Buprenorphine
Loren Bonner
In September 2024, the National Association of Boards of Pharmacy along with the National Community Pharmacists Association released a new guideline about buprenorphine access in community pharmacies.
The Pharmacy Access to Resources and Medication for Opioid Use Disorder (PhARM–OUD) Guideline—endorsed by an array of professional societies and organizations, including APhA— is designed to educate pharmacists about buprenorphine and help them navigate a complex set of regulatory and clinical barriers with making the medication more readily available to patients.
Pharmacy Todaydiscussed the guideline with lead author, Tyler Varisco, PharmD, assistant professor at the University of Houston College of Pharmacy.
Why did you feel this guideline was necessary to develop?
The available guidelines that already exist provide evidence-based recommendations for buprenorphine prescribers but do not address the complex regulatory, administrative, and procurement barriers that community pharmacists face on a daily basis with buprenorphine for OUD.
Buprenorphine is a DEA Schedule III Controlled Substance and an opioid. The national opioid settlement made it more difficult for pharmacies to order and dispense controlled substances, including buprenorphine. This new guideline is intended to provide recommendations to practicing pharmacists to help them reconcile regulatory complexity with clinical necessity.
We worked with a wide variety of nontraditional health care providers when preparing this guidance, and the end result is an evidence-based consensus and multiperspective guidance that will expand access to medication for OUD by providing pharmacists with new strategies to fulfill their corresponding responsibility when reviewing buprenorphine prescriptions.
How do you think community pharmacists should use the guideline?
The document is structured to address difficult, but common, scenarios that community pharmacists encounter every day. There are dedicated sections on considerations for cash paying patients, telehealth prescriptions, and wholesale buprenorphine purchase, among others.
The interpretation and review of evidence offered in each section is intended to bolster pharmacists’ confidence when dispensing buprenorphine to those with OUD.
What are the main takeaways?
The main takeaway is that pharmacists can be a critical resource for patients with OUD by dispensing buprenorphine.
Throughout the document, we encourage pharmacists to take a more nuanced perspective when reviewing buprenorphine prescriptions. For instance, patients may not wish to use their employer-sponsored prescription insurance because they are concerned that their employer will learn that they are in treatment. Patients may have to travel further to access buprenorphine because pharmacies in their area do not stock the medication.
In each of these scenarios, a black-and-white interpretation of traditional red flags would potentially preclude that patient from accessing treatment, dramatically increasing their risk of mortality.
How does the guideline have legs beyond community pharmacy?
Even though the guideline is written primarily for community pharmacists, there are takeaways for physicians and other buprenorphine prescribers.
Controlled substance dispensing is complex, and not all prescribers are aware of the steps that pharmacists must take while verifying prescriptions.
There are also potential applications for student pharmacists. The guidance provides a thorough and approachable review of recent controlled substance policy and litigation. Bringing these recommendations into the classroom will help ensure that future pharmacists are well prepared to provide care to patients with OUD.
We also hope that this guidance will encourage federal and state lawmakers to reconsider how future policy changes impact access to treatment.
Anything else you’d like to add?
On a policy note, emerging legislation will continue to shape pharmacy practice. The Modernizing Opioid Treatment Access Act would allow methadone to be prescribed outside of the opioid treatment provider setting and would allow pharmacists to dispense. The Broadening Utilization of Proven and Effective Treatment for Recovery Act would exempt buprenorphine from suspicious order reporting requirements.
Both pieces of legislation would remove long-standing barriers to treatment and would allow pharmacists to provide more services to patients with OUD. The impact of these landmark changes, however, will be limited if pharmacists are not compensated for nondispensing services. Payment parity is critical to improving the access landscape. ■