Lack of access to buprenorphine: Many explanations

Abstract

“Why doesn't my pharmacy carry buprenorphine?” Is a common complaint from both patients and prescribers. During last week's July 4 holiday, those of us who couldn't break away from the topic of substance use tried to answer this question via Twitter. As always, Lucas G. Hill, Pharm.D., had many answers, as did Ryan Marino, M.D. “Stigma, mythology, and downstream effects of civil litigation re: past opioid dispensing also factor into poor availability, with some pharmacies refusing to order buprenorphine and others being extremely cautious about patients with ‘red flags’ for diversion,” wrote Hill, director of the Pharmacy Addictions Research and Medicine program at the University of Texas at Austin. Marino, an emergency physician and the medical director of the Toxicology Addiction Medicine Bridge Clinic at University Hospitals in Cleveland, also had answers: “In large part due to manufactured obstacles put in place by the [Drug Enforcement Administration] DEA, only 60% of pharmacies in the U.S. carry/dispense buprenorphine, one of the two lifesaving treatments for opioid use disorder and currently the only one available by outpatient prescription.” Marino added that, in general, drug “shortages are a huge problem.” But in the case of buprenorphine, “this isn't even a shortage; this is policy designed to restrict the medication.” Another medication that is restricted by policy: methadone. “And all this is without mentioning that the other lifesaving medicine, methadone, is not available to be prescribed or even dispensed from pharmacies for treatment of addiction or withdrawal,” said Marino. “These policies are not only meritless and unscientific — they are killing people.” But what could really help fill the pharmacy shelves is more prescriptions. “The number one cause of poor availability is lack of demand,” said Hill. “Most pharmacists are willing to order, but don't keep every dose and formulation on the shelf proactively because they are so rarely dispensed.” The promise of eliminating the X‐waiver — more prescriptions — has not yet been realized.