Varisco Tyler J, Thornton Douglas, Hussain Taha, Fish Hannah, Bolin Joshua, Dadiomov David, Essien Ekere J, Wanat Matthew A, Ginsburg Diane, Waggener Jeanne, Bratberg Jeffrey P, DiPaula Bethany, Hill Lucas G
Pharmacy Addictions Research and Medicine Program, University of Texas at Austin College of Pharmacy, US.
Health Outcomes Division, University of Texas at Austin College of Pharmacy, US.
Drug Alcohol Depend Rep. 2025 Jul 10;16:100360. doi: 10.1016/j.dadr.2025.100360. eCollection 2025 Sep.
Less than one-in-four patients with opioid use disorder receive opioid agonist treatment. This is in part due to the fact that less than 60 % of pharmacies stock and dispense buprenorphine products for the treatment of opioid use disorder (OUD). Pharmacies do not stock for many reasons but wholesale distribution remains a major barrier to buprenorphine availability. The objective of this study was to create consensus recommendations to improve wholesale distribution of buprenorphine for the treatment OUD in community pharmacies.
This study involved a qualitative elicitation study, grounded in the theory of planned behavior, with seven-focus groups and 46 total pharmacists in Texas, California, and West Virginia. Results of the reflexive thematic analysis were used to create a vignette describing pharmacy-based barriers to buprenorphine supply. Non-legislative recommendations to improve buprenorphine purchase were created through a four-round Delphi study with 22 experts in psychiatry, pharmacy practice, drug distribution, and drug-policy and public comment review between June 2022 and September 2024.
The elicitation study demonstrated that distributor thresholds led to buprenorphine rationing, care interruptions, payer limitations, and fear of enforcement in community pharmacies. The expert panel recommended six, consensus actions that pharmacists, DEA and distributors could take to avoid further interruptions in buprenorphine availability.
DEA and distributors can act now, without congressional intervention, to ensure that the terms of the opioid injunctive relief agreement do not impede the ability of pharmacists to provide care to persons with OUD.
患有阿片类药物使用障碍的患者中，接受阿片类激动剂治疗的不到四分之一。部分原因在于，不到60%的药房储备并分发用于治疗阿片类药物使用障碍（OUD）的丁丙诺啡产品。药房不储备有多种原因，但批发分销仍然是丁丙诺啡供应的主要障碍。本研究的目的是制定共识性建议，以改善社区药房中用于治疗OUD的丁丙诺啡的批发分销。
本研究涉及一项基于计划行为理论的定性启发式研究，在得克萨斯州、加利福尼亚州和西弗吉尼亚州开展了7个焦点小组讨论，共有46名药剂师参与。反思性主题分析的结果用于创建一个描述基于药房的丁丙诺啡供应障碍的案例。通过与22名精神病学、药房实践、药品分销以及药物政策方面的专家进行四轮德尔菲研究，并在2022年6月至2024年9月期间进行公众意见审查，制定了改善丁丙诺啡采购的非立法性建议。
启发式研究表明，分销商门槛导致社区药房出现丁丙诺啡配给、护理中断、付款方限制以及对执法的担忧。专家小组建议药剂师、美国缉毒局（DEA）和分销商可以采取六项共识行动，以避免丁丙诺啡供应的进一步中断。
DEA和分销商现在可以采取行动，无需国会干预，以确保阿片类禁令救济协议的条款不会妨碍药剂师为患有OUD的人提供护理的能力。
