Ostrach Bayla, Potter Rachel, Wilson Courtenay Gilmore, Carpenter Delesha
J Am Pharm Assoc (2003). 2022 Mar-Apr;62(2):588-597.e2. doi: 10.1016/j.japh.2021.10.002. Epub 2021 Oct 8.
Opioid-related drug overdoses have been rapidly increasing in the United States, especially in rural Southern and Appalachian regions. The use of buprenorphine-containing medications to treat opioid use disorder (OUD) is an evidence-based approach proven to reduce overdose death risks. Access to such treatment is uneven, with less access in parts of the United States where overdose rates are higher. Pharmacy dispensing of buprenorphine is a key component of access, yet barriers related to perceived and actual regulatory constraints, training gaps, stigma, and challenges to prescriber-pharmacist communication limit dispensing of this life-saving medication.
The objectives of this study were to explore the experiences of rural patients with OUD filling prescriptions for buprenorphine-containing medications at community pharmacies.
Rural community pharmacies, both commercial chain and independent, in 2 rural South-Central Appalachian counties where the local health departments prescribe buprenorphine-containing medications.
The local county health departments each entered into dedicated dispensing arrangements with a local independent community pharmacy to ensure a stable supply of medication for their patients with OUD who were prescribed buprenorphine.
Qualitative interviews (n =16) with patients prescribed buprenorphine from their county health department; county health department staff, local harm reduction program staff, and harm reduction program participants prescribed buprenorphine. Transcripts were analyzed using thematic analysis.
Participants reported problems with buprenorphine dispensing at rural community pharmacies, dispensing delays that resulted in experiencing withdrawal symptoms and hesitation to continue in treatment, high medication costs, and stigmatizing treatment by some pharmacists. Participants also reported that access improved after dedicated dispensing arrangements began.
Agreements between prescribing health departments and community pharmacies could increase access to buprenorphine, especially in rural areas.
在美国，与阿片类药物相关的药物过量使用情况一直在迅速增加，尤其是在南部农村和阿巴拉契亚地区。使用含丁丙诺啡的药物治疗阿片类药物使用障碍（OUD）是一种经证实可降低过量用药死亡风险的循证方法。获得这种治疗的机会并不均等，在美国一些过量用药率较高的地区，获得治疗的机会较少。丁丙诺啡的药房配药是获得治疗的关键组成部分，但与感知到的和实际的监管限制、培训差距、耻辱感以及处方医生与药剂师沟通方面的挑战相关的障碍限制了这种救命药物的配药。
本研究的目的是探讨农村阿片类药物使用障碍患者在社区药房开具含丁丙诺啡药物处方的经历。
位于阿巴拉契亚中南部两个农村县的农村社区药房，包括商业连锁药房和独立药房，当地卫生部门在这些药房开具含丁丙诺啡的药物。
当地县卫生部门分别与当地一家独立社区药房达成专门的配药安排，以确保为开具丁丙诺啡处方的阿片类药物使用障碍患者稳定供应药物。
对从县卫生部门开具丁丙诺啡处方的患者进行定性访谈（n = 16）；县卫生部门工作人员、当地减少伤害项目工作人员以及开具丁丙诺啡处方的减少伤害项目参与者。使用主题分析法对访谈记录进行分析。
参与者报告了农村社区药房在丁丙诺啡配药方面存在问题，配药延迟导致出现戒断症状以及对继续治疗犹豫不决、药物成本高昂，并且一些药剂师对治疗存在污名化现象。参与者还报告说，专门的配药安排开始后，获得治疗的机会有所改善。
开处方的卫生部门与社区药房之间的协议可以增加获得丁丙诺啡的机会，尤其是在农村地区。
