Factors in rural community buprenorphine dispensing

Erin G Major; Courtenay Gilmore Wilson; Delesha M Carpenter; J Chase Harless; Grace Trull Marley; Bayla Ostrach

doi:10.1016/j.rcsop.2022.100204

Factors in rural community buprenorphine dispensing

Explor Res Clin Soc Pharm. 2022 Dec 26:9:100204. doi: 10.1016/j.rcsop.2022.100204. eCollection 2023 Mar.

Authors

Erin G Major¹, Courtenay Gilmore Wilson^{2

3}, Delesha M Carpenter³, J Chase Harless⁴, Grace Trull Marley³, Bayla Ostrach⁵

Affiliations

¹ Boston University School of Public Health, 715 Albany Street, Boston, MA 02118, USA.
² Charles George Veterans Affairs Medical Center, 110 Tunnel Road, Asheville, NC 28805, USA.
³ UNC Eshelman School of Pharmacy, 1 University Heights, Asheville, NC 28804, USA.
⁴ Eastern Tennessee State University, 1276 Gilbreath Drive, Johnson City, TN 37614, USA.
⁵ Boston University School of Medicine, 72 E Concord Street, Boston, MA, USA 02118.

Abstract

Background: There are pharmacy-related barriers to the dispensing of buprenorphine for the treatment of opioid use disorders. These include pharmacists' moral objections and mistrust of treatment regimens; the perception of a limit on the amount of buprenorphine able to be ordered and dispensed; stigma and concerns about diversion; and knowledge and communication gaps.

Objectives: To document pharmacy stakeholders' awareness and interpretation of regulatory policies that may impact rural community pharmacists' willingness and ability to dispense buprenorphine. To identify factors that affect rural community pharmacists' willingness and ability to dispense buprenorphine in Appalachian North Carolina.

Methods: Qualitative analysis and thematic coding of phone interviews with eight pharmacists from several rural North Carolina counties where local health departments recently began prescribing MOUD and four pharmacy industry stakeholders representing knowledge of wholesale distributors and pharmacy education.

Results: Three major themes were identified: stigma and misinformation, provider-prescriber communication, and perceived and actual regulatory constraints. A number of respondents indicated a desire to better understand MOUD treatment plans and displayed a misunderstanding of evidence-based treatment guidelines. Stakeholders indicated the importance of pharmacists establishing a relationship with prescribers and described pharmacist preference for dispensing buprenorphine to established patients over new or out-of-area patients. Pharmacist stakeholders and industry/education stakeholders expressed concern over a perceived DEA 'cap' for buprenorphine ordering.

Conclusions: This study provides insight on possible approaches to address rural pharmacy-related barriers patients may face when filling buprenorphine prescriptions. There is a demonstrated need for further pharmacist training on evidence-based practices for treating opioid use disorders and ordering limits, as well as a need for increased communication between prescribers and pharmacists.

Keywords: Buprenorphine; Buprenorphine dispensing; Dispensing cap; Medication-assisted treatment; Pharmacy; Rural.