A study in the New England Journal of Medicine showed that pharmacies can offer a safe and accessible treatment starting point for patients with opioid use disorder and keep them better engaged than usual care with a physician.
PROVIDENCE, R.I. [Brown University] - A study from researchers at Brown University, Rhode Island Hospital and the University of Rhode Island found that pharmacists - not just physicians at clinics and doctor's offices - can safely and effectively start patients with opioid use disorder on the lifesaving medication buprenorphine.
"With over 100,000 overdose deaths in 2022 and an opioid crisis impacting states across the country, improving access to buprenorphine is a critical and necessary next step," said Traci Green, lead study author and co-director of Rhode Island Hospital's Center of Biomedical Research Excellence on Opioids and Overdose, which was established in 2018 to research innovations to address the opioid epidemic.
"Dramatically increasing capacity to provide good, lifesaving treatment for people with opioid use disorder through pharmacies is an approach that could be ramped up today," said Green, who is also an adjunct professor at Brown University's Warren Alpert Medical School. "It's a game-changer."
The first-of-its-kind pilot study, published on Thursday, Jan. 12, in the New England Journal of Medicine, documents the experiences of 100 patients who started taking buprenorphine after visiting a specially trained pharmacist for their care. Once stabilized on the medication, 58 patients were randomly assigned to receive either continued care in the pharmacy or usual care in a clinic or physician's office.
After one month, the patients in the pharmacy care group showed dramatically higher rates of retention: 25 patients (89%) continued to receive treatment in the pharmacy compared to five (17%) in the usual care group.
"To have so many people in the pharmacy group continue on with their care was completely unexpected," Green said. "The results from this pilot study show how pharmacies can be an effective and viable pathway to treatment for opioid use disorder."
A third of patients in the study identified as Black, Indigenous or persons of color, and almost half were without a permanent residence.
"Considering overdose deaths are increasing the fastest among Black and Hispanic communities and over 1,500 Rhode Islanders are currently unhoused, pharmacy-based addiction care models could be a pathway to promote racial and economic equity in accessing addiction treatment," said study author Dr. Josiah D. Rich, a professor of medicine and epidemiology at Brown University.
"Treatment with medications can only work if it is available and accessible in the community," said Rich, who is also an attending physician at the Miriam and Rhode Island Hospitals. "Opioid use disorder is too often a lethal disease, and it kills by stigma and isolation. Widespread, equitable access to effective treatment is the answer. Our study showed that the pharmacy treatment model increases access, which benefits a diverse patient population and increases equity."
Buprenorphine is an opioid agonist/antagonist medication that has proven safe and effective in treating opioid withdrawal, Rich noted, and has been approved by the U.S. Food and Drug Administration to treat opioid use disorder.
Currently, patients with an opioid use disorder who are prescribed buprenorphine or naltrexone must see an approved physician or go to a U.S. Drug Enforcement Agency-approved opioid treatment facility for their care. Patients typically then have the medications dispensed at the clinic or go to the pharmacy to pick them up.
Regulatory hurdles have prevented widespread use of buprenorphine, the researchers noted; a 2019 national survey found that 80% of people with substance use disorder never receive any evidence-based medication treatment. Those who are prescribed treatment often face barriers such as long-distance travel to clinics, inconvenient clinic hours, time-consuming paperwork and bureaucracy, stigma and more.
"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, a study 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."
The study enabled pharmacists trained in the foundations of addiction treatment to instead be a convenient and community-located place for patients to go for care and access medication. At the "one-stop" community pharmacy visit, patients filled their prescriptions, obtained medication management and received follow-up care.
