August 20, 2021

by Brenda Pahl, Pharm.D., BCPS

As pharmacists, we are well aware of the opioid epidemic that has plagued the United States since the late 1990s. While the number of deaths from opioids was declining across the U.S, statistics from the Centers for Disease Control and Prevention show that overdose deaths for the 12-month period from August 2019 to August 2020 rose from the previous year’s 12-month span, possibly being the highest number of overdose deaths ever recorded in a 12-month period.

Many patients who would benefit from medication treatment for opioid use disorder do not receive it.
Opioid use disorder (OUD) is a complex condition that affects more than 1.6 million people aged 12 and older, according to the data collected by SAMHSA for the year 2019. However, many patients who would benefit from medication treatment for opioid use disorder do not receive it. Two common issues facing patients who want to receive treatment for opioid use disorder are the ability to be connected to a provider who is able to prescribe medication (buprenorphine, methadone) used in the treatment of OUD and the stigma associated with OUD and the medications used during treatment.

Recognizing the barriers patients may have to access to a provider who can prescribe buprenorphine, the Department of Health and Human Services (HHS) released new guidelines that remove barriers associated with prescriber training and ancillary services.

What are the new buprenorphine guidelines?

Physicians, nurse practitioners, physician assistants, and other eligible providers can prescribe suboxone for the treatment of OUD for up to 30 patients without completing the required eight hours of training. Providers are also waived from the requirement of certifying their capacity to provide counseling and ancillary services. Providers may only prescribe Scheduled III-V medications for OUD and must submit a “Notice of Intent” to SAMHSA in order to obtain approval for exemption from the Practice Guidelines for the Administration of Buprenorphine for Treating Opioid Use Disorder. Providers who wish to treat more than 30 patients must follow the rules and regulations pertaining to the Title 21 United States Code 823(g).

What role can pharmacists play in assisting with treating patients with OUD?

A study published in Addiction by Wu, L.T. et al. concluded that a physician-pharmacist collaboration can increase patient adherence and lead to improved outcomes in patients prescribed buprenorphine. The study enrolled 71 patients, 6 physicians and 6 community pharmacists. After the patients completed the initial treatment phase under a waivered physician, the follow up care was provided by a community pharmacist. The patients met with the pharmacist at least once a month. The pharmacist assessed how well the buprenorphine was working, suggested dose adjustments, provided medication counseling, made referrals to specialists and support services, and provided feedback to the partnering physician. During the six6-month study conducted at Duke University, the patients experienced no opioid-related emergencies or hospitalizations, and opioid-positive drug screens were less than 5%. Program satisfaction rates were reported by participants, physicians, and pharmacists. This study demonstrated that providing support services for patients receiving buprenorphine for OUD could be an innovative practice for community pharmacies.

What role does stigma play in patients seeking treatment?

A study published in July 2021 in Drug and Alcohol Dependence highlighted that one in five pharmacies blocks access to buprenorphine. Researchers contacted 921 pharmacies across the United States during the months of May and June 2020 asking if they would dispense buprenorphine. Of the pharmacies contacted, 20% stated they were unable or unwilling to dispense buprenorphine for opioid use disorder and 7% would not disclose controlled substance availability over the phone. This survey was conducted during the COVID-19 pandemic when patients were experiencing difficulty accessing treatment due to closed treatment centers and physician offices.

While the study did not seek the reason for not dispensing, the authors posed a few suggestions for reasons behind the refusal. The fear of DEA investigation may lead pharmacies to self-impose purchasing limits on the amount of buprenorphine and other controlled substances. Another discussion involved the stigma toward individuals with OUD. The stigma often associated with OUD can lead to non-adherence with treatment by the patients. Once a patient has committed to seeking treatment for their illness, barriers to obtaining medications can be one more reason why they discontinue treatment. Pharmacists must consider how they can create a welcoming environment for patients receiving treatment for OUD. Using non-stigmatizing language and putting aside perceptions and stereotypes are examples of how a pharmacy can better serve these patients.

Dr. Brenda Pahl is Assistant Professor of Pharmacy Practice and Interim Assistant Dean of Student Affairs at the Cedarville University School of Pharmacy. Her interests include hospital pharmacy practice, ambulatory care – anticoagulation, medication/patient safety, and substance use disorder.


The Cedarville University School of Pharmacy is equipping its Doctor of Pharmacy students to be on the leading edge of healthcare innovation. Cedarville’s Pharm.D. students are fully prepared to begin a rewarding career as a pharmacist and to use their calling to make a difference for Christ as they serve with excellence and compassion.

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