title: Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians.
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.
  
  
  METHODS
  Cross-sectional survey study.
  
  
  METHODS
  375 physicians attending HIV educational conferences in six cities in 2006.
  
  
  METHODS
  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.
authors.affiliation: Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA. ccunning@montefiore.org
authors.forename: Chinazo O
authors.initials: CO
authors.lastname: Cunningham
authors.forename: Hillary V
authors.initials: HV
authors.lastname: Kunins
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Roose
authors.forename: Rashiah T
authors.initials: RT
authors.lastname: Elam
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Sohler
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D011307:Drug Prescriptions; D004335:Drug and Narcotic Control; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000150:complications / Q000188:drug therapy*
chemical_list: D002047:Buprenorphine