The Roles, Activities, and Opportunities of Clinical Pharmacists in a National Initiative to Improve Office-Based...

Implementing buprenorphine medication treatment for opioid use disorder (B-MOUD) in office-based, non-addiction specialty care settings is challenging. Clinical pharmacist practitioners (CPPs) can facilitate this care. The Veterans Health Administration's (VHA) Stepped Care for Opioid Use Disorder Train the Trainer Initiative (SCOUTT) implemented B-MOUD in primary care, mental health, and pain clinics across 37 VHA facilities. B-MOUD activities provided by CPPs within SCOUTT are not well known.

We sought to examine CPPs' roles, typical activities, and opportunities to provide B-MOUD.

We performed a cross-sectional survey of CPPs within SCOUTT facilities.

In March 2023, known CPPs in SCOUTT clinics were invited via email to participate in an online survey. We also emailed local SCOUTT leaders to forward the invitation to CPPs not initially invited. The anonymous survey gathered information on clinic settings, CPP roles in 25 B-MOUD related tasks (eg, patient intake, risk assessment, initiation), state licensure, and whether they had or desired controlled substance prescriptive authority for B-MOUD.

Twenty-two CPPs responded to the survey working in pain (40.9%), primary care (27.3%), mental health (22.7%), and primary care mental health integrated (22.7%) settings. Nearly all (95.5%) reported involvement in naloxone education and distribution and patient management after B-MOUD initiation. Additionally, 90.9% reviewed and interpreted urine drug test results, 90.9% conducted B-MOUD follow-up (assessing side effects or treatment outcomes) and 72.7% assisted in B-MOUD initiation. Most CPPs (95.5%) indicated they work in a team-based environment often acting as a medication expert, were prescribing B-MOUD (27.3%), or desired to do so (86.4%).

In the VHA's SCOUTT Initiative, CPPs play a significant role in leading and collaboratively facilitating B-MOUD. The VHA's SCOUTT approach to CPP management and B-MOUD prescribing efforts may be a model to emulate in other health systems to improve access to and management of B-MOUD care.