Success of medication-assisted drug treatment will rest on providers and pharmacists working together, advocates say

Pharmacists will play a maor role in medication-assisted treatment.
(Photo by Tbel Abusezine, Unsplash)

The federal government has opened the door to addiction treatment wider by removing a requirement that providers be trained and apply for a waiver from the Drug Enforcement Administration to prescribe buprenorphine, "a primary drug used to treat opioid-use disorder," reports Taylor Sisk of The Daily Yonder. "Now, those providers with a current DEA registration that includes Schedule III authority can prescribe it." But that's just the start of a new day in drug treatment.

Dr. Blake Fagan, director of opioid-treatment services for the Mountain Area Health Education Center's family health centers in western North Carolina, is "a longtime advocate for the lifting of the X-waiver," as it was called. "Fagan said that while there have been some 130,000 providers across the country authorized to prescribe buprenorphine, there will now be more than 1.8 million. . . . Dr. Bayla Ostrach, a medical anthropologist with Fruit of Labor Action Research and Technical Assistance in the region, told Sisk: "We know that [buprenorphine is] evidence-based; we know that it's more important than ever with fentanyl and xylazine in the drug supply. We want more buprenorphine prescriptions."

The federal change, made in an omnibus bill late last year, is only one part of helping rural areas address the opioid epidemic. "Ostrach, Fagan, and others who know rural health care and addiction treatment well stress that a lot of education will be required," Sisk writes. "In a recent paper for the Journal of the American Pharmacists Association, Ostrach and their colleagues write that "If prescribing increases but is not matched by increased dispensing, bottlenecks may worsen. Any worsening of buprenorphine bottlenecks could have a disproportionate impact in rural areas where residents may rely on fewer pharmacies to fill prescriptions." Sisk notes, Resistance among pharmacists is a widespread issue. Research Ostrach and their colleagues conducted found that 62%of community pharmacists surveyed had refused to fill a buprenorphine prescription."

Countering phamacists' resistance is part of tackling addiction's stigma. The more opioid addiction and treatment are understood and treatment protocols accepted, the more the medical community can approach it as any other mental/physical disorder. "Ostrach said North Carolina’s pharmacist association has been proactive in providing guidance on the specifics of the act, and that it does appear recent pharmacy school graduates are more willing than their predecessors to dispense buprenorphine," Sisk reports. Fagan told Sisk: “You have to give people time to ask their questions. . . . You have to let them say all those things, get it out, and then tell them the real deal. Tell them stories about people in rural areas who have actually stabilized their lives, or they’ve gotten their kids back from foster care.”

Dr. Travis Williams is a young practitioner advocating for medication-assisted treatment in rural areas. "He’s building collaborative relationships with a peer recovery support specialist and a prevention specialist. He’s working to bring more pharmacies on board," Sisk reports. "It’s about building an addiction prevention ecosystem, Williams stressed. . . . Facilitating medication in treatment is a critical step on the path to building that ecosystem."