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Legislation in 2022 sought to expand access to the opioid use disorder treatment drug buprenorphine by eliminating previous caps on the number of patients a prescribing provider could manage and by eliminating prescriber waiver requirements. At the same time, pharmacists with prescribing authority were permitted to directly prescribe the medication without a collaborative agreement with a physician, although state-specific restrictive criteria could still apply. As a result of these changes, there was a significant increase in pharmacist-prescribed buprenorphine from 2019 to 2024, according to a recent Research Letter published in JAMA. The study examined the quarterly impact of the legislation on trends in pharmacist-prescribed buprenorphine. Prior to the legislation, the quarterly number of prescriptions written by pharmacists was increasing by 5.5 prescriptions per quarter (95% confidence interval [CI], 2.8 to 8.1;P < .001)—a fairly slow rate of increase. After implementation, there was an initial level increase of 80.9 pharmacist-prescribed buprenorphine prescriptions (95% CI, 35.0 to 126.9; P = .002). In other words, the number of prescriptions written by pharmacists immediately jumped by about 81 prescriptions in just 1 quarter. There was also a slope change of 72.1 prescriptions per quarter (95% CI, 63.6 to 80.5; P < .001)—which indicates that not only did the numbers increase initially (the level increase), but they also began climbing faster in each quarter afterward. Even so, the authors note that less than 1% of buprenorphine prescriptions are written by pharmacists, and buprenorphine remains an underutilized treatment modality for opioid use disorder.
More to consider: “A pharmacist may be effective in a straightforward test-and-treat scenario, but pharmacist training does not include collecting the patient history and conducting a physical exam to consider co-morbidities or complications that may affect treatment plans,” says Alan A. Ayers, MBA, MAcc, President of Urgent Care Consultants and Senior Editor of JUCM. “Addiction can often result from self-medication to mask underlying, undiagnosed medical issues, so it’s worth questioning whether this could lead to prescribing treatment without identifying and correcting the underlying causes.” Read more about buprenorphine from the JUCM archive: The X-Waiver is No More. What This Means For Urgent Care.