Pharmacists May Be Key to Expanding Bupe Access, NIDA Pilot Shows

    Collaboration between physicians and pharmacists may boost patients’ satisfaction with, and adherence to, buprenorphine treatment for opioid use disorder (OUD), research suggests.

    In the first US pilot trial exploring a physician-pharmacist collaborative model for delivering buprenorphine care to OUD patients, over 90 percent of participants reported being “very satisfied” with their overall experience. The research, published in Addiction on January 11, was supported by the National Institute on Drug Abuse (NIDA).

    Typically, patients receiving buprenorphine see their physician and a pharmacist monthly to refill their prescriptions. Under this care model, physicians are responsible for prescribing the buprenorphine (and for monitoring the patient), and pharmacists are responsible for dispensing it.

    Under the new collaborative model explored in the study, physicians are still responsible for prescribing buprenorphine. Pharmacists, however, take on a role in counseling and educating patients about their drug use—eliminating the need for patients to visit their physician on a regular basis. This arrangement also freed up time for the physicians to see more patients.

    The vast majority of Americans with OUD do not receive medication for it (MOUD): Only around 18 percent received MOUD in 2019. But around 90 percent of Americans live within five miles of a community pharmacy—meaning community pharmacists have the potential to connect more patients to MOUD. 

    Meanwhile, almost 20 million Americans live in a county without a practitioner licensed to prescribe buprenorphine. In part, that’s because less than 10 percent of primary care providers possess the waiver required to provide it to OUD patients. 

     

    Benefits for All Parties 

    The NIDA pilot enrolled 71 patients with OUD regularly receiving buprenorphine, six buprenorphine-waivered physicians and six pharmacists across three clinic-community pharmacy partnerships in North Carolina. After agreeing to participate in the study, patients had their treatment transferred from their provider’s clinic to the partner pharmacy for six months.

    The vast majority—nearly 89 percent—of patients remained enrolled in the study for all six months. Of those participants, none experienced an overdose during that time, and all but one said they would re-enroll if the study pilot was offered again.

    The majority of physicians and pharmacists agreed that the collaborative care model was “more effective” than the standard one, and all reported being “very satisfied” with the overall experience.

    There has been only one previous report of such a model for buprenorphine treatment in the US. In that instance, a pilot program involved 12 patients receiving buprenorphine care at a suburban health department, but patient satisfaction and outcomes were not formally studied the way they were in the NIDA pilot.

    “We have underutilized the infrastructure that we get from pharmacies across the country,” NIDA director Dr. Nora Volkow told Filter. “The involvement of pharmacies in administering the flu vaccine represents an example about how we can use them in ways that can facilitate treatment and health outcomes.”

     

    What’s Next?

    Expanding this collaborative model to different types of pharmacies and environments will be crucial. The study’s authors note that, in particular, further research in rural areas—where residents face access issues in obtaining buprenorphine care—is needed. 

    Volkow told Filter “it will be very much of interest” to see how pharmacies can get engaged in dispensing not just buprenorphine, but also methadone and naltrexone. Naltrexone is the third and newest MOUD to be approved by the FDA, but has not been shown to reduce rates of fatal overdose the way that methadone and buprenorphine have. 

    Greater pharmacy involvement would also benefit patients “who don’t want to be associated with a methadone clinic,” Volkow said. Canada has been using pharmacies to provide treatment for a long, long time. And that has not been in any way associated with any ill effects.”

    France has allowed buprenorphine to be prescribed by general practitioners since 1995. Within four years, France’s overdose deaths dropped by 79 percent

     


     

    Photograph via Pixabay

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