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Role of Pharmacists

Why now? 

I count on pharmacists to get my patients their buprenorphine products. I can write the script, but the pharmacy is where my patients actually get their medication. OUD treatment provider, 2021

  • With the passage of the Mainstreaming Addiction Treatment (MAT) act, the Drug Enforcement Agency “X-waiver” program governing the office-based prescription of buprenorphine for opioid use disorder has been eliminated.
  • With the elimination of the X-waiver, any provider licensed to prescribe schedule 3 medications are now able to prescribe buprenorphine, substantially increasing the prescriptive authority for buprenorphine.
  • The Drug Enforcement Administration and the Department of Health and Human Services released a statement showing commitment to ensure safe and ready access to medications for opioid use disorder.23
  • Neither the Controlled Substance Act nor DEA regulations establish quantitative thresholds or limits on the amounts of MOUD that DEA registrant may order or dispense, nor do they require registrants to set such thresholds or limits.
  • The DEA administrator Anne Milgram announced a commitment to expanding access to medication-assisted treatment to help those with substance use disorder in a statement that reads: “Medication-assisted treatment helps those who are fighting to overcome substance use disorder by sustaining recovery and preventing overdoses. At DEA, our goal is simple: we want medication-assisted treatment to be readily and safely available to anyone in the country who needs it.”
Read more about the injunctive relief provisions in the resources section.28

What do you think?

Between 2019-2020, how many North Carolina providers completed X-waiver trainings, paid for by the state? Click the response that you think is correct.

A graphic representing the bottleneck of buprenorphine supply

The buprenorphine bottleneck

Buprenorphine is becoming increasingly difficult to access. The combination of increased buprenorphine prescribing alongside wholesaler thresholds and stigma work together to produce a bottleneck that limits access. This creates a ‘prescribing cliff’16 where more prescribing does not result in more access to buprenorphine, if pharmacies cannot or do not dispense.

Who is most at risk when buprenorphine is not available?

The patients.

  1. Pattani A. DEA takes aggressive stance toward pharmacies trying to dispense addiction medicine. NPR. https://www.npr.org/sections/health-shots/2021/11/08/1053579556/dea-suboxone-subutex-pharmacies-addiction. Published November 8, 2021.

Why pharmacists?

… at first, we had some trepidation about filling [buprenorphine] because not everybody else was doing it. Now we fill those scripts. I understand the need that’s out there. And my staff knows a positive attitude goes a long way toward encouraging OUD patients to stay the course for treatment…Rural community pharmacist in North Carolina, 2020

Pharmacists play an important role in ensuring buprenorphine access in their communities. Efforts to provide access are most successful when the entire pharmacy team, including pharmacy technicians, interns, and cashiers, understand the benefits of buprenorphine for OUD. 

Patients report having more positive, less stigmatizing experiences when all staff make them feel welcome at the pharmacy. A warm welcome supports treatment continuity. When pharmacists are unable or unwilling to dispense buprenorphine products for OUD patients, the chance of withdrawal symptoms increases, and the patient has an increased risk for returning to use of non-prescribed substances and overdose.17

  1. Williams AR, Samples H, Crystal S, Olfson M. Acute care, prescription opioid use, and overdose following discontinuation of long-term buprenorphine treatment for opioid use disorder. American Journal of Psychiatry. 2020;177(2):117-124.

Ways to create a welcoming environment for patients starts with technician and staff buy-in:

  • Discussing opioid use disorder as a disease is the first step to ensure technician and staff buy-in.
  • Opioid use disorder, similar to diabetes and hypertension is a chronic disease state that we treat with medications. We would not want to deny someone access to insulin for their diabetes, we also would not want to deny access to buprenorphine for opioid use disorder.
  • The benefits of buprenorphine should be highlighted26
    • Use of medications for opioid use disorder increases the likelihood that a person will remain in treatment, which is associated with a lower risk of overdose death
    • Use of buprenorphine reduces the risk of infectious disease transmission (like HIV and HCV) that can be costly to treat
    • Use of buprenorphine for OUD reduces criminal behavior associated with drug use.
    • Use of buprenorphine for OUD leads to a greater likelihood of employment.
  • Sharing why you personally support filling buprenorphine prescriptions for patients with OUD
  • Discussing how a positive, friendly experience at the pharmacy can encourage people with OUD to continue with treatment

But I think any pharmacist who sees somebody come in and is willing to pay hard-earned money in cash just to get this lifesaver, just give it to him, dude. Because no matter what he does with it, just the fact that somebody’s willing to get Suboxone…as long as it’s getting out there in the streets and into the people and getting used. Because every time somebody uses Suboxone, that is another day that they’re gonna live. OUD patient, 2020