Increasing Buprenorphine Access in Rural North Carolina via Innovative Pharmacy-Focused Solutions

This session will present results from a four-part mixed methods study on the policy, organizational, interpersonal, and patient-level factors that impact buprenorphine access in rural community pharmacies in North Carolina. Through an expert review of Drug Enforcement Agency (DEA) policy, statewide surveys of pharmacists and prescribers, in-depth interviews with patients, providers, and other stakeholders, and a secret shopper study, presenters uncovered a complex interplay between DEA enforcement, state-level initiatives to increase the number of buprenorphine-waivered providers, pharmacy wholesaler ordering limits, lack of communication between pharmacists and prescribers, and stigma towards individuals with opioid use disorder (OUD) restricts buprenorphine access in rural North Carolina communities.

Because community pharmacists are both the most accessible healthcare provider and main dispenser of buprenorphine in rural areas, presenters will propose several potential solutions to overcome these multi-level barriers to increase access to OUD treatment. Specifically, they will highlight the development of a new online training module for community pharmacists called BUPE: Buprenorphine Understanding in the Pharmacy Environment. The BUPE module was co-developed with pharmacy stakeholders in three southeastern states and provides pharmacists with innovative solutions to overcome the barriers described above. For example, to address wholesaler buprenorphine ordering limits, example letters and phone scripts are provided that pharmacists can use to negotiate order limit increases. Also included is a sample dedicated buprenorphine dispensing contract between a health department and a community pharmacy, which has been effective at increasing buprenorphine access in two rural communities. The module also includes videos that model non-stigmatizing communication with patients.