Increasing Buprenorphine and Naloxone Access in Texas Community Pharmacies Through an Academic Detailing Intervention

Patients with opioid use disorder need prompt buprenorphine/naloxone (BUP/NX) and naloxone nasal spray (NNS) access from pharmacies, but audit studies report substantial availability deficits. No specific intervention has increased BUP/NX stocking, and little is known about the impact of transitioning specific NNS formulations to over-the-counter. The purpose of this study was to assess the impact of mailed academic detailing on BUP/NX availability and the ability to obtain NNS without a prescription.

A prospective interventional study was conducted in a sample of 1000 Texas community pharmacies assigned 1:1 to intervention and control groups. The intervention group received academic detailing handouts with links to continuing education addressing BUP/NX and NNS. Pre- and post-intervention audits were conducted using a telephonic secret-shopper approach. Outcomes for BUP/NX included stocking, willingness to order if not stocked, and a composite outcome of stocking and willingness to order. NNS outcomes included availability without a prescription. McNemar and Wilcoxon signed-rank tests, and generalized estimating equations (GEE) were used for analyses.

Data from 757 pharmacies were included in analyses (374 intervention, 383 control). Baseline BUP/NX stocking was low (36.7%) with no statistically significant pre-to-post changes for either group. Most pharmacies were willing to order (60.5%) with no significant pre-to-post changes for either group. GEE analysis found no significant difference in odds of stocking between groups (aOR = 1.08, P = .73), but the intervention group had a significantly higher likelihood to order (aOR = 2.25, P = .02) and of achieving the composite outcome (aOR = 2.17, P = .01). NNS availability increased in both groups but did not differ significantly between groups (aOR = 1.00, P = .99).

A mailed academic detailing intervention did not change NNS availability or BUP/NX stocking but did modestly increase willingness to order BUP/NX. This intervention is easily replicable and scalable, but modifications to increase the magnitude of its effect are needed.