Physician-Delegated Unobserved Induction with Buprenorphine in Pharmacies

Green, Traci C.; Serafinski, Rachel L.; Clark, Seth; Rich, Josiah D.; Bratberg, Jeffrey

doi:10.1056/nejmc2208055

Cited by 18 publications

(8 citation statements)

References 3 publications

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“…The literature search identified eight collaborative models with outcome data and one trial protocol published within the past 3 years (three within the past 12 months) [29 ▪▪ ,30 ▪▪ ,31 ▪▪ ,32 ▪ ,33 ▪▪ ,34,35 ▪▪ ,36,37 ▪ ], as well as a smaller number of collaborative models published before 2021 [38–41]. These earlier models are not discussed in detail in the following sections, but have been included to ensure an accurate overview of pharmacist responsibilities within collaborative models has been provided.…”

Section: Resultsmentioning

confidence: 99%

“…Outside these models of care, it is not typical practice for a pharmacist to initiate patients on these medications, to adjust doses, or change the number of allocated unsupervised doses (often called ‘carries’ or ‘takeaway doses’). In order to increase access to OAT, pharmacists have been trained to implement facilitated unobserved (“take-home”) induction of buprenorphine [29 ▪▪ ,30 ▪▪ ,31 ▪▪ ,32 ▪ ,41]. In the MATPharm study (Rhode Island, USA), a trained pharmacist was able to initiate the patient on buprenorphine via a collaborative practice agreement, meaning patients could present to a single location (pharmacy) for an initial assessment and start treatment the same day [31 ▪▪ ,44].…”

Section: Resultsmentioning

confidence: 99%

“…In the MATPharm study (Rhode Island, USA), a trained pharmacist was able to initiate the patient on buprenorphine via a collaborative practice agreement, meaning patients could present to a single location (pharmacy) for an initial assessment and start treatment the same day[31 …”

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confidence: 99%

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Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research

Cheetham,

Grist,

Nielsen

2024

Current Opinion in Psychiatry

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Purpose of review Collaborative models of care where pharmacists work alongside physicians have been developed for a range of physical health conditions, with benefits including improved patient outcomes and increased access to ongoing care. Opioid agonist treatment (methadone and buprenorphine) is a clinically effective and cost-effective treatment for opioid use disorder that is under-utilized in many countries due to a shortage of prescribers. In recent years, there has been increased interest in the development of collaborative models that utilize pharmacists to overcome barriers to treatment. In this article, we present a narrative review to synthesise recent work in this rapidly developing area. Recent findings Two key aspects of opioid agonist treatment were identified: Collaborative models have utilized pharmacists to facilitate buprenorphine induction, and collaborative models provide increased capacity for delivering ongoing care in a variety of settings and patient groups where prescriber access is limited. Pharmacists have undertaken direct patient care responsibilities with varying degrees of autonomy, with benefits including a reduction in prescriber workload, and improvements in treatment retention and continuity of care. Summary Collaborative models in which pharmacists are responsible for buprenorphine induction and ongoing management with methadone and buprenorphine have been shown to reduce demands on prescribers while improving or maintaining patient outcomes, and appear feasible and acceptable in a wide range of outpatient settings.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research

Cheetham,

Grist,

Nielsen

2024

Current Opinion in Psychiatry

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“…54,74 A 2021 to 2022 randomized trial in Rhode Island expanded on this finding by engaging community pharmacists in 6 chain behavioral health pharmacies to facilitate unobserved induction with buprenorphine in 100 patients and demonstrated superior retention at 1 month compared to usual care. 75 Community pharmacist administration of long-acting injectable naltrexone has also been described in pragmatic studies, and patient satisfaction with pharmacist administration of other long-acting injectable medications has been established. [76][77][78] Two significant barriers to scalable enhanced pharmacist services for MOUD are the lack of consistent insurer payment for such services and the need for a standardized pharmacist scope of practice and collaborative practice agreements.…”

Section: Pharmacy Opportunities and Barriersmentioning

confidence: 99%

“…The Opioid Overdose Crisis An estimated 5.6 million people in the United States (U.S.) over 12 years of age had opioid use disorder (OUD) in 2021. 1,2 Over 109 000 drug overdose deaths occurred in the U.S. from September 2021 through August 2022, 75.6% of which involved opioids. 3 The origins of the opioid overdose crisis began with morbidity and mortality related to prescription opioid analgesics and has since evolved into a public health crisis dominated by potent illicitly manufactured synthetic opioids such as fentanyl contributing to the majority of overdose deaths, only complicated further by the rise in concomitant stimulant use.…”

Section: Introductionmentioning

confidence: 99%

Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy

Jarrett,

Bratberg,

Burns

et al. 2023

Substance Abuse

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In the last decade, the U.S. opioid overdose crisis has magnified, particularly since the introduction of synthetic opioids, including fentanyl. Despite the benefits of medications for opioid use disorder (MOUD), only about a fifth of people with opioid use disorder (OUD) in the U.S. receive MOUD. The ubiquity of pharmacists, along with their extensive education and training, represents great potential for expansion of MOUD services, particularly in community pharmacies. The National Institute on Drug Abuse’s National Drug Abuse Treatment Clinical Trials Network (NIDA CTN) convened a working group to develop a research agenda to expand OUD treatment in the community pharmacy sector to support improved access to MOUD and patient outcomes. Identified settings for research include independent and chain pharmacies and co-located pharmacies within primary care settings. Specific topics for research included adaptation of pharmacy infrastructure for clinical service provision, strategies for interprofessional collaboration including health service models, drug policy and regulation, pharmacist education about OUD and OUD treatment, including didactic, experiential, and interprofessional curricula, and educational interventions to reduce stigma towards this patient population. Together, expanding these research areas can bring effective MOUD to where it is most needed.

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Interprofessional team‐based care in the community pharmacy setting: A summary of existing models and best practice recommendations

Irwin,

Marciniak,

Awad

et al. 2024

J Am Coll Clin Pharm

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Community pharmacies are rapidly becoming destinations for health services beyond medication dispensing. Delivery models for community‐based services have become increasingly complex, creating expanded opportunities and necessitating collaboration between pharmacists in the community setting and other health care professionals. As a result, it is essential to articulate best practices and recommendations to assist stakeholders in responding to the changing landscape and optimize care for patients. This white paper provides a summary of published examples of interprofessional practice that include community pharmacies in the United States and internationally, and then adapts established guiding principles for interprofessional practice to the community pharmacy setting to outline a framework and specific recommendations for consideration. This framework highlights a need to place patients at the center of collaborative community‐based care models, have organizational leaders show a commitment to and establish an infrastructure for interprofessional collaboration that includes community‐based pharmacists, foster respect for community pharmacy practice, address communication and technology barriers in the health care system, and finally, embrace interprofessional learning in the community pharmacy setting. Addressing challenges and embracing opportunities is vital to accelerate practice transformation and further position community‐based pharmacists as essential members of interprofessional care teams.

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Physician-Delegated Unobserved Induction with Buprenorphine in Pharmacies

Cited by 18 publications

References 3 publications

Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research

Pharmacist-prescriber collaborative models of care for opioid use disorder: an overview of recent research

Research Priorities for Expansion of Opioid Use Disorder Treatment in the Community Pharmacy

Interprofessional team‐based care in the community pharmacy setting: A summary of existing models and best practice recommendations

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