Community pharmacy-based buprenorphine programs and pharmacists' roles, knowledge, attitudes, and barriers to providing buprenorphine-related services: A systematic review

Abstract

Background: Buprenorphine is an effective medication for treating opioid use disorder (OUD) and reducing opioid-related overdose deaths. Community pharmacies are key access points for buprenorphine, with pharmacists well-positioned to dispense and counsel patients on appropriate use. Recent evidence has identified pharmacists' growing engagement in buprenorphine services; yet, access to buprenorphine and related services in community pharmacies remains limited.

Objectives: This systematic review aimed to investigate and synthesize evidence from existing literature on pharmacy-based buprenorphine programs for OUD, including stocking/dispensing patterns, and pharmacists' knowledge, attitudes, and barriers (KAB) to providing buprenorphine services.

Methods: Searches were performed across 4 databases: PubMed, Web of Science, CINAHL, and Google Scholar. Eligible articles included U.S.-based, peer-reviewed original research conducted between 2002 and 2024, focusing on pharmacy-based buprenorphine programs for OUD and community pharmacists' KAB related to buprenorphine. PRISMA guidelines were followed.

Results: Search retrieved a total of 488 articles with 38 meeting the criteria for inclusion. Community pharmacy-based buprenorphine programs for OUD included physician-pharmacist collaborative care models, established dispensing agreements, and reinforced counseling. Buprenorphine stocking/availability varied across pharmacy types, with independent pharmacies less likely to stock and dispense the medication than chain pharmacies. Pharmacists appeared to exhibit limited knowledge and a cautious willingness to dispense buprenorphine. Barriers included concerns about perceived Drug Enforcement Administration (DEA) "caps"/investigations, wholesaler flags, diversion risks, inadequate knowledge, and insufficient communication with clinicians.

Conclusion: This study found that community pharmacist involvement in buprenorphine programs has the potential to improve access to OUD treatment. However, wider adoption of these initiatives requires rigorous evaluation through randomized controlled trials and longitudinal studies to demonstrate their effectiveness. Barriers, including perceived DEA investigations and wholesaler restrictions, may limit pharmacist engagement in providing buprenorphine. Policy reforms addressing these concerns are needed, alongside efforts to increase pharmacists' knowledge and foster better communication/collaboration between clinicians and pharmacists to enhance buprenorphine access and utilization.