Many Pharmacies Still Do Not Stock Buprenorphine Despite Eased Prescribing Rules

Faced pinch a worsening supplier crisis, policymakers successful caller years person made it overmuch easier for doctors to prescribe nan highly effective opioid addiction curen buprenorphine. However, galore patients whitethorn still struggle to find pharmacies carrying nan treatment, finds caller investigation led by nan USC Schaeffer Center for Health Policy & Economics.

Buprenorphine was disposable astatine conscionable 39% of U.S. unit pharmacies successful 2023, a humble summation from 33% successful 2017, according to nan study published Sept. 2 successful Health Affairs. But disparities successful who tin entree nan curen person persisted. Pharmacies successful predominantly Black neighborhoods (18%) and Latino neighborhoods (17%) stay importantly little apt to transportation buprenorphine arsenic those successful achromatic neighborhoods (46%).

Buprenorphine is 1 of respective medications that tin easiness opioid cravings and withdrawal, and it is nan only 1 that tin beryllium prescribed successful superior attraction settings and dispensed astatine unit pharmacies. Because these treatments are milder opioids and considered controlled substances, they historically person been taxable to tight prescribing and dispensing rules.

Recent efforts to easiness prescribing rules see nan 2023 elimination of nan alleged "X-waiver" that required doctors to person specialized training and registration to prescribe nan treatment. However, dispensing rates person changed little, suggesting that drugstore regulations aimed astatine preventing opioid (and buprenorphine) diversion, maltreatment and misuse proceed to discourage pharmacies from carrying nan treatment, peculiarly successful number neighborhoods and immoderate areas deed hardest by nan opioid epidemic.

Relaxing buprenorphine prescribing rules was an important measurement successful making this captious curen much accessible, but excessively galore patients deficiency a adjacent drugstore that carries it. Federal and authorities policymakers must trim barriers that make it difficult for pharmacies to banal buprenorphine, particularly successful immoderate of nan much susceptible communities."

Dima Mazen Qato, elder clever clever astatine nan Schaeffer Center and nan Hygeia Centennial Chair astatine nan USC Mann School of Pharmacy and Pharmaceutical Sciences

Limited entree successful immoderate hard-hit areas

Researchers analyzed buprenorphine claims from 2017 to 2023 from an IQVIA drugstore database from covering 93% of U.S. unit medicine claims. Among their cardinal findings:

• Although buprenorphine readiness accrued successful astir states, location were important declines successful 5 states (Florida, Ohio, Tennessee, Washington, Virginia) and Washington, DC.
• In astir each state, buprenorphine readiness was lowest successful Black aliases Latino neighborhoods. In immoderate states (California, Illinois and Pennsylvania), readiness successful these neighborhoods was astir 4 to 5 times little than successful achromatic neighborhoods.
• Independent pharmacies successful Black and Latino neighborhoods were importantly little apt to banal buprenorphine and were besides much apt to extremity carrying it complete time. But erstwhile these pharmacies did banal nan treatment, they persistently filled astir doubly arsenic galore prescriptions per period compared pinch different types of pharmacies.
• Pharmacies successful agrarian counties and those pinch precocious rates of opioid-related overdose deaths were persistently much apt to transportation buprenorphine. Yet successful 73 hard-hit agrarian counties, little than 25% of pharmacies carried nan medication, and different 25 counties lacked a pharmacy.

Areas pinch less dispensing barriers had amended access

Researchers said states should see easing tight controls connected buprenorphine dispensing, which tin restrict entree to nan curen successful respective ways.

When buprenorphine request rises, suppliers whitethorn hold aliases region shipments to pharmacies to debar scrutiny from nan Drug Enforcement Agency (DEA), and pharmacies often garbage to banal buprenorphine retired of interest nan orders will beryllium flagged to nan DEA. Some pharmacies transportation nan medicine but garbage to dispense it for fearfulness of moving afoul of nan national Controlled Substances Act and akin authorities drugstore regulations and laws, which require pharmacists to guarantee that prescriptions for controlled substances are valid.

The researchers recovered buprenorphine readiness was top successful states pinch nan slightest restrictive medicine supplier monitoring programs, including those that constricted really rule enforcement could entree nan physics databases to analyse suspicious prescribing.

The researchers said authorities and section governments should see requiring pharmacies to support buprenorphine stock, noting that immoderate person issued akin orders for nan overdose reversal curen naloxone and emergency contraception successful an effort to amended access.

"If policymakers neglect to present policies that summation equitable entree to buprenorphine astatine section pharmacies, existing group and taste disparities successful opioid usage upset curen and betterment will apt worsen," said first writer Jenny S. Guadamuz, an adjunct professor astatine nan University of California, Berkeley School of Public Health.