Is buprenorphine a magic bullet for opioid addicted HIV infected individuals? A case study of patients electing buprenorphine therapy in a primary care setting

Background: Opioid abuse continues to be a major consideration in the care of individuals with HIV/AIDS. Methadone has been the primary medical treatment for opioid abuse. However, it is provided primarily in regulated methadone clinics, many of which have long waiting lists, impose substantial requirements on patients, and are difficult for many HIV infected patients to reach. The implementation of an office-based buprenorphine treatment intervention for HIV positive persons appears to be an optimal alternative. Methods: El Rio Neighborhood Health Center, Special Immunology Associates is participating in a five-year demonstration study funded by the Health Resources Services Administration to integrate a buprenorphine opioid abuse treatment program into an existing HIV primary care setting. In order to elucidate ways in which patient characteristics and other factors impact on buprenorphine treatment outcomes, we reviewed case histories of five patients. Results: As with many types of substance abuse treatment, the success of buprenorphine therapy is influenced by a variety of patient characteristics, including treatment history, substance use history and patterns, recovery environment, physical and mental health status, legal pressure, and self-efficacy.Discussion: Because of the diversity of patient characteristics and factors associated with successful substance abuse treatment, providing buprenorphine in a primary care setting poses a number of challenges. Recommendations for primary medical care settings that are interested in providing buprenorphine to patients are discussed.