Pharmacist-Physician Collaboration Boosts Buprenorphine Access

A collaborative pilot project involving community pharmacists and physicians effectively increased adherence to the opioid use disorder (OUD) medication buprenorphine, according to the results of a recent study.

An article detailing the study, which was supported by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health, was published in Addiction.¹

Buprenorphine has been used in opioid addiction treatment for nearly 2 decades, however, providers must complete training and receive a waiver to prescribe the medication to treat OUD. Less than 10% of primary care providers are authorized to prescribe buprenorphine and more than 20 million Americans live in a county without a buprenorphine-waivered physician. This lack of access creates barriers to treatment, especially for those in underserved communities, according to NIH.²

To help address the lack of access and adherence to buprenorphine, investigators from Duke University studied the transfer of care of 71 participants using buprenorphine maintenance therapy for OUD from waivered physicians to trained community pharmacists.

“Community pharmacists are among the most trusted health care professionals in the US,” said Li-Tzy Wu, ScD, RN, MA, one of the study’s authors and director of the Community-Based Substance Use Disorder Research Program at Duke University School of Medicine. “Community pharmacies are highly accessible, even in…US rural areas.”

Six physicians and 6 community pharmacists took part in the initial phase of the pilot project. Participating community pharmacies included Health Park Pharmacy in Raleigh, North Carolina; Clinic Pharmacy in Durham, North Carolina; and Josef Pharmacy, also in Durham.

Participants, physicians, and pharmacists who participated reported high rates of satisfaction with the program, according to the findings. More than 90% of patients said they were “very satisfied with their experience and the quality of treatment offered,” the investigators wrote. In addition, patients noted that “treatment transfer from physician's office to the pharmacy was not difficult at all” and that “holding buprenorphine visits at the same place the medication is dispensed was very or extremely useful/convenient,” according to the study.¹

Moreover, the program appeared to be effective. With the physician-pharmacist collaborative model, nearly 89% of participants remained in the study and 95.3% adhered to the daily medication regimen. In addition, during the 6-month trial of the program in 2018, no opioid-related emergencies or hospitalizations were reported. The proportion of opioid-positive urine drug screens was less than 5% at month 6 among participants who completed all urine drug screens in the study.¹

The initial treatment phase, in which the buprenorphine dose is gradually increased until a satisfactory daily dose is reached, was carried out under the care of a waivered physician. Participants attended monthly maintenance visits during which pharmacists dispensed buprenorphine, assessed how well the medication was working, and provided counseling and referrals to specialists as needed. Pharmacists provided feedback to the partnering physician to adjust buprenorphine dosage as needed. Pharmacists used prescription drug monitoring programs at 96.8% of visits. No opioid‐related safety events were reported.¹

“Community pharmacists are experts in medication therapy management and are natural partners of physicians, providers, [and] prescribers,” Wu said. For this reason, community pharmacists may further help address the physician shortage in the United States, Wu noted. 

Overall, the results of pilot study offered strong support for advancing physician-pharmacist team-based approaches to leverage community pharmacies as a resource in expanding access to OUD treatment, according to NIH. However, larger clinical trials are needed to establish strategies and approaches to most effectively implement team-based buprenorphine care and respond to the needs of diverse clinical settings and populations, the investigators concluded.^1,2

References:

1. Wu LT, John W, Ghitza UE, et al. Buprenorphine physician-pharmacist collaboration in the management of patients with opioid use disorder: results from a multisite study of the National Drug Abuse Treatment Clinical Trials Network. Addiction. Published online January 11, 2021. 2021;10.1111/add.15353. doi:10.1111/add.15353
2. Physician-pharmacist collaboration may increase adherence to opioid addiction treatment. News release. National Institutes of Health. January 11, 2021. Accessed February 8, 2021. https://www.nih.gov/news-events/news-releases/physician-pharmacist-collaboration-may-increase-adherence-opioid-addiction-treatment