Diversion Concerns Among Pharmacists Impede Buprenorphine Dispensing

A majority of pharmacists in a US survey said they are willing and able to dispense buprenorphine promptly for patients with opioid use disorder but were concerned about the potential diversion, according to a study published in the Journal of the American Pharmacists Association.

“Increasing buprenorphine prescribing for opioid use disorder has been a major focus of US opioid response efforts,” wrote Lucas G Hill, PharmD, a clinical associate professor at the University of Texas at Austin College of Pharmacy, and coauthors. “However, concerns related to dispensing buprenorphine have been identified among pharmacists.”

The anonymous survey, conducted in the fall of 2021, included 281 pharmacists. Half of the pharmacists practiced in a chain pharmacy, and more than one-third in an independent pharmacy. Some 68.1% said they could usually or always promptly fill a prescription for buprenorphine.

According to the study, common policies for buprenorphine dispensing included checking the prescription drug monitoring program (71.3%), validating a prescriber’s X-waiver (44.9%), limiting prescription fills to those from local prescribers (37.4%), and prohibiting refills more than one day early (35.8%).

“Policies limiting buprenorphine access to local prescribers, local patients, and established patients varied by practice setting and were most common in independent pharmacies,” researchers reported.

Respondents indicated the biggest dispensing barriers were insurance prior authorization, difficulty reaching prescribers with questions, and diversion concerns, the study found. On the other hand, better communication and trust with prescribers, trust with patients, and pharmacist education were strong facilitators.

“Mitigating this hypersensitivity to diversion risk among pharmacists should be a focus of regulatory agencies and professional organizations,” researchers advised. “Efforts to address the unique concerns of independent pharmacists will also be essential to improve access.”

Reference:
Hill LG, Light AE, Green TC, Burn AL, Zadeh PS, Freeman PR. Perceptions, policies, and practices related to dispensing buprenorphine for opioid use disorder: a national survey of community-based pharmacists. J Am Pharm Assoc. Published online August 23, 2022. doi:10.1016/j.japh.2022.08.017