Barriers to obtaining waivers to prescribe buprenorphine for opioid addiction treatment among HIV physicians

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.