Only 57.9% of pharmacies in the U.S. stock buprenorphine, a prescription used for medication-assisted treatment (MAT).
That’s according to new research published in JAMA highlighting a potential access issue for patients in substance use disorder (SUD) treatment. The cross-sectional study was based on data from virtual MAT provider Bicycle Health and included responses from 5,283 unique pharmacies across 32 states about their supply of buprenorphine.
Buprenorphine is one of three FDA approved MAT options – often the go-to for outpatient use. In some cases, it’s combined with naloxone.
“What’s happening with patients on buprenorphine is that they are sometimes getting to pharmacies, and the pharmacies are saying we don’t have the medicine,” Dr. Scott Weiner, Bicycle Health’s director of research, told Behavioral Health Business. “And that’s literally a worst-case scenario. Because they’re going to go into withdrawal, and they’re going to want to start to use other opioids. It’s how people fall out of treatment.”
Researchers found a great deal of variation between states, and between chain and independent pharmacies. For example, 61.6% of chain pharmacies reported having buprenorphine availability, whereas 45.3% of independent pharmacies reported having the medication in stock.
Additionally, Bicycle found that only 37.1% of pharmacies in Florida had medication in stock, making it the state with the lowest availability of buprenorphine in the study. Washington state pharmacies were likely to have it in stock, with 83.9% reporting availability.
“If you’re in an area that doesn’t even have a lot of pharmacies and the pharmacy doesn’t carry it, you are truly in a treatment desert,” Weiner said. “The most concerning part of all that is that for many, many years, it was felt like the prescriber was the barrier. We didn’t have enough prescribers that had the X-waiver. And, of course, that went away at the beginning of the year, fortunately. But now we’re seeing an additional barrier where even when we want to prescribe it, patients aren’t able to get filled, which is just tragic in the face of an epidemic.”
The research doesn’t answer the question why there is a shortage of pharmacies carrying the medication. But Weiner said that, anecdotally, there are a number of potential reasons. One of the major issues is still stigma around MAT.
“There are also structural issues around the prescribing of buprenorphine, which are huge barriers for pharmacies to want to carry it,” Weiner said “The first is from the [Drug Enforcement Administration] DEA, which has a specific [program], called the suspicious orders report system, which pharmacies have to fill out if they prescribe over a certain quota of buprenorphine. So it’s a disincentive for them to even want to provide it.”
This research comes as the opioid epidemic continues to claim the lives of thousands across the country each year. Roughly 1.6 million people had an opioid use disorder (OUD) in the last year, according to the U.S. Department of Health and Human Services (HHS). Additionally, 70,630 million people died from a drug overdose in 2019.
“We’re trying to use this to share with policymakers. We hope that people will learn that, again, in the face of an epidemic that we need to reduce barriers to buprenorphine, for appropriate patients, as opposed to increasing barriers,” Weiner said. “And we also hope that pharmacies will take a look at their internal processes and figure out why this is.”
This research comes at a pivotal time for SUD providers. Earlier this year the DEA released proposed rules, which would cut back telehealth flexibilities rolled out during the public health emergency (PHE), essentially prohibiting virtual providers from prescribing MAT to a patient without an in-person visit within 30 days. However, in May, the DEA announced that it would temporarily extend COVID-19 era flexibilities through Nov. 11, 2023.
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