The opioid crisis had already existed prior to the COVID-19 pandemic. However, the social restrictions associated with the pandemic have contributed to an increase in illicit opioid use. While only those deemed “qualified providers” (i.e., nurse practitioners, physician assistants, clinical nurse specialists, certified registered nurse anesthetists, and certified nurse-midwives) are able to prescribe buprenorphine, pharmacists can still play a role in assisting patients with medications for opioid use disorder (MOUD).

In recent years, peer recovery coaches (PRCs; i.e., specially trained persons who bring lived experience of recovery to assist other in achieving and maintaining long-term recovery) have been increasingly utilized in the treatment process with much success.

However, health professionals often function in silos that serve as barriers to optimal patient care.

Researchers conducted a study involving individual semistructured interviews of prescribers, pharmacists, and PRCs to identify barriers, facilitators, and opportunities for improvement in Indiana community pharmacy MOUD care practice. Indiana has one of the highest rates of drug overdose deaths in the country.

The goal was to interview 10 healthcare professionals from each stakeholder group with representation from both urban and rural areas. Pharmacists were eligible for participation in the study if they had an active pharmacy license and practiced in a community pharmacy setting in Indiana. Prescribers were eligible for inclusion in the study if they had an active license and were DATA-waivered. PRCs were eligible for involvement if they self-identified as a PRC. Recruitment was performed through professional organizations involved in substance use disorder management. Participants were contacted from March 2021 to February 2022.

A unique interview guide was developed for each stakeholder group to address their views on their role in current MOUD-care practices; their experiences, including stigma at the prescriber’s office and the community pharmacy regarding MOUD; and how current MOUD-care practices could be improved from each discipline’s perspective. Study participants, which consisted of 10 PRCs, 10 pharmacists, and six prescribers, received a $45 gift card for their involvement.

Interviews were recorded and transcripts were coded using deductive and inductive codes. Deductive coding is a “top-down approach” in which the researcher starts with a set of predetermined codes and finds interview excerpts that fit those codes, whereas inductive coding is a “bottom-up approach” that starts with no codes and develops codes as the dataset is analyzed.

All three stakeholder groups identified stigma as a major barrier. PRCs reported that there are negative connotations associated with MOUD (i.e., MOUD is viewed as exchanging one addiction for another). Pharmacists, PRCs and prescribers felt that stigma is present in community pharmacies. Pharmacists often felt that patients on MOUD were “red flags” for improper opioid use. PRCs feel that prescribers fail to view MOUD as a long-term treatment and are eager to taper patients off these medications.

Among the practice model barriers that were identified by pharmacists were that there was a negative pharmacist/patient relationship, largely because technicians perform most of the direct contact with patients on MOUD. Prescribers felt that pharmacists had limited amount of time for patient care for patients on MOUD. Another practice model barrier identified by prescribers and pharmacists was lack of patient-specific information on MOUD available at community pharmacies.

Pharmacy-specific barriers identified by pharmacists included the need to balance patient care and legal considerations as pharmacies are only allowed to purchase a limited supply of buprenorphine by wholesalers and large purchases may result in a Drug Enforcement Agency investigation. Pharmacists also identified external factors, such as insurance and prior authorization policies as negatively affecting the level of patient care provided.

Facilitators of MOUD care practices reported by PRCs included proximity of the community pharmacy, cost/insurance coverage, friendly pharmacy staff, and convenient hours while prescribers cited a positive prescriber/pharmacist relationship as being beneficial.

Opportunities for improvement were also identified with the most common being proactive MOUD education from pharmacists according to PRCs. PRCs also felt that having community resource information available at the pharmacy; pharmacists providing direct referrals for OUD; willingness of pharmacy staff to navigate patient-specific issues; and pharmacy staff demonstrating concern, respect, and empathy would also be helpful. Pharmacists viewed expanding their understanding on MOUD as an opportunity for improvement as only 40% felt “confident” or “fairly confident” about their knowledge on MOUD. The American Academy of Psychiatric Pharmacists has a free toolkit on MOUD (https://aapp.org/guideline/oud). Other areas of improvement included educating pharmacy technicians to reduce stigma and establishing more formal partnerships and collaborations with prescribers.

As communities all across America are struggling with the opioid epidemic, this article provides pharmacists with insight on how to identify barriers and opportunities to promote optimization of MOUD in the community.

The content contained in this article is for informational purposes only. The content is not intended to be a substitute for professional advice. Reliance on any information provided in this article is solely at your own risk.

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