The evidence base for medication treatments for opioid use disorder continues to grow, with more progress being made against stigmatizing attitudes toward use of evidence-based buprenorphine and methadone. In order for the substance use treatment field to maximize these treatments’ potential, more work needs to be done to overcome the remaining barriers to high-quality care.
A study published in August in JAMA Network Open illustrates what can happen when important advances in treatment collide with traditional views. Based on a survey of patients enrolled in a telemedicine practice covering five states, the study reported that one-third of patients had to go without prescribed buprenorphine because of problems filling a prescription at their pharmacy. Among those who reported this problem, 1 in 4 said the situation forced them to be without their medication for at least a full week.
The most frequently cited reason for the difficulty in getting a prescription filled was a shortage of the medication in the pharmacy’s stock. Many pharmacies simply weren’t carrying enough of the drug to meet the demand in their community. Some of this results from the scrutiny pharmacies receive from regulators over supplies of the highly regulated medication.
But stigma remains a barrier as well. Pharmacist hesitancy to fill a buprenorphine prescription was listed in the survey as the third most common reason for difficulty in receiving the medication. Stock shortages and insurance barriers were cited most often. Many pharmacists remain uncomfortable working with patients who are being treated for a substance use disorder. Because of this, education targeting pharmacists was listed as one of the chief recommendations from the study’s authors.
The patients in this survey were enrolled in an innovative telehealth program for treatment of substance use disorders. The stigmatizing experiences at the pharmacy are all the more disappointing given the research evidence for telehealth as a facilitator of high-quality care for opioid use disorder.
It has been known for years that telehealth is an effective vehicle for initiating buprenorphine treatment. A JAMA Network Open study published in 2023, based on two states’ Medicaid data from 2019-2020, found that patients whose medication treatment was initiated through telehealth actually had better odds of staying in treatment for the next three months than those whose treatment had begun with an in-person consultation.
The only downside to the 2023 study’s findings was that telehealth care did not appear to be as accessible to some subpopulations in the studied states, including Black individuals and persons with a past history of overdose.
Great strides have been made to improve patient access to the opioid use disorder treatments that are most supported by research. But more work remains. The provider community should continue to advocate best practice both within their own programs and across the industry. This will help to ensure that all the potential benefits of telehealth and other advances in technology are realized.
