By: Geraldine Ciaccio, PharmD Candidate c/o 2025
The role of pharmacists in public health has been expanding in recent years. The list of pharmacists’ responsibilities continues to grow with the treatment of the opioid crisis in the United States. In the past year, pharmacists newly received the authority to dispense naloxone under a standing order. Similarly, a study conducted this past January showed pharmacists could effectively start patients on buprenorphine.1 Improving access to lifesaving medications for patients with opioid-use disorder is necessary to combat the ongoing opioid crisis.
Researchers from Brown University, Rhode Island Hospital, and the University of Rhode Island collaborated on a first-of-its-kind feasibility pilot study. Published by the New England Journal of Medicine, this pilot trial was a part of a phase 3 randomized control trial that evaluated pharmacy-based treatment of addiction.1 The overarching goal of both studies was to increase the accessibility of first-line opioid disorder medications, such as buprenorphine. Pharmacists are viewed as the most accessible healthcare professionals, especially community pharmacists. Jeffrey Bratberg, a clinical pharmacy practice professor at the University of Rhode Island and investigator in the study, described pharmacists as underutilized, stating “there is a pharmacy within five miles of where 95% of Americans live.” 2 Considering the convenience of pharmacies for most Americans, the researchers decided to test the efficacy of opioid use disorder treatment when treated with pharmacy-based care.
The study was conducted from February 2021 to April 2022 in Rhode Island and involved six behavioral health pharmacies, 21 pharmacists, and 100 patients. Of these 100 patients, 34 were people of color, 44 were homeless, and 76 had no reliable transportation.1 The pharmacists received training in buprenorphine treatment from the American Society of Addiction Medicine, which is required for prescribers of buprenorphine.3 Inclusion criteria for patients included a history of an opioid-use disorder, interest in being treated with buprenorphine, and aged 18 years and older. Patients received 1:1 care and follow-up, either with a pharmacist or a provider, for three months. Pharmacists were instructed to assess the patients’ opioid use history and withdrawal symptoms using the Clinical Opiate Withdrawal Scale. After reviewing patient information, the pharmacist recommended a buprenorphine regimen, consulted an addiction medicine physician, and initiated the treatment plan. Initial buprenorphine regimens varied between patients and lasted for three to seven days. 1 participant received 4 mg per day, 6 received 8 mg per day, 82 received 16 mg per day, 1 received 20 mg per day, and 10 participants received 24 mg per day. After the initial doses, 30 participants received weekly doses, 10 participants received doses every two weeks, and 18 participants received a combination of weekly and biweekly doses. All participants were also offered naloxone, but only 36 chose to accept.1
The outcome of interest in this study was treatment retention after one month. Out of 100 participants, 58 progressed to maintenance care. Randomization assigned 28 patients to be given pharmacy-based care, which served as the experimental group, and 30 to be given provider care, which served as the standard group. After one month of treatment, 25 patients (89%) receiving pharmacy-based care kept up with attending follow-up visits, versus only 5 patients (17%) in the standard care group did so.1 Pharmacy-based care proved to have higher patient outcomes and satisfaction. A clinical pharmacist who participated in the study, Linda Rowe-Varone, shared one of her patient experiences while providing buprenorphine. The patient told her that the pharmacy hours and location were more convenient than the clinic she had previously used. She also felt more comfortable attending the pharmacy for her appointments and bringing her children along.4 The pharmacy environment and convenient location remove the stigma of going to a clinic or doctor’s office, which typically can discourage patients from following up on their health conditions.
The researchers who conducted this study described their passion for making medications accessible to everyone regardless of socioeconomic status. Dr. Josiah D. Rich at Brown University School of Medicine explained that opioid use disorder “kills by stigma and isolation” and the study showed that “a diverse patient population could benefit from treatments offered in a community pharmacy.”2 In December of 2022, President Joe Biden signed the Mainstreaming Addiction Treatment (MAT) Act, which aims to make buprenorphine more readily accessible to patients suffering from opioid use disorder.5 This also abolishes the X waiver, which was previously required for providers to have to prescribe buprenorphine.2 Due to these recent changes in legislation, the researchers are hopeful of expanding the pharmacist’s role in no time.
References
- Green TC, Serafinski R, Clark SA, Rich JD, Bratberg J. Physician-Delegated Unobserved Induction with Buprenorphine in Pharmacies. N Engl J Med. 2023;388(2):185-186. doi:10.1056/NEJMc2208055.
- Luce P. Study shows pharmacists can safely, effectively start treatment for patients with opioid use disorder. URI News. Published January 12, 2023. https://www.uri.edu/news/2023/01/study-shows-pharmacists-can-safely-effectively-start-treatment-for-patients-with-opioid-use-disorder/.
- Green TC, Serafinski R, Clark SA, Rich JD, Bratberg J. Physician-Delegated Unobserved Induction with Buprenorphine in Pharmacies Supplementary Appendix. N Engl J Med. 2023;388(2):185-186. doi:10.1056/NEJMc2208055.
- Pikul C. Pharmacists can start patients on road to recovery from opioid use disorder, study shows. Brown University. Published January 11, 2023. https://www.brown.edu/news/2023-01-11/pharmacy-addiction-treatment.
- Doyle S, Baaklini V. President Signs Bipartisan Measure to Improve Addiction Treatment. The Pew Charitable Trusts. Published December 30, 2022. https://www.pewtrusts.org/en/research-and-analysis/articles/2022/12/30/president-signs-bipartisan-measure-to-improve-addiction-treatment.
