Parth Patel, PharmD
Even after passage of the Mainstreaming Addiction Treatment (MAT) Act in late 2023, patients still face difficulty gaining access to buprenorphine—the gold standard for treating patients with OUD.
The MAT Act eliminated the need for prescribers to register and fill out the X-waiver, which served as a system to control the number of providers who could prescribe buprenorphine.
Currently, 10 states allow pharmacists to prescribe controlled substances. Upon passage of the MAT Act, pharmacists in these states have the ability to prescribe buprenorphine to patients with OUD depending on CPAs and the pharmacist’s practice setting within their respective state. With the X-waiver requirement removed, all physicians will be able to prescribe buprenorphine, but other health care providers who don’t have full prescriber status can only prescribe if their state allows it. For pharmacists, this only affects those in the 10 states that allow them to prescribe buprenorphine.
While the passage of the MAT Act has efficiently eliminated one barrier affecting patients’ ability to gain access to buprenorphine, there is no evidence that more patients are being treated with the medication.
During a November 2023 APhA Pulse on Practice Presentation, Josh Bolin, associate executive director of government affairs and innovation at the National Association of Boards of Pharmacy (NABP), stated that one of the main reasons for not seeing an increase in buprenorphine prescribing from all health care providers, including pharmacists, is due to a “lack of awareness and stigma.”
Bolin said that providers are focused on taking care of patients and may not be aware of the changes in federal legislation that would allow them to prescribe this FDA-approved medication.
Stigma
Stigma associated with seeking treatment and caring for patients who have OUD is a limiting factor, and resources must be created to help prescribers feel confident in helping patients suffering from OUD, noted speakers during the Pulse on Practice presentation.
Elizabeth Connolly, assistant director of the Public Health Office of National Drug Control Policy, said that one way to fight the stigma associated with OUD is to “continue to push education and understanding...that buprenorphine is safe.”
Bolin responded that NABP and APhA are collaborating with various colleges of pharmacy to create a multiperspective consensus-based practice guideline that pharmacists can use as a resource to help guide their decisions in the treatment of OUD.
Bolin said the creation of this resource could help pharmacists confidently make decisions for their patients who would benefit from buprenorphine and other FDA-approved medications for OUD treatment. Methadone and naltrexone are also FDA-approved for this purpose.
Barriers at the pharmacy
Stigma and prescribing hesitancy are not the only barriers patients are currently facing when trying to obtain buprenorphine, however. Patients are going to pharmacies with valid prescriptions, but due to limits on how much buprenorphine is being supplied to pharmacies, they are still unable to obtain their prescriptions.
When asked why patients who are prescribed buprenorphine are still having issues getting access to medications at the pharmacy counter, Matthew Strait, deputy assistant administrator at DEA’s Office of Diversion Control Regulatory, said that the issue is complex because drug distributors set the amount of medications they send to pharmacies, and the only requirement from DEA is that each distributor has a system in place to report suspicious activity.
Despite the expected increase in buprenorphine shipping, many drug distributors seem to be apprehensive about increasing the amount of stock they send to pharmacies because of worries about the increase in supply appearing suspicious to DEA.
Strait said that DEA is trying to address these concerns so that pharmacies can get larger supplies and provide the medications to patients who are coming in with valid prescriptions.
Connolly said that the White House has put in place several programs to help end the opioid epidemic, including creating more drug-free community coalitions, increasing access to opioid reversal agents, and expanding access to buprenorphine and methadone. ■