Abstract
This cross-sectional study assesses the availability of buprenorphine for opioid use disorder treatment at local pharmacies in the US by state and retail pharmacy chain.
Introduction
Deaths from opioid-related overdose have remained at epidemic levels for more than a decade without a clear solution in reach. Buprenorphine is a US Food and Drug Administration–approved medication for opioid use disorder (OUD) that can be prescribed in an outpatient setting, including telehealth, and dispensed at retail pharmacies.1 Despite this, there are some reports that patients may encounter barriers in filling this medication at their local pharmacy.2
In this cross-sectional study, we analyzed data from a telehealth OUD treatment provider group currently operating in 32 states to assess the extent of buprenorphine availability at local pharmacies. We also sought to identify states and specific pharmacy chains where patients with OUD might have difficulty filling buprenorphine prescriptions.
Methods
This study was deemed exempt from review, with a waiver of informed consent, by WCG IRB because it was not human participant research. The study followed the STROBE reporting guideline. We performed a retrospective analysis of an internally maintained administrative log of pharmacy calls between January 1 and December 31, 2022. Patients who were newly enrolled in the telehealth program were asked their preferred pharmacy by clinical support staff, who then used a standardized script (eMethods in Supplement 1) in which that pharmacy’s staff was asked about the current availability of different strengths and forms (tablet or film) of buprenorphine/naloxone at their store. For analysis, this was operationalized to a binary yes or no if at least 1 formulation was available. Because staff do not routinely call back pharmacies that previously reported no stock, to reduce bias, only the first call in 2022 was included and no pharmacy that was called in 2021 was included. Pharmacy names, addresses, and chain vs independent classification were based on the National Council for Prescription Drug Programs database. States with more than 100 calls and pharmacy chains in the 5 states with the most pharmacies called were reported separately. Data were analyzed with JMP, version 16. Two-sided P < .05 was considered significant.
Results
There were 5283 unique pharmacies called on behalf of 3779 patients, of which 3058 (57.9%) reported stock. Table 1 shows availability by state and subdivided into chain and independent pharmacy types. Chains were more likely to report stock compared with independent pharmacies (2631 of 4270 [61.6%] vs 415 of 917 [45.3%]; P < .001), and there was variation between states, ranging from 37.1% (281 of 757; Florida) to 83.9% (146 of 174; Washington). Table 2 shows stock by pharmacy brand and in selected states, with rates ranging from 31.2% (57 of 183; Publix) to 82.5% (33 of 40; H-E-B).
Table 1. Availability of Buprenorphine at Retail Pharmacies by State and Pharmacy Type, 2022.
| State | Pharmacies reporting stock, No./total No. called (%) | P valuea | ||
|---|---|---|---|---|
| Overall | Chain | Independent | ||
| Overall | 3058/5283 (57.9) | 2631/4270 (61.6) | 415/917 (45.3) | <.001 |
| Florida | 281/757 (37.1) | 228/602 (37.9) | 50/136 (36.8) | .81 |
| California | 330/705 (46.8) | 283/567 (49.9) | 45/126 (35.7) | .004 |
| Michigan | 283/536 (52.8) | 222/420 (52.9) | 59/105 (56.2) | .54 |
| Texas | 351/524 (67.0) | 322/468 (68.8) | 28/53 (52.8) | .02 |
| North Carolina | 312/461 (67.7) | 261/350 (74.6) | 50/101 (49.5) | <.001 |
| Pennsylvania | 167/276 (60.5) | 156/245 (63.7) | 10/29 (34.5) | .002 |
| Virginia | 130/212 (61.3) | 118/168 (70.2) | 11/38 (29.0) | <.001 |
| Illinois | 145/196 (74.0) | 135/176 (76.7) | 10/18 (55.6) | .049 |
| Mississippi | 84/190 (44.2) | 54/97 (55.7) | 30/82 (36.6) | .01 |
| Washington | 146 /174 (83.9) | 127/152 (83.6) | 19/22 (86.4) | .74 |
| Arizona | 127/168 (75.6) | 121/154 (78.6) | 6/13 (46.2) | .01 |
| Maryland | 64/150 (42.7) | 57/126 (45.2) | 7/20 (35.0) | .39 |
| Colorado | 93/137 (67.9) | 86/122 (70.5) | 7/14 (50.0) | .12 |
| Alabama | 62/131 (47.3) | 41/74 (55.4) | 21/50 (42.0) | .14 |
| Oregon | 90/117 (76.9) | 84/108 (77.8) | 6/9 (66.7) | .44 |
| Wisconsin | 87/109 (79.8) | 78/98 (79.6) | 9/11 (81.8) | .86 |
| Otherb | 306/440 (69.6) | 258/343 (75.2) | 47/90 (52.2) | <.001 |
P values are from χ2 analysis comparing availability at chain vs independent pharmacies; 96 pharmacies that did not have a chain code indicating 1 of these 2 categories were excluded.
Other indicates those with fewer than 100 pharmacies called: Iowa, 55; Maine, 43; New Mexico, 42; Nebraska, 41; Connecticut, 38; Delaware, 33; Montana, 29; Minnesota, 22; North Dakota, 18; Wyoming, 18; Nevada, 12; South Carolina, 12; Vermont, 11; Massachusetts, 10; New York, 10; Tennessee, 10; Idaho, 6; West Virginia, 6; Georgia, 5; Indiana, 4; Kentucky, 4; Oklahoma, 4; Louisiana, 3; Missouri, 2; New Hampshire, 1; and Ohio, 1.
Table 2. Availability of Buprenorphine at Retail Pharmacies by Parent Organization and Select States, 2022.
| Parent organization | Pharmacies reporting stock, No./total No. called (%) | |||||
|---|---|---|---|---|---|---|
| Overall | California | Florida | Michigan | North Carolina | Texas | |
| CVS | 750/1256 (59.7) | 119/230 (51.7) | 74/196 (37.8) | 34/102 (33.3) | 109/136 (80.2) | 108/153 (70.6) |
| Walgreens | 820/1167 (70.3) | 63/108 (58.3) | 82/160 (51.3) | 65/96 (67.7) | 91/113 (80.5) | 94/130 (72.3) |
| Walmart | 206/354 (58.2) | 12/37 (32.4) | 19/52 (36.5) | 10/15 (66.7) | 33/45 (73.3) | 27/48 (56.3) |
| Rite-Aid | 197/337 (58.5) | 43/92 (46.7) | NA | 51/91 (56.0) | NA | NA |
| Publix | 57/183 (31.2) | NA | 41/157 (26.1) | NA | 7/13 (53.9) | NA |
| Safeway | 92/132 (69.7) | 12/22 (54.6) | NA | NA | NA | NA |
| Kroger | 50/90 (55.6) | NA | NA | 10/30 (33.3) | NA | 25/36 (69.4) |
| Meijer | 33/50 (66.0) | NA | NA | 29/43 (67.4) | NA | NA |
| Costco | 31/47 (66.0) | 8/12 (66.7) | NA | NA | NA | NA |
| H-E-B | 33/40 (82.5) | NA | NA | NA | NA | 33/40 (82.5) |
| Harris | 19/34 (55.9) | NA | NA | NA | 12/22 (54.6) | NA |
| Sav-On | 18/31 (58.1) | 3/10 (30) | NA | NA | NA | NA |
| Brookshires | 16/29 (55.2) | NA | NA | NA | NA | 16/28 (57.1) |
| Ralphs | 4/14 (28.6) | 3/13 (23.1) | NA | NA | NA | NA |
| Vons | 3/13 (23.1) | 3/13 (23.1) | NA | NA | NA | NA |
| Other | 729/1506 (48.1) | 64/168 (38.1) | 65/192 (33.9) | 84/159 (52.8) | 60/132 (45.5) | 48/89 (53.9) |
Abbreviation: NA, not applicable.
Discussion
This large-scale study demonstrated limitations in buprenorphine availability at retail pharmacies at the time of a patient’s need. Only 57.9% of pharmacies reported buprenorphine/naloxone in stock at the time of request, with substantial differences observed among states and pharmacy chains in the US. Limitations include restriction to a limited number of states and the inability to ascertain whether the pharmacy could order the medication in a timely manner, whether the pharmacy had enough stock to cover the patient’s entire prescription, the reason why the pharmacy reported no stock, or whether the pharmacy subsequently stocked buprenorphine after the first call.
These findings from many states and pharmacies supplement prior secret shopper studies that suggest pharmacy-level barriers in accessing buprenorphine.2 Dispensing regulations imposed by federal and state governments may be contributing to lack of access at retail pharmacies.3 Although the number of prescribers willing to provide buprenorphine was identified as a barrier to this evidence-based OUD treatment in the past,4 pharmacy availability of buprenorphine may be an additional barrier, particularly in the post–COVID era in which telehealth can be used for patients in areas with few or no prescribers.5 The government’s recent elimination of a special waiver needed to prescribe buprenorphine to increase access6 also highlights the importance of pharmacy availability.
eMethods
Data Sharing Statement
References
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Associated Data
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Supplementary Materials
eMethods
Data Sharing Statement