Promise of pharmacist-led addiction care

Researchers from Brown University, Rhode Island Hospital, and the University of Rhode Island found that pharmacy-based opioid addiction care can dramatically improve medication adherence and health outcomes.  

The study, published in the New England Journal of Medicine in January, explored one question – if pharmacists could prescribe, monitor, and manage opioid use disorder (OUD) medication, would patient retention increase?  

Researchers took 100 participants suffering from OUD and connected them directly to participating pharmacists that could provide care without requiring them to see a physician first. Patients that were stabilized on the medication were then randomly assigned continued care in either a pharmacy setting or in a typical physician and specialty clinic setting.  

After one month of treatment, the pharmacy care group had an 89% retention rate compared to a 17% retention rate from the physician or specialty clinic care group.  

“To have so many people in the pharmacy group continue on with their care was completely unexpected,” said Traci Green, lead study researcher and co-director of Rhode Island Hospital’s Center on Biomedical Research Excellence on Opioids and Overdose. 

“The results from this pilot study show how pharmacies can be an effective and viable pathway to treatment for opioid use disorder.” 

Currently, patients seeking opioid use disorder medication must make an appointment with a provider or go to a speciality clinic. In most states for the past twenty years, only providers who have sought out an “X-waiver” are able to prescribe buprenorphine.  

In 2023, the Biden administration removed the X-waiver requirements with the intention of expanding access to OUD care, but studies show that doctors are still hesitant to treat opioid use disorder patients with buprenorphine and their hesitation might have more to do with the social and medical complications of the disorder than it ever had to do with federal regulation.  

Of the participants in the study, 44% were unhoused and 76% had no reliable transportation. Patients facing barriers to treatment – like driving far away or pushing through bureaucratic red tape – often choose not to seek treatment at all.  

“We have a serious treatment gap — we are missing 90% of the people with opioid use disorder who need and want treatment,” said Jeffrey Bratberg, study co-author and clinical professor of pharmacy practice at the University of Rhode Island College of Pharmacy. 

“Pharmacists are an underutilized partner in the health care workforce, especially the behavioral health care workforce. There is a pharmacy within 5 miles of where 95% of Americans live.” 

Currently 10 states allow pharmacists to prescribe controlled substances like buprenorphine, as long as they obtain a license from the Drug Enforcement Administration (DEA), so incorporating a pharmacy-approach to OUD treatment in those states is possible.  

What might be sustainable across the country is to leverage Collaborative Practice Agreements (CPA) that allow pharmacists to initiate and administer treatment in collaboration with a qualified treatment provider.   

“The MATPharm study really epitomizes the share-care experience. It creates an environment where providers and pharmacists work closely together to improve access to life-saving medication to Rhode Islanders at risk of overdose. Overall it benefits the healthcare system by decreasing physician workload, allowing for an increased patient capacity, and connecting our at-risk population to our medication experts and treatment on-demand to provide a  harm reduction, medication-first model,” said Seth Clark MD, of Lifespan Recovery Center at Rhode Island Hospital.