Your Role
Why Now?
Prescribers Perspective
Pharmacists are an essential part of the care team and are relied upon to dispense buprenorphine for patients.
- With the elimination of the Drug Enforcement Agency X-waiver, many new providers are authorized to prescribe buprenorphine.
- The Drug Enforcement Administration and the Department of Health and Human Services released a statement showing commitment to ensure safe and ready access to MOUD. 14
- Neither the Controlled Substance Act nor DEA regulations establish quantitative thresholds or limits on the amounts of MOUD that DEA registrant may order or dispense, nor do they require registrants to set such thresholds or limits. However, wholesaler distributors are still monitoring orders that may be considered suspicious and may contact you regarding such orders.
- The DEA administrator Anne Milgram announced a commitment to expanding access to MOUD to help those with substance use disorder in a statement that read:
“Medication-assisted treatment helps those who are fighting to overcome substance use disorder by sustaining recovery and preventing overdoses. At DEA, our goal is simple: we want medication-assisted treatment to be readily and safely available to anyone in the country who needs it.”
What do you think?
On average, how many buprenorphine prescriptions are dispensed in North Carolina per year? What is the correct number?| 100,000 | |
| 450,000 | |
| 650,000 | |
| 800,000 |
The Buprenorphine Bottleneck
Buprenorphine is becoming increasingly difficult to access. The combination of increased buprenorphine prescribing alongside wholesaler thresholds and stigma work together to produce a bottleneck that limits access. This creates a 'prescribing cliff' 16 where more prescribing does not result in more access to buprenorphine, if pharmacies cannot or do not dispense.
THE PATIENTS
Why Pharmacists?
Pharmacists play an important role in ensuring buprenorphine access in their communities.
Patients report having more positive, less stigmatizing experiences when all staff make them feel welcome at the pharmacy.
...at first, we had some trepidation about filling buprenorphine because not everybody else was doing it. Now we fill those scripts. I understand the need that's out there. And my staff knows a positive attitude goes a long way toward encouraging OUD patients to stay the course for treatment.
Rural community pharmacist in North Carolina
Create a Welcoming Patient Environment
- OUD, similar to diabetes and hypertension, is a chronic disease state that we treat with medications. We would not want to deny someone access to insulin for their diabetes; we also would not want to deny access to buprenorphine for OUD.
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Highlight the benefits of buprenorphine,
including but not limited to:- Increased retention in treatment 17
- Lowered risk of overdose death 18
- Reduction in infectious disease transmission like HIV and HCV 19
- Reduction in criminal behavior 20
- Increased likelihood of employment 21
- Share with your pharmacy staff why you personally support filling buprenorphine prescriptions for patients with OUD.
- Discuss how a positive, friendly experience at the pharmacy can encourage people with OUD to continue treatment.
But I think any pharmacist who sees somebody come in and is willing to pay hard-earned money in cash just to get this lifesaver, just give it to him, dude. Because no matter what he does with it, just the fact that somebody's willing to get Suboxone... as long as it’s getting out there in the streets and into the people and getting used. Because every time somebody uses Suboxone, that is another day that they're gonna live.OUD patient