Clinical pharmacist practitioners prescribing of buprenorphine for opioid use disorder

Clinical Pharmacist Practitioners (CPPs) have a long history of collaborating with other prescribers for the provision of buprenorphine medication treatment for opioid use disorder (B-MOUD). In January 2023, with the removal of the DATA 2000 X-waiver process, CPPs were allowed to prescribe B-MOUD in states that allow CPP prescriptive authority of controlled substances. We sought to examine CPP prescribing patterns of B-MOUD in a large heath care system in 2023.

We conducted a retrospective cohort study of patients with opioid use disorder (OUD) who received B-MOUD care in 2023 within the Veterans Health Administration (VHA). B-MOUD was defined as a formulation of buprenorphine indicated for OUD. We characterized Veterans who were prescribed B-MOUD by CPPs and examined the characteristics of these prescriptions and the episodes of care (EOC).

In 2023, 22,863 Veterans received B-MOUD; 1090 (4.8 %) from a CPP. Veterans prescribed B-MOUD by CPPs were primarily 36-50 years old (n = 419, 38.4 %), male (n = 987, 90.6 %), white (n = 987, 90.6 %), non-Hispanic/Latino (n = 1043, 95.7 %), and in urban areas (n = 648, 59.4 %). 110 CPPs prescribed B-MOUD in 36 states representing 1.9 % of all B-MOUD prescribers in 2023. CPPs prescribed 5258 B-MOUD prescriptions, conducted 339 (2.7 %) initiations, were involved in 1162 (4.2 %) of all EOC throughout the year, and were the sole prescriber for 16.6 % of EOC. CPP-involved EOC had 86.9 % (n = 867) 90-day retention.

When they were able to, VHA CPPs were early adopters in prescribing B-MOUD. B-MOUD prescribing by CPPs is an emerging opportunity to further expand access to B-MOUD.