Study: Buprenorphine for OUD unavailable at many pharmacies

Key takeaways:

• Just over half of 5,283 pharmacies had medications for opioid use disorder in stock.
• Researchers said that dispensing regulations imposed by federal and state governments may contribute to retail availability.

About 58% of pharmacies reported availability of buprenorphine for opioid use disorder at the time of patients’ requests, according to researchers.

Prior research has suggested that pharmacists play a critical role in providing effective and consistent care for opioid use disorder (OUD). One study found that pharmacy-based care was associated with higher rates of retention in OUD treatment compared with usual care.

Despite this, “there are some reports that patients may encounter barriers in filling [buprenorphine prescriptions] at their local pharmacy,” Scott G. Weiner, MD, MPH, FAAEM, FACEP, an associate professor of emergency medicine at Harvard Medical School, and colleagues wrote in JAMA Network Open.

To determine potential limitations in prescribing abilities, Weiner and colleagues performed a retrospective analysis of pharmacy call logs in 2022 from a telehealth OUD treatment provider group operating in 32 states. Newly enrolled patients within the program had called to ask pharmacies about their stock of buprenorphine-naloxone.

The researchers found that 57.9% of 5,283 unique pharmacies reported having buprenorphine-naloxone in stock at the time of patients’ requests.

Chains were more likely to report stock compared with independent pharmacies (61.6% vs. 45.3%). Among retail pharmacies, H-E-B had the highest overall stock (82.5%), followed by Walgreens (70.3%) and Safeway (69.7%).

The availability of medication varied by state. Pharmacies in Florida reported the lowest stock (37.1%) while those in Washington had the greatest availability (83.9%).

The study was limited by its restriction in the number of states. Additionally, the analysis could not assess whether pharmacies had enough time to order medications in a timely manner; if they had enough stock to cover a patient’s entire prescription; the reason why no stock was reported; and whether the pharmacy restocked buprenorphine after the first call.

“Dispensing regulations imposed by federal and state governments may be contributing to lack of access at retail pharmacies,” the researchers wrote. “Although the number of prescribers willing to provide buprenorphine was identified as a barrier to this evidence-based OUD treatment in the past, pharmacy availability of buprenorphine may be an additional barrier, particularly in the post-COVID era in which telehealth can be used for patients in areas with few or no prescribers.”
Weiner and colleagues also concluded the government’s recent elimination of the X waiver, which was previously required for practitioners to prescribe buprenorphine for OUD, “highlights the importance of pharmacy availability.”

References:

• Weiner S, et al. JAMA Netw Open. 2023;doi:10.1001/jamanetworkopen.2023.16089.
• Removal of DATA waiver (X-waiver) requirement. https://www.samhsa.gov/medications-substance-use-disorders/removal-data-waiver-requirement. Accessed May 30, 2023.