Barriers to and facilitators of buprenorphine dispensing for opioid use disorder: Evidence from focus groups in Appalachian Kentucky

Background: As efforts to increase buprenorphine prescribing continue to intensify, pharmacy dispensing plays an important role in access to essential medications for opioid use disorder. Existing survey research suggests stigma and regulatory concerns are barriers to pharmacists dispensing buprenorphine, but facilitators are less clear, as are in-depth perceptions of pharmacists regarding buprenorphine. Objective: To assess barriers and facilitators to buprenorphine dispensing in Appalachian Kentucky using a series of focus groups with pharmacy employees. Methods: Between September and October 2023, 5 structured focus groups were conducted with a total of 19 pharmacists and pharmacy technicians across a mixture of high- and low-buprenorphine-dispensing counties. Investigators independently coded focus group transcriptions using a grounded theory approach to describe current dispensing practices as well as barriers to and facilitators of buprenorphine dispensing. Results: Most participants described dispensing buprenorphine, but there was substantial variation in dispensing practices. Participants identified patient-, provider-, pharmacy-, regulatory-and medication-related barriers to and patient-, provider-, pharmacy-, and regulatory-related facilitators of pharmacy dispensing. Patient- and provider-related barriers accounted for over half of barriers identified. The most common facilitators were also patient- and provider-related. Conclusion: In a series of 5 focus groups with pharmacy staff in Appalachian Kentucky, the most common barriers to buprenorphine dispensing were patient and provider behaviors. Patient stories were the most common facilitators. Interventions to increase pharmacy buprenorphine dispensing should focus on addressing misperceptions regarding behavior, preferably driven by positive patient testimony.