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Addressing wholesale distributor barriers to buprenorphine access: Consensus recommendations from the PhARM-OUD
Tyler J Varisco1,2, Douglas Thornton3,4, Taha Hussain3
1Pharmacy Addictions Research and Medicine Program, University of Texas at Austin College of Pharmacy, US.
Drug and Alcohol Dependence Reports
|July 29, 2025
Summary
Wholesale distribution barriers limit buprenorphine access for opioid use disorder (OUD) treatment. This study developed recommendations for pharmacists, distributors, and the DEA to improve buprenorphine availability in community pharmacies.
Area of Science:
- Pharmacy Practice
- Public Health
- Substance Use Disorder Treatment
Background:
- Opioid agonist treatment (OAT) is underutilized, with less than 25% of patients with opioid use disorder (OUD) receiving it.
- Less than 60% of pharmacies stock buprenorphine, a key medication for OUD treatment, hindering patient access.
- Wholesale distribution challenges significantly impede the availability of buprenorphine in community pharmacies.
Purpose of the Study:
- To develop consensus recommendations aimed at enhancing the wholesale distribution of buprenorphine for OUD treatment in community pharmacies.
- To address systemic barriers affecting buprenorphine supply and accessibility.
Main Methods:
- A qualitative elicitation study using seven focus groups with 46 pharmacists across Texas, California, and West Virginia, guided by the theory of planned behavior.
- Analysis of findings to create a vignette detailing pharmacy-based barriers to buprenorphine supply.
- A four-round Delphi study involving 22 experts in pharmacy, psychiatry, drug distribution, and policy to generate non-legislative recommendations.
Main Results:
- Distributor thresholds were identified as a cause of buprenorphine rationing, treatment interruptions, payer limitations, and fear of enforcement.
- Six consensus actions were recommended for pharmacists, the Drug Enforcement Administration (DEA), and distributors to prevent future buprenorphine supply disruptions.
- The study highlighted the need for immediate action to ensure consistent buprenorphine availability.
Conclusions:
- The DEA and distributors can implement changes without new legislation to improve buprenorphine distribution.
- Ensuring adequate buprenorphine supply is crucial for enabling pharmacists to provide essential care to individuals with OUD.
- Addressing wholesale distribution issues is a critical step in expanding access to evidence-based OUD treatment.
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