Abstract
Background: Increasing buprenorphine prescribing for opioid use disorder (OUD) has been a major focus of U.S. opioid response efforts. However, concerns related to dispensing buprenorphine have been identified among pharmacists. Objectives: This study aimed to describe perceptions, policies, and practices reported by community-based pharmacists in relation to dispensing buprenorphine for OUD and to compare these responses by practice setting. Methods: A cross-sectional online survey was administered to a random sample of 6376 pharmacists. Responses were collected anonymously from October 16, 2021, to November 7, 2021. Results: A response rate of 5.1% was achieved with 325 responders, and 281 were eligible to complete the survey. Most reported practicing in a chain (50.9%) or independent pharmacy (34.7%) as a staff pharmacist (39.7%) or pharmacist-in-charge (37.0%). Most (68.1%) indicated they could usually or always fill a buprenorphine prescription promptly. The most common pharmacy policies related to buprenorphine dispensing were checking the prescription drug monitoring program (71.3%), validating the prescriber's X-waiver (44.9%), accepting only local prescribers (37.4%), and prohibiting refills more than one day early (35.8%). Policies limiting buprenorphine access to local prescribers, local patients, and established patients varied by practice setting and were most common in independent pharmacies. The strongest barriers to buprenorphine dispensing were insurance prior authorization, difficulty reaching prescribers with questions, and concerns about buprenorphine diversion. The strongest facilitators of buprenorphine dispensing were increased communication with prescribers, increased trust with prescribers, increased trust with patients, and increased education for pharmacists. Conclusion: Most respondents indicated they were willing and able to dispense buprenorphine products for OUD promptly. However, they also reported discomfort dispensing when factors representing potential risk of diversion are present. Mitigating this hypersensitivity to diversion risk among pharmacists should be a focus of regulatory agencies and professional organizations. Efforts to address the unique concerns of independent pharmacists will also be essential to improve access.
| Original language | English |
|---|---|
| Pages (from-to) | 252-260.e6 |
| Journal | Journal of the American Pharmacists Association |
| Volume | 63 |
| Issue number | 1 |
| DOIs | |
| State | Published - Jan 1 2023 |
Bibliographical note
Publisher Copyright:© 2022 American Pharmacists Association®
Funding
Funding: This study was made possible (in part) by grant no. H79TI083343 from the Substance Abuse and Mental Health Services Administration. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Traci C. Green's involvement was supported in part by the following grants from the National Institutes of Health: P20GM125507, DA045848, and DA045745.The authors thank the American Academy of Addiction Psychiatry for supporting this study, Daniel Ventricelli for contributing to survey conceptualization, Gina Scime for survey generation and administration, and Aiya Almogaber and Brittany Botescu for supporting study team meetings and developing visual abstracts. Disclosure: Lucas G. Hill reports serving on a community advisory board for Hikma Specialty USA Inc., in December 2020. The views expressed in this publication and by the authors do not necessarily reflect the policies of the Department of Health and Human Services; nor does the mention of trade names, commercial practices, or organizations imply endorsement by the U.S. government. The authors declare no other relevant conflicts of interest or financial relationships. Funding: This study was made possible (in part) by grant no. H79TI083343 from the Substance Abuse and Mental Health Services Administration. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Traci C. Green’s involvement was supported in part by the following grants from the National Institutes of Health : P20GM125507 , DA045848 , and DA045745 .
| Funders | Funder number |
|---|---|
| Aiya Almogaber and Brittany Botescu | |
| Hikma Specialty USA Inc. | |
| U.S. Government | |
| National Institutes of Health (NIH) | P20GM125507, DA045745, DA045848 |
| U.S. Department of Health and Human Services | |
| Substance Abuse and Mental Health Services Administration | |
| American Academy of Addiction Psychiatry |
ASJC Scopus subject areas
- Pharmacology (nursing)
- Pharmacy
- Pharmacology