OUD
Loren Bonner
A recent study finds that buprenorphine prescribing from pharmacists remains low and variations in state laws may still restrict pharmacist prescribing even after the implementation of the Mainstreaming Addiction Treatment (MAT) Act in December 2022. That law removed federal requirements for clinicians to obtain a waiver to prescribe buprenorphine and made it easier for pharmacists to prescribe buprenorphine for OUD.
Pharmacist prescribing of buprenorphine still only accounts for less than 1% of total buprenorphine prescribing, according to the study findings, which were published in JAMA on June 16, 2025.
However, the research suggests that pharmacist-prescribed buprenorphine can impact diverse patient populations. According to lead author Emmy Tran, PharmD, MPH, they found that after the MAT Act was put in place, more pharmacists dispensed buprenorphine across patient sex and age groups.
“This might imply that some states and institutions were aware of the MAT Act and might have already had infrastructure in place to facilitate the introduction or continuation of pharmacist prescribing of buprenorphine for opioid use disorder in their practice,” said Tran, who is with CDC’s Division of Overdose Prevention, National Center for Injury Prevention and Control.
According to Tran, the low buprenorphine prescribing numbers by pharmacists might change over time as awareness of the clinical opportunity increases and federal and state laws continue to evolve.
“We hope these findings demonstrate how laws and regulations can impact pharmacy practice and prescribing of buprenorphine for patients with opioid use disorder,” said Tran.
What contributed
According to Tran, institutions who adopted such practice models or already had an interest in increasing access to OUD treatment likely contributed to the relatively quick implementation of pharmacist prescribing of buprenorphine, resulting in increased dispensation rates within the first quarter after the MAT Act went into effect, as the study revealed.
Prior to the MAT Act (fourth quarter 2022), the number of prescriptions prescribed by pharmacists was increasing by 5.5 prescriptions per quarter. After implementation of the MAT Act (first quarter 2023), there was an increase of 80.9 pharmacist-prescribed buprenorphine prescriptions per quarter.
Data included buprenorphine prescriptions written by pharmacists and dispensed from January 2019 to September 2024.
State laws
Data from the study, which came from the IQVIA National Prescription Audit database, did not assess buprenorphine prescribing rates by state. However, variations in state laws can affect pharmacists prescribing buprenorphine.
“Variations often lead to large employers not offering the services because of the difficulty to implement and the regulatory risk when a majority of states do not allow for the services from pharmacists,” said Jennifer Adams, PharmD, from Idaho State University L.S. Skaggs College of Pharmacy, who was not involved with the study.
Most states still have not adopted laws that allow pharmacists to prescribe buprenorphine. As of 2023, at least 10 states allowed pharmacists to prescribe buprenorphine as part of a CPA with a clinician who can prescribe controlled substances, and at least two states allowed autonomous prescribing of buprenorphine without a prescribing collaborator.
“States often have restrictions in CPA statutes and rules preventing prescribing of controlled substances,” said Adams. “Even though they allow CPAs, the restrictions prevent pharmacists from partnering in prescribing of [medication for OUD].”
Tran said future research could consider analyzing these data by state.
Also, the data only included retail pharmacies and excluded federal pharmacies, such as those in the Veteran Health Administration.
Research from June 2025 published in the journal Drug and Alcohol Dependence found that VHA facilities also had an increase in pharmacist-prescribed buprenorphine in states that allowed controlled substance prescriptive authority for pharmacists. ■
Buprenorphine access
Buprenorphine is an essential and evidence-based tool to improve outcomes for those with OUD, said Adriane Irwin, PharmD, during a presentation at the 2025 APhA Annual Meeting & Exposition in Nashville. Research has shown that there are several barriers to buprenorphine dispensing in community pharmacies, however.
What are some drivers of those barriers? According to Irwin, who is a professor at Oregon State University College of Pharmacy, these include stigma, patient burden, reclass, violation fears by pharmacists with controlled substances, and pharmacy burden, which can include low reimbursement rates, prior authorization requirements, and an inability to modify the prescription. Buprenorphine is a Schedule III drug, but it’s treated like a Schedule II opioid medication by distributors, which creates self-imposed “caps” on the amount of buprenorphine that can be distributed. ■