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pharmacies can be a barrier to battling opioid addiction
research shows that pharmacies are likely to decline to dispense a drug that helps curb cravings and ease withdrawal symptoms.
apr 27 2021
3 minute read
suboxone is used to treat dependence on opioid drugs.
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twenty per cent of u.s. pharmacies are blocking access to suboxone, researchers say, depriving customers of access to an indispensable tool in the struggle against opiate addiction.
the research, published in the journal drug and alcohol dependence , shines a light on an opiate epidemic that has only intensified in the shadow of covid-19. curious researchers called 921 pharmacies from around the u.s. last may and june to determine if they were dispensing suboxone — also known as buprenorphine — to patients during an extremely stressful time. the results were not encouraging.
“buprenorphine is a vital, lifesaving medication for people with opioid use disorder, but improving access has been a problem for a variety of reasons,” said daniel hartung , senior author of the study and a professor in the college of pharmacy at oregon state university. “although anecdotes and smaller studies have suggested problems, our study is the first to systematically characterize this barrier.”
buprenorphine is a long-acting opioid drug that helps prevent the cravings and withdrawal symptoms associated with opiate use disorder, according to the centre for addiction and mental health . the effects of the drug can last up to 36 hours and help restore normal brain function by acting on the same targets in the brain as opioids or heroin. when used in combination with medical care, buprenorphine is an effective tool for stemming and eventually reducing addiction. providing, of course, it can be obtained.
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“this study is the largest and most comprehensive pharmacy-focused assessment of buprenorphine availability to date and confirms that pharmacies can be a significant barrier to buprenorphine access nationwide,” researchers wrote.
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the study, which focused on the 473 u.s. counties with the highest rates of death from opioid-related overdoses, found that 183 of 921 pharmacies — just under one in five — made clear they would not fill prescriptions for buprenorphine. independent pharmacies and those in the southern u.s. were most likely to decline to dispense the drug — an action that can severely impact the efforts of patients to break their addiction.
“if i see a patient and they want to get started on buprenorphine, they’ve already gone through a lot of processing to make that behaviour change,” said ximena a. levander, co-author of the study and a clinical instructor at the oregon health & science university school of medicine. “any barrier can be very disruptive, especially when initiating treatment because they’re at high risk to return to use.”
there are a number of reasons why pharmacists may be hesitant to fill a prescription for buprenorphine, according to npr , including the risk of the drug not being used by its intended recipient. “we started seeing people (sell the drug) in our store in front of us,” said richard ost, the owner of an independent pharmacy in philadelphia. “once we saw that with a patient, we terminated them as a patient.
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“so, if we were having a lot of people in recovery coming out of our stores, the people who were dealing illicit drugs knew that, and they would be there to talk to them. and they would say, ‘well, i’ll give you this’ or ‘i’ll give you that’ or ‘i’ll buy your suboxone’ or ‘i’ll trade you for this.’”
turning patients away can have dire consequences, according to silvana mazella, the associate executive director at prevention point , a non-profit public health organization that provides harm reduction services to people in philadelphia. “we’re in a situation where if you are in withdrawal, you’re sick — you need to get well,” she said. “you want help today and you can’t get it through medication-assisted treatment. unfortunately, you will find it a block away — very quickly and very cheaply.”
with 70,000 people in the u.s. dying annually from opioid overdoses — and at least 15,393 in canada between january 2016 and december 2019 — pharmacists need to be a bigger part of the solution, according to neda kazerouni, the study’s lead author.
“pharmacists can have a role in reducing opioid use disorder by reducing stigma,” she said. “community pharmacists should be encouraged to work collaboratively with a patient’s provider to ensure there is continuity of care in all stages of treatment.”
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dave yasvinski is a writer with healthing.ca
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