SUPPORT Act Empowers Pharmacists to Prescribe Buprenorphine

On the front lines of the opioid crisis, pharmacists are stepping into a new and consequential role by prescribing medications to aid in substance use disorder. A recent federal policy shift—the SUPPORT Act of 2025—is poised to transform how buprenorphine, a gold-standard treatment for opioid use disorder (OUD), is accessed in community and clinical settings across the country.

Historically, prescribing buprenorphine has been tightly regulated, largely confined to physicians and certain other prescribers who met specific federal requirements. Pharmacists, despite being among the most accessible health care professionals, were often relegated to dispensing rather than initiating this life-saving therapy. The Support Act of 2025 changes that, formally recognizing a federal pathway for pharmacists to prescribe buprenorphine—provided they obtain a Drug Enforcement Administration (DEA) registration and complete new training requirements.

Under the law, pharmacists who are new DEA registrants, as well as those renewing an existing registration, must complete 8 hours of education focused on substance use disorders. This mandate is intended to bolster clinical competence and ensure that those writing buprenorphine prescriptions are equipped to manage the complexities of OUD treatment, from induction and stabilization to ongoing follow-up.

Yet, as with many federal reforms, the promise of expanded access collides with the reality of state-level regulation. Even with a DEA license in hand and the federal green light, pharmacists may still be blocked by state scopes of practice that either restrict or do not explicitly authorize buprenorphine prescribing. Some federal pharmacists—such as those practicing in the VA and licensed in states like Idaho or California—may be able to move more quickly, leveraging more permissive state laws to put the new authority into practice.

Alisha Nicks West, PharmD, BCPP, clinical staff pharmacist at the Menninger Clinic, explores how pharmacists can navigate these overlapping federal and state requirements, what training and infrastructure are needed, and how a growing array of buprenorphine formulations—from sublingual tablets and films to long-acting injectables—can be matched to patient needs and preferences while remaining affordable and accessible.

“There are the traditional oral options, such as the sublingual film and the sublingual tablets,” she said. “If it's not broke, I say don't fix it if the patient's doing well on it, but it's definitely important to make patients aware of these options, such as the long-acting injectables and the buccal forms.”