Training HIV physicians to prescribe buprenorphine for opioid dependence.
ABSTRACT Few HIV physicians are trained to provide buprenorphine treatment. We conducted a cross-sectional survey to assess the impact of an eight-hour course on the treatment of opioid dependence on HIV physicians' preparedness to prescribe buprenorphine. 113 of 257 trained physicians (44%) provided HIV care. Post-course, the majority of both HIV physicians and non-HIV physicians (66% vs. 67%, P = .8) planned to pursue a registration to prescribe buprenorphine. The most common reason for not planning to do so was lack of experience (9% vs. 15%, P = .19). 52 of the 113 (46%) HIV physicians had concerns about prescribing buprenorphine. 30 of the 52 (58%) indicated that interactions between buprenorphine and HAART was their primary concern. Following training, most physicians feel prepared and plan to obtain a registration to prescribe buprenorphine. HIV physicians' concerns regarding interactions between buprenorphine and HAART need to be addressed in future training efforts.
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ABSTRACT: Abstract The benefits of integrating primary care and substance use disorder treatment are well known, yet true integration is difficult. We developed and evaluated a team-based model of integrated care within the primary care setting for HIV-infected substance users and substance users at risk for contracting HIV. Qualitative data were gathered via focus groups and satisfaction surveys to assess patients' views of the program, evaluate key elements for success, and provide recommendations for other programs. Key themes related to preferences for the convenience and efficiency of integrated care; support for a team-based model of care; a feeling that the program requirements offered needed structure; the importance of counseling and education; and how provision of concrete services improved overall well-being and quality of life. For patients who received buprenorphine/naloxone for opioid dependence, this was viewed as a major benefit. Our results support other studies that theorize integrated care could be of significant value for hard-to-reach populations and indicate that having a clinical team dedicated to providing substance use disorder treatment, HIV risk reduction, and case management services integrated into primary care clinics has the potential to greatly enhance the ability to serve a challenging population with unmet treatment needs.AIDS patient care and STDs 01/2014; DOI:10.1089/apc.2013.0179 · 3.58 Impact Factor
American Journal of Preventive Medicine 01/2013; 44(1):S86-S90. DOI:10.1016/j.amepre.2012.09.035 · 4.28 Impact Factor
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ABSTRACT: To examine awareness of, experience with, and attitudes toward buprenorphine, to begin to understand why opioid users may not access buprenorphine treatment. Factors associated with attitudes toward buprenorphine were also explored. Cross-sectional study. A community-based organization's syringe exchange program in mobile units at nine street-side outreach sites in New York City. One hundred eighty-six adult opioid users visiting a syringe exchange program. Awareness of, experiences with, and attitudes toward buprenorphine. Most (68.5 percent) participants were aware of buprenorphine, 27.8 percent had taken buprenorphine, and 58.6 percent knew someone who had taken buprenorphine. Of the 98 who had taken or knew someone who had taken buprenorphine, 85.7 percent endorsed positive attitudinal statements about its effectiveness, and up to 31.6 percent endorsed statements about its limited access. Participants' attitudes about the need for formal buprenorphine treatment were mixed. Current heroin users were more likely than nonusers to have heard of buprenorphine (76.0 percent vs 61.5 percent, p < 0.05), have taken buprenorphine (46.8 percent vs 9.6 percent, p < 0.01), endorse buprenorphine's effectiveness (96.3 percent vs 72.7 percent, p < 0.01), and believe that illicit and prescribed buprenorphine have similar benefits (35.2 percent vs 13.6 percent, p < 0.02) CONCLUSIONS: Most opioid users visiting a syringe exchange program had positive attitudes about buprenorphine's effectiveness, and few believed that buprenorphine was difficult to access. Attitudes about the benefits of illicit versus prescribed buprenorphine use were inconsistent. Understanding awareness of, experience with, and attitudes toward buprenorphine is important, as these factors are likely to influence opioid users' decisions about engaging in buprenorphine treatment.Journal of opioid management 9(6):407-413. DOI:10.5055/jom.2013.0183