
  The design of the study was a survey conducted in New York State. Two hundred sixty-one directors of primary care and/or human immunodeficiency virus specialty clinics (response rate, 61.1%) that serve Medicaid enrollees were questioned. Outcomes were willingness to provide methadone and buprenorphine. Predictors included clinic characteristics, attitudes about drug users and their treatment, and reported barriers and facilitators to treatment.
  
  
  RESULTS
  Clinics were more willing to provide buprenorphine than methadone treatment (59.8% vs 32.6%; P < .001). Clinics offering human immunodeficiency virus specialty care (adjusted odds ratio [AOR], 2.16; 95% confidence interval [CI], 1.18-3.95) or a safe location to store narcotics (AOR, 2.99; 95% CI, 1.57-5.70) were more willing to prescribe buprenorphine and more willing to provide methadone. Willingness was positively associated with continuing medical education credits for training, but negatively associated with greater concern about medication abuse. Immediate telephone access to an addiction expert was associated with willingness to provide buprenorphine (AOR, 2.08; 95% CI, 1.15-3.76). Greater willingness to provide methadone was associated with a belief that methadone-treated patients should be seen along with other patients (AOR, 6.20; 95% CI, 1.78-21.64), methadone program affiliation (AOR, 4.76; 95% CI, 1.64-13.82), and having more patients with chronic pain in the clinic (AOR, 2.80; 95% CI, 1.44-5.44).
  
  
  CONCLUSIONS
  These clinics serving Medicaid enrollees were more receptive to buprenorphine than methadone treatment. Willingness to provide this care was greater in clinics offering human immunodeficiency virus services, treating more chronic pain, or affiliated with methadone programs. Accessible addiction experts and continuing medical education for training may facilitate adoption of this care.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA. bturner@mail.med.upenn.edu
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: Turner
authors.forename: Christine
authors.initials: C
authors.lastname: Laine
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Lin
authors.forename: Kevin
authors.initials: K
authors.lastname: Lynch
mesh_terms: D002047:Buprenorphine / Q000627:therapeutic use*; D015658:HIV Infections / Q000628:therapy; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008691:Methadone / Q000627:therapeutic use*; D015999:Multivariate Analysis; D009292:Narcotic Antagonists / Q000627:therapeutic use*; D009518:New York; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011320:Primary Health Care / Q000706:statistics & numerical data
chemical_list: D009292:Narcotic Antagonists; D002047:Buprenorphine; D008691:Methadone