Andrew Terranova, a pharmacist and general manager at Genoa Healthcare in Providence, was optimistic when his pharmacy signed onto a study intended to create new pathways for opioid use disorder treatment.
Instead of starting at a doctor’s office or clinic, the study, led by researchers at Brown University and the University of Rhode Island, allowed patients to start and continue buprenorphine treatment through a “one-stop shop” approach at their local pharmacies.
The results, published last month in the New England Journal of Medicine, went far beyond Terranova’s expectations.
“I hoped [patients] would find our treatment and our time with them to be valuable,” Terranova said, “and the study blew my expectations away. I think we had much better outcomes than I could have imagined.”
The study started with 100 patients, and then divided the 58 who stayed with treatment for 30 days into two groups: one that started and continued buprenorphine treatment through the pharmacy, and another through the typical care setup.
Usually, patients seeking buprenorphine, a medication that helps to mitigate opioid withdrawal symptoms, must go through a doctor’s office or clinic to obtain a prescription. While buprenorphine can sometimes be dispensed on-site in these situations, a patient often must make another trip to their pharmacy.
Of the patients who accessed buprenorphine through a doctor or clinic, five patients, or 17% of the group, continued with the treatment. In the pharmacy group, those numbers soared to 25 patients, or 89%, who continued the course of buprenorphine.
Prior to the Brown/URI study, the pharmacy-based treatment plan “had not existed in the U.S., let alone in most parts of the world,” said lead study author Traci Green, co-director of Rhode Island Hospital’s Center of Biomedical Research Excellence on Opioids and Overdose and an adjunct professor at Brown’s Warren Alpert Medical School.
But the study’s findings suggest that there could be a significantly more effective way to dispense the medication, which helps to mitigate opioid withdrawal symptoms and poses less risks than other common opioid use disorder treatments, such as methadone.
While the study took place entirely in Genoa Healthcare locations in Rhode Island, Ocean State pharmacists didn’t always have the ability to start patients on buprenorphine treatment.
On a national basis, most states still need to overcome regulatory barriers to make the pharmacy-based model possible, Green said. The researchers identified 10 states that have the capability to set up similar programs in the short term, while others would likely need to update their laws.
A regulatory hurdle came down in late 2022, when President Joe Biden signed an omnibus bill that struck a strict waiver requirement on who can dispense buprenorphine, allowing Rhode Island to loosen its own restrictions.
But within pharmacies, compensation is a major issue. While a $2.2 million grant from the National Institutes of Health’s National Institute on Drug Abuse funded the pharmacists’ pay in the pilot program, pharmacies won’t have this financial support moving forward.
“The real limit, even to Rhode Island, is how do people get paid,” said Jeffrey Bratberg, a study co-author and clinical professor of pharmacy practice at URI’s College of Pharmacy. “The pharmacists get paid for dispensing the drugs, but all the other counseling, monitoring and testing were paid for by the grant. To do this in an ongoing way, everyone needs to get paid for their time and work.”
In a doctor’s office, where the provider is paid per visit, this process is less complicated.
Regulatory measures that recognize pharmacists as providers, such as nurse practitioners and physician’s assistants, would simplify this process, Bratberg said.
Green said that states can also look to fund the model through opioid settlement funds, which states have been directed to use toward community investment.
And while Rhode Island leads many states in the availability of opioid use disorder treatment, many roadblocks remain in place, Bratberg said, such as transportation barriers, a lack of trust in the health care system and social stigma.
For patients, making buprenorphine accessible through local pharmacies creates additional, closer options for obtaining the medication, Green said, in turn mitigating some transportation barriers. And, she noted, the regularity of a pharmacy setting can help to lessen anxieties stemming from social stigma.
“The geography is important for people, and that kind of trust that we were able to establish in training our study pharmacists,” Green said. “They were able to listen to the patients.”
And while the model is still in its early phases, Terranova said the study marks a major step forward in expanding treatment options.
“You come in, you meet with a pharmacist and come back for follow-up care at that same space,” Terranova said. “I think it really does speak to the ability to improve outcomes for substance use disorder.”