Pharmacy Buprenorphine Programs Can Increase OUD Treatment Access, But Barriers Limit Engagement
The top reported barriers to providing buprenorphine included regulatory and administrative, operational and attitudinal, and patient-related challenges.
Community pharmacists who take part in buprenorphine programs can help improve access to opioid use disorder (OUD) treatment, according to recent data published in the Journal of the American Pharmacists Association.1 However, the authors said regulatory scrutiny and gaps in knowledge continue to limit engagement in providing the medication.
Pharmacy Buprenorphine Programs Can Increase OUD Treatment Access, But Barriers Limit Engagement / luchschenF - stock.adobe.com
In the United States, there were over 81000 opioid overdose deaths in 2022, with 90% of those involving synthetic opioids.2 Although provisional data indicates that the number of overdose deaths in the country is declining, it remains significantly elevated from a decade ago. There are currently 3 medications approved to treat OUD: naltrexone, methadone, and buprenorphine. However, due to prescribing and regulatory restrictions, as well as a lack of access, they remain underutilized.
READ MORE: For Pharmacists With Substance Use Disorders, Recovery Is Possible
“Community pharmacists are well-positioned to play a vital role in expanding buprenorphine access, especially since 96% of Americans live within 10 miles of a community pharmacy,” the authors wrote. “Their frequent patient contact and ability to collaborate with clinicians to support patient care make them well-suited for expanding access to buprenorphine and improving treatment outcomes.”
A team of investigators from the University of Georgia and Emory University conducted a study to synthesize evidence from existing literature on pharmacy-based buprenorphine programs for OUD. The systematic review aimed to understand stocking and dispensing patterns, as well as pharmacist knowledge, attitudes, and barriers to providing buprenorphine services. Data for the study was gathered from a search of PubMed, Web of Science, CINAHL, and Google Scholar for research published between 2002 and 2024.
The systematic review included 38 articles in total, with 32 being nonintervention studies. The study found community pharmacists were key members of collaborative care models. They led buprenorphine initiation, provided ongoing patient care, expanded access to buprenorphine via dispensing agreements, and provided additional counseling to encourage non-pharmacological treatments.
Of the 15 studies that examined buprenorphine stocking and dispensing, stocking rates ranged from 31% to 90% and dispensing rates ranged from 20% to 90%. Although many pharmacies stocked the medication, 62% of surveyed pharmacists refused to fill it. The data also showed that rural and independent pharmacies were less likely to stock and dispense buprenorphine compared to urban and chain community pharmacies. The most common reasons for limited stocking or dispensing of buprenorphine included out-of-state prescribing, concerns about diversion and misuse, mistrust of some prescribers, and stigmatized attitudes toward OUD.
Many of the included studies reported that community pharmacists had inadequate knowledge about buprenorphine, as well as misconceptions about its use for OUD treatment. Pharmacists and prescribers both emphasized the need for additional pharmacist training in medication for OUD, with curriculum development and continuing education programs being recommended approaches. Additionally, pharmacist attitudes toward buprenorphine were mixed, with some studies reporting positive attitudes and others negative attitudes.
The top reported barriers to providing buprenorphine included regulatory and administrative, operational and attitudinal, and barriers related to patients, including financial and logistical challenges, low engagement, and processing prescriptions from unfamiliar prescribers.
“As buprenorphine prescriptions are expected to increase due to expanded prescriber eligibility, community pharmacies, especially those in high-need areas with elevated OUD rates and limited health care access, should prepare to meet this growing demand,” the authors wrote. “Strategies to ensure buprenorphine availability across pharmacy types and regions could include legislative mandates for stocking, cost subsidies, and mechanisms to help pharmacies offset financial losses from expired medications.”
READ MORE: Substance Use Disorder Resource Center
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