Adaptation and factor analysis of a buprenorphine attitudes scale: Association with attitudes and dispensing practices among community pharmacists in Puerto Rico.

Abstract

Background: Community pharmacist attitudes toward medication for opioid use disorder (MOUD) have been associated with refusal to dispense buprenorphine in mainland U.S. populations, but no contemporary study had characterized these attitudes among pharmacists in Puerto Rico OBJECTIVES: To adapt and conduct the first formal psychometric evaluation of a buprenorphine attitudes scale in a Puerto Rico community pharmacist sample, and to examine the association between pharmacist attitudes and refusal to dispense buprenorphine.

Methods: A cross-sectional survey adapted from Carpenter et al. was distributed to community pharmacists registered with the Colegio de Farmacéuticos de Puerto Rico between January and November 2025. The instrument included a seven-item buprenorphine attitudes scale adapted from Davenport et al. Exploratory factor analysis was conducted on the 98 respondents with complete attitudes data. Multivariable logistic regression estimated the association between the attitudes composite and self-reported refusal to dispense, adjusting for pharmacy type, years of practice, and highest degree.

Results: A total of 101 community pharmacists completed the survey. Factor analysis supported a single-factor solution accounting for 49.5% of common variance; scale reliability was acceptable (Cronbach's α 0.807; McDonald's ω 0.862). The item assessing concern about diversion and misuse loaded weakly (loading 0.302; communality 0.091) and was psychometrically distinct from the remaining six items. In adjusted analyses, more negative attitudes were the strongest predictor of dispensing refusal (adjusted OR 5.45 [95% CI 2.19-13.55], p < .001), an association that remained significant in a sensitivity analysis excluding the diversion item (adjusted OR 3.92 [95% CI 1.80-8.53], p < .001). Overall, 39 pharmacists (38.6%) reported ever refusing to dispense buprenorphine. Pharmacists were significantly more willing to dispense to familiar than unfamiliar patients (mean 4.11 vs. 3.34; p < .001).

Conclusion: Buprenorphine attitudes are the primary modifiable predictor of dispensing refusal among Puerto Rico community pharmacists. The adapted attitudes scale is psychometrically sound, with concern about diversion identified as a distinct construct warranting separate treatment in future research and instrument development.