Pharmacists help keep patients with opioid use disorder engaged in care
Pharmacy-based care was associated with higher rates of retention in opioid use disorder treatment compared with usual care, a pilot study in the New England Journal of Medicine found.
According to Traci C. Green, PhD, MSc, a professor at the Heller School for Social Policy and Management at Brandeis University in Massachusetts, and colleagues, inaccessibility of buprenorphine has impeded care during the opioid crisis. A 2022 Internal Journal of Drug Policy study found that over the past decade, most individuals with opioid use disorder in the United States (87%) did not receive medication.
“Treatment with medications can only work if it is available and accessible in the community,” Josiah D. Rich, MD, MPH, a professor of medicine and epidemiology at Brown University and coauthor of the current study, said in a press release. “Widespread, equitable access to effective treatment is the answer. Our study showed that the pharmacy treatment model increases access, which benefits a diverse patient population and increases equity.”
The researchers pointed out that pharmacists can help expand access to buprenorphine through collaborative practice agreements “that allow prescribers to delegate evaluation and some treatment decisions to pharmacists.”
Green, Rich and colleagues conducted a pilot trial from February 2021 to April 2022 to examine the plausibility of pharmacy-based care for opioid use disorder. The trial involved 21 pharmacists at six behavioral health pharmacies in Rhode Island.
The researchers enrolled 100 participants, 60 of whom were men and 34 were people from historically underrepresented groups. All participants received buprenorphine treatment. The initial doses included 4 mg per day (n = 1), 8 mg per day (n = 6), 16 mg per day (n = 82), 20 mg per day (n = 1) and 24 mg per day (n = 10). The participants were initially given doses for 3 to 7 days and then received them weekly or bi-weekly.
After initial treatment, 58 participants’ conditions were stabilized, according to the researchers. These participants went on to receive maintenance care and were randomly assigned to either pharmacy-based care (n = 28) or usual care (n = 30).
The researchers found that 89% (n = 25) of patients receiving pharmacy-based care continued to attend visits 1 month following randomization compared with 17% (n = 5) of patients receiving usual care — a difference of 72 percentage points (95% CI, 48-84).
"To have so many people in the pharmacy group continue on with their care was completely unexpected,” Green said in the release. “The results from this pilot study show how pharmacies can be an effective and viable pathway to treatment for opioid use disorder.
By expanding access to buprenorphine, Rich said that pharmacists may also help address health inequities.
“Considering overdose deaths are increasing the fastest among Black and Hispanic communities and over 1,500 Rhode Islanders are currently unhoused, pharmacy-based addiction care models could be a pathway to promote racial and economic equity in accessing addiction treatment,” he said.
The researchers concluded that longer comparative-effective trials are needed “in order to determine the risks and benefits of induction with patient-centered buprenorphine regimens through pharmacy-based care as compared with conventional and other care models for the treatment of opioid use disorder in the community.”
References:
- Green T, et al. N Engl J Med. 2023;doi:10.1056/NEJMc2208055.
- Krawczyk N, et al. Int J Drug Policy. 2022;doi:10.1016/j.drugpo.2022.103786.
- Pharmacists can start patients on road to recovery from opioid use disorder, study shows. https://www.eurekalert.org/news-releases/976397. Published Jan. 11, 2023. Accessed Jan. 18, 2023.