Rawal Smita, Welsh Justine W, Yarbrough Courtney R, Abraham Amanda J, Crawford Natalie D, Khail Jordan W, Chinchilla Ashley, Caballero Joshua, Villa Zapata Lorenzo, Young Henry N
J Am Pharm Assoc (2003). 2025 Mar-Apr;65(2):102319. doi: 10.1016/j.japh.2024.102319. Epub 2024 Dec 27.
Buprenorphine is an effective medication for treating opioid use disorder (OUD) and reducing opioid-related overdose deaths. Community pharmacies are key access points for buprenorphine, with pharmacists well-positioned to dispense and counsel patients on appropriate use. Recent evidence has identified pharmacists' growing engagement in buprenorphine services; yet, access to buprenorphine and related services in community pharmacies remains limited.
This systematic review aimed to investigate and synthesize evidence from existing literature on pharmacy-based buprenorphine programs for OUD, including stocking/dispensing patterns, and pharmacists' knowledge, attitudes, and barriers (KAB) to providing buprenorphine services.
Searches were performed across 4 databases: PubMed, Web of Science, CINAHL, and Google Scholar. Eligible articles included U.S.-based, peer-reviewed original research conducted between 2002 and 2024, focusing on pharmacy-based buprenorphine programs for OUD and community pharmacists' KAB related to buprenorphine. PRISMA guidelines were followed.
Search retrieved a total of 488 articles with 38 meeting the criteria for inclusion. Community pharmacy-based buprenorphine programs for OUD included physician-pharmacist collaborative care models, established dispensing agreements, and reinforced counseling. Buprenorphine stocking/availability varied across pharmacy types, with independent pharmacies less likely to stock and dispense the medication than chain pharmacies. Pharmacists appeared to exhibit limited knowledge and a cautious willingness to dispense buprenorphine. Barriers included concerns about perceived Drug Enforcement Administration (DEA) "caps"/investigations, wholesaler flags, diversion risks, inadequate knowledge, and insufficient communication with clinicians.
This study found that community pharmacist involvement in buprenorphine programs has the potential to improve access to OUD treatment. However, wider adoption of these initiatives requires rigorous evaluation through randomized controlled trials and longitudinal studies to demonstrate their effectiveness. Barriers, including perceived DEA investigations and wholesaler restrictions, may limit pharmacist engagement in providing buprenorphine. Policy reforms addressing these concerns are needed, alongside efforts to increase pharmacists' knowledge and foster better communication/collaboration between clinicians and pharmacists to enhance buprenorphine access and utilization.
丁丙诺啡是治疗阿片类物质使用障碍（OUD）和减少阿片类物质相关过量死亡的有效药物。社区药房是获取丁丙诺啡的关键途径，药剂师在配药和指导患者正确使用方面具有优势。最近的证据表明药剂师越来越多地参与丁丙诺啡服务；然而，社区药房中丁丙诺啡及相关服务的获取仍然有限。
本系统评价旨在调查和综合现有文献中关于基于药房的丁丙诺啡治疗OUD项目的证据，包括库存/配药模式，以及药剂师提供丁丙诺啡服务的知识、态度和障碍（KAB）。
在4个数据库中进行检索：PubMed、科学网、护理学与健康领域数据库（CINAHL）和谷歌学术。符合条件的文章包括2002年至2024年期间在美国进行的、经过同行评审的原创研究，重点是基于药房的丁丙诺啡治疗OUD项目以及社区药剂师与丁丙诺啡相关的KAB。遵循系统评价和Meta分析的首选报告项目（PRISMA）指南。
检索共获得488篇文章，其中38篇符合纳入标准。基于社区药房的丁丙诺啡治疗OUD项目包括医生 - 药剂师协作护理模式、既定的配药协议和强化咨询。丁丙诺啡的库存/可获得性因药房类型而异，独立药房比连锁药房更不可能储存和配药。药剂师似乎表现出有限的知识和谨慎的丁丙诺啡配药意愿。障碍包括对美国缉毒局（DEA）“上限”/调查的担忧、批发商标记、转移风险、知识不足以及与临床医生沟通不足。
本研究发现社区药剂师参与丁丙诺啡项目有可能改善OUD治疗的可及性。然而，这些举措的更广泛采用需要通过随机对照试验和纵向研究进行严格评估，以证明其有效性。包括感知到的DEA调查和批发商限制在内的障碍可能会限制药剂师参与提供丁丙诺啡。需要进行政策改革以解决这些问题，同时努力增加药剂师的知识，并促进临床医生和药剂师之间更好的沟通/协作，以提高丁丙诺啡的可及性和利用率。
