Buprenorphine Dispensing Barriers Among Community Pharmacies in Rural Kentucky

April 29, 2020

A recent study included interviews with pharmacists in rural Kentucky counties regarding pharmacy-level barriers to opioid use disorder treatment.

A recent study identified pharmacy-level barriers to treatment for opioid use disorder (OUD) in rural areas, indicating a need for policy changes regarding buprenorphine access and monitoring.1

The case study, published in the International Journal of Drug Policy, looked at buprenorphine dispensing practices in 12 rural Kentucky counties across 15 community pharmacies. The investigators aimed to determine whether dispensing patterns were influenced by features of the rural risk environment.1

Fourteen pharmacists operating 15 pharmacies in these counties participated in 1-on-1 semi-structured interviews. Investigators analyzed policy documents and administrative databases to explore the relationship among risk environment factors and dispensing practices.1

Related: Addressing the Opioid Crisis in 2020

According to the results, 12 of the 15 pharmacies in the Appalachian region of Kentucky reported limiting dispensing, either by refusing to serve new patients, limiting dispensing to known patients or prescribers, or refusing to dispense buprenorphine altogether.1

“Concerns about exceeding a ‘Drug Enforcement Administration (DEA) cap’ on opioid dispensing stifled dispensing,” the investigators wrote. The other factors that influenced dispensing were distrust of pharmaceutical companies and prescribers of opioid analgesics and a general stigma against individual who use drugs and/or against the medications to treat substance use disorder.1

Additionally, the investigators wrote in the study that, “A legacy of aggressive and fraudulent marketing of opioid analgesics (OAs) by pharmaceutical companies and physician OA overprescribing undermined pharmacist trust in buprenorphine and its prescribers.”1

Furthermore, because buprenorphine is classified as a controlled substance, it is subject to monitoring, which may contribute to pharmacies' reluctance to increase the amount they typically order, according to the findings.2

“Unfortunately, the wholesalers’ algorithms are proprietary, which means we don’t know the specifics as to what types of controlled substances may trigger an investigation,” April Young, PhD, lead study investigator, associate professor of epidemiology in the University of Kentucky College of Public Health and faculty member of UK’s Center on Drug and Alcohol Research, said in a press release.2 “Moving forward, we recommend that buprenorphine be removed from opioid monitoring systems, and if it must be tracked, it should be tracked separately.”

A pharmacist quoted in the study also noted, “You can have all the funding in the world to have all these programs to [prescribe] all of these medicines. If your pharmacies can’t physically get it [from the wholesalers], it ain’t doing no good,” according to the release.2

The investigators concluded that policy changes to increase dispensing must accompany initiatives aimed at increasing prescribing.1

References:

1. Young AM, Cooper HL, Cloud DH, et al. Buprenorphine dispensing in an epicenter of the US opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky. International Journal of Drug Policy. 2020. doi: 10.1016/j.drugpo.2020.102701.

2. New Study Reveals Pharmacy-level Barriers to Treatment for Opioid Use Disorder in Appalachian Kentucky. News Release. University of Kentucky; April 28, 2020. Accessed April 29, 2020. http://uknow.uky.edu/research/new-study-reveals-pharmacy-level-barriers-treatment-opioid-use-disorder-appalachian.