Pilot evaluation of a pharmacist-led technical assistance program to address buprenorphine dispensing in community pharmacies

Abstract

Background

Pharmacy-based barriers, including stigma and prescriber communication difficulties, can limit patient access to buprenorphine.

Objective

The purpose of this pilot study was to evaluate the feasibility, acceptability, and perceived usefulness of a pharmacist-led technical assistance (TA) program in addition to an online training to support buprenorphine dispensing in community pharmacies.

Methods

A mixed-methods pilot study was conducted between February and November 2025 with five North Carolina community pharmacists. Participants completed an online training, approximately six meetings with a pharmacist TA, and two standardized patient interactions (one interaction before and after TA was complete). TAs tracked their time, and semi-structured interviews assessed feasibility, acceptability, and perceived usefulness.

Results

Pharmacists found the TA sessions acceptable and useful because they addressed site-specific needs, including communication with staff, patients, and prescribers; wholesaler thresholds; red flags; telehealth prescribing concerns; and filling bridge scripts. Pharmacists particularly valued learning from a peer with dispensing experience. Regarding feasibility, pharmacists emphasized the importance of an in-person visit followed by 13–22-min virtual follow-up sessions and recommended expanding the program to additional staff. Communication with SPs improved after receiving TA, though stigmatizing language persisted.

Conclusion

A pharmacist-led TA model was feasible, acceptable, and useful for addressing practice barriers to buprenorphine dispensing.

Introduction

Community pharmacists play a vital role in ensuring patient access to Medications for Opioid Use Disorder (MOUD) like buprenorphine. Patients unable to promptly receive MOUD are more likely to experience fatal or nonfatal overdose.¹ Despite the importance of pharmacy-based access, pharmacists continue to face barriers to dispensing buprenorphine, including uncertainty about regulatory requirements, workflow challenges, communication difficulties with prescribers, and stigma-related concerns.2, 3, 4, 5, 6, 7, 8 Independent pharmacies, and those located in the South, are more likely to report barriers to buprenorphine access.5, 7, 9

A content review of buprenorphine trainings for pharmacists identified that despite previous trainings providing medication-specific treatment information, most lacked guidance on how to address dispensing barriers or ordering thresholds.¹⁰ To address these content gaps, an interdisciplinary team of pharmacists, researchers, and educators co-developed a community pharmacist training (Buprenorphine Understanding in the Pharmacy Environment (B.U.P.E.))¹¹ designed to build pharmacists' skills to overcome common buprenorphine dispensing barriers.2, 7, 8 The training was shown to increase pharmacists' knowledge of buprenorphine and willingness to dispense.¹¹ Since the passage of the Mainstreaming Addiction Treatment Act,¹² which eliminated the “X” Waiver, which was a requirement for prescribers of buprenorphine to obtain additional training and certification,¹³ the authors updated the training to reflect these changes. The training also reflected two other updates including the expansion of telehealth buprenorphine prescribing,¹⁴ and new practice guidelines for community pharmacy-based buprenorphine dispensing.¹⁵

It was hypothesized that based on the outcomes of the initial training, the addition of technical assistance (TA) for participating pharmacists would be a useful strategy to further address dispensing barriers, as it can provide practice-based, tailored support that extends beyond a single educational session.¹⁶ It was anticipated that having a practicing pharmacist serve as the facilitator for TA sessions would be particularly well-received because peer delivery can increase credibility, improve relevance, and allow for practical problem-solving grounded in knowledge of community pharmacy workflow.17, 18 The purpose of this pilot study was to evaluate how well received a pharmacist-led TA program in addition to an online training, was to support buprenorphine dispensing in community pharmacies.

Methods

Design and participants

A convergent mixed-methods pilot study was conducted with a convenience sample of five community pharmacists practicing in North Carolina (NC) in which quantitative and qualitative data were collected concurrently and integrated during interpretation to provide a comprehensive understanding of the participants' experiences and intervention outcomes. Verbal consent was obtained from the pharmacists prior to data collection for each activity. The protocol was reviewed and determined exempt from further review by the University of North Carolina Institutional Review Board (IRB: 24-1931).

Data collection

Pharmacists completed five activities. First, pharmacists completed the updated B.U.P.E. training (online, 45 min) focused on overcoming buprenorphine dispensing barriers, workflow considerations, and practical strategies for implementation. Second, they participated in a standardized patient (SP) interaction on Zoom. The SP assessment was designed to objectively assess pharmacist communication skills in a standardized manner so that changes in communication, stigma, and patient-centered language could be assessed (script shown in Fig. 1).¹⁹ Third, participants received approximately bi-weekly TA meetings over a 3-month period with a practicing community pharmacist between February and November 2025. Two community pharmacists with experience developing training related to buprenorphine dispensing (GM and TM) served as the TA facilitators.

Fig. 1.

Standardized patient script depicting a pharmacy technician expressing stigma toward a patient prescribed buprenorphine.

The first TA meeting was in-person, where facilitators established rapport, identified site-specific needs, and prioritized barriers to address during subsequent meetings. Follow-up TA sessions were conducted by Zoom or phone and tailored to each pharmacist's identified concerns. One TA session was dedicated to discussing the SP assessment and communication strategies to address pharmacy staff stigma. Fourth, after the TA sessions were completed, participants completed a second SP assessment with the same actor and script. Lastly, participants completed a qualitative semi-structured interview to provide more in-depth understanding on the training and TA intervention.

Measures

SP assessments: The 2–3-min SP interactions were audio recorded and evaluated by the facilitator to determine if the pharmacist: used non-stigmatizing language (yes/no), what stigmatizing language was used (if any), highlighted the benefits of buprenorphine for patients (yes/no), and, if so, what benefits were described. The SP interactions were assessed utilizing the same observation guide for both SP interactions conducted before and after TA interactions.

Facilitator log: Facilitators used an Excel spreadsheet to document how much time they spent scheduling and preparing for meetings. Additionally, facilitators documented how much time they spent with participants and were instructed to provide brief notes regarding the topics discussed.

Interview guide: After pharmacists' participation had ended, two authors (G.M. and T.M.) conducted semi-structured interviews to assess the pilot program, including perceptions of feasibility, acceptability, usefulness, and suggestions for improvement (see Supplemental Appendix for interview guide). Participants were assigned an interviewer that did not provide their TA facilitation to avoid bias in responses.

Analysis

Descriptive statistics were calculated to characterize facilitator time and SP assessment data. Participant interviews were deidentified, and audio-recordings were coded using the rapid identification of themes set forth by Neal et al²⁰ to identify recurring perceptions related to the training and TA experience. The interviews were coded by a program manager, and one of the pharmacist facilitators with experience with qualitative research (G.M). Consistent with the pilot nature of the study and the use of rapid coding techniques, an initial set of a priori codes was developed to assess the acceptability, feasibility, and recommendations for improving the TA experience. Emergent themes were subsequently identified through iterative analysis of the coded data.

Results

Five community pharmacists participated, representing two independent pharmacies in Eastern NC, and three independent pharmacies in Western NC.

Technical assistance

During the first in-person TA session, participants identified their goals for facilitation, and subsequent meetings with the participants were tailored to address their goals. Specific topics addressed in TA meetings, average meeting time, and outcomes of the meetings are shown in Table 1. The topics during TA were tailored to pharmacists needs. Facilitators addressed the topic of ‘communication with pharmacy staff’ with all participants, through a review of the SP interaction. Participants requested facilitation and TA support related to communication with patients, and prescribers most often. Two of the five participants requested information related to “red flags” (such as concern for patient or prescriber distance from pharmacy, patients requesting a specific manufacturer or color of tablet, etc.). Only one participant requested facilitation related to navigating wholesaler thresholds (pharmacy-specific purchasing limits set by drug distributors to flag potential suspicious orders under DEA monitoring rules),²¹ and overcoming buprenorphine telehealth prescribing concerns.

Table 1.

Technical assistance topics covered, average time spent during meetings, and outcomes of meetings.

Technical Assistance Topics⁎	Average time (min)	Tasks accomplished
TA topics discussed with all participants:
Communication with staff	25	Reviewed SP interactions to discuss communication with staff that led to improved knowledge/confidence; addressed stigma (via SP encounters)
TA topics discussed with three participants
Communication with patients	20	Reviewed website resources related to creating a welcoming environment at the pharmacy. Also reviewed patient SP interactions.
Communication with prescribers	15	Emailed/called local prescribers to inform them that their pharmacy was committed to providing buprenorphine; discussed methods of communication with prescribers and drafted potential scripts, and faxes to share with prescribers.
TA topics discussed with two participants
Red Flag discussions	22	Reviewed adverse events with buprenorphine/naloxone. Reviewed literature regarding the use of monoproduct instead of combination product for patients with adverse effects. Discussed treatment challenges that may necessitate patients travelling distances to see a prescriber or filling at their pharmacy (vs one closer to their home)
TA topics discussed with one participant
Sharing content with other pharmacists	30	Provided draft emails/phone scripts to share with pharmacy networks related to the importance of filling buprenorphine
Telehealth prescribing concerns	30	Reviewed policy related to telehealth prescribing; improved pharmacist comfort in dispensing; provided documentation suggestions
Filling bridge scripts	10	Reviewed NC Board of Pharmacy policy related to filling bridge scripts when a patient is in need.
Navigating wholesaler thresholds	19	Negotiated wholesaler threshold increase on ordering of buprenorphine.

^⁎Table note: Multiple meetings with participants covered more than one topic; to calculate time spent on a specific topic, the total time of the meeting was divided by the number of topics discussed to calculate the average amount of time covering the specific topics.

Facilitation and pharmacist time

On average, each facilitator spent approximately 300 min planning and facilitating the pilot project (range per pharmacy: 225 min- 452 min). Participants received TA for an average of 142.5 min over the course of six meetings (23.8 min/ meeting). The initial site visit was the longest (55 min), and the subsequent five phone and Zoom-based meetings averaged between 13 and 22.5 min in length. The length of time spent on various TA topics is shown in Table 1.

Standardized patient interactions

On the pre-TA SP assessment, four out of five participants used stigmatizing language with a technician who had used stigmatizing language when referring to a buprenorphine patient: whereas only one used stigmatizing language during the post-TA assessment. Participant responses to the SPs before and after TA facilitation can be found in the Appendix. For example, one pharmacist affirmed the technician who asked if buprenorphine was replacing one addiction with another, stating:

Yes, it is replacing one addiction with another, but it is legal, and they're not getting it off the street, and who knows if what they're getting off the streets is laced with fentanyl that can kill them. (P02)

Additionally, two participants highlighted the benefits of buprenorphine (a topic that was covered in the training) pre and post-TA; however, the way in which they approached the conversation with the technician changed. Specifically, participants transitioned from defensive baseline questioning of the technician to collaborative, validating approaches. Notably, participants struggled less with addressing the technician's comment that buprenorphine was “replacing one addiction with another” and were more likely to provide clinical justifications such as comparing buprenorphine to chronic disease management and approaching buprenorphine dispensing as a public health concern, relating their role as the pharmacist in reducing harm. Listed below is an example quote from a participant interacting with the SP:

We need to treat it like a disease like we do hypertension and diabetes. We need to help them get access to the medication and not use negative language like drug abuser. We need to treat them like a patient that has a substance use issue. (P02)

Qualitative findings

Four themes emerged from the interviews: 1) The virtual TA was feasible, acceptable, and easily integrated into pharmacy workflow; 2) Value of peer facilitation by a practicing pharmacist with real-world experience; 3) Value of an initial in-person TA session to address site-specific workflow and operational challenges; and 4) technicians and other pharmacists at the practice site should also be engaged in TA and training. Exemplary quotes are provided in Table 2.

Table 2.

Exemplary quotes with pharmacists provided technical assistance.

Theme	Quote
Virtual TA was feasible, acceptable, and easily integrated into the pharmacy workflow	I mean, it was it was done in a well, well designed way and it was, you know, in easily digestible bites. P03
	I think it was about once a month, which was perfect for me, because it gives you time to make any changes that you see where things could be tweaked, but it's not so, too much of a check into where it's time consuming. P02
	Honestly, I think once a week is feasible, like, I think that's the appropriate time between coaching sessions.” - P01
Value of peer facilitation by a practicing pharmacist with real-world dispensing experience.	I thought it was important to have a pharmacist come and, you know, talk to someone because you want someone that has kind of skin in the game that's dispensing as well. That understands I guess what obstacles are, and that type of stuff. But I don't know. I do think when you have a face to face contact with someone, I feel like there's more skin in the game. There's more just liability to it. P02
	Nice to work with someone who has been doing this for a while, someone to turn to with real-world experience when you have questions. P05
Value of an initial in-person TA session to address site-specific workflow and operational challenges	I've got some people that like are having trouble in an adjacent town that are getting it [buprenorphine], and they're just, you know, they go from store to store and like nobody can help them. We'll let them know that we can be an access point for this. I probably wouldn't have been that open to go out there and have that conversation if I hadn't had those facilitating meetings.-P01
	I think the initial meet and greet is, you know, important to be in person. But I think after that the virtual was fine. Honestly, I prefer virtual when it comes to like quick meetings like that, because I was able to, while I was on the bench like just step away for a few minutes to finish what we were doing. -P02
Engage technicians and other pharmacists at practice site in TA and training	Debriefing with technicians after encounters with a Bupe patient. Like case studies. What the coach does with the pharmacist, the pharmacist then does with their technician(s). Could also include in future coaching tools “how to provide feedback to technicians.” P01

Discussion

This pilot study provides preliminary evidence that a pharmacist-led TA model in combination with an online buprenorphine training,¹¹ is both feasible and acceptable for addressing barriers to buprenorphine dispensing in community pharmacy settings. These findings suggest that adding longitudinal, tailored TA support may help translate knowledge gains into changes in communication behaviors, and workflow integration when dispensing buprenorphine.

Although stigmatizing language was not fully eliminated after completing TA, SP assessments demonstrated that participants moved from defensive or uncertain responses toward more collaborative, clinically grounded communication with the pharmacy staff. This shift is meaningful, as stigma within the pharmacy team has been identified as a barrier to buprenorphine access.5, 8, 22 These behavioral observations aligned with the qualitative interview findings in which pharmacists described the TA sessions as valuable for practicing difficult conversations. Through reframing buprenorphine as a treatment for a chronic condition (opioid use disorder), pharmacists appeared more confident in addressing misconceptions among staff. This may reflect pharmacists' perception of their professional roles and responsibilities, and of providing chronic disease state management.²³ These findings align with previous research indicating that behavior change in healthcare professionals often occurs incrementally and is reinforced through practice, feedback, and social interaction rather than didactic education alone.24, 25

Having a practicing pharmacist be the facilitator appears to be vital for this TA model. Participants consistently highlighted the value of working with a peer who understood real-world constraints, including workflow pressures, wholesaler limitations, and prescriber communication challenges. This finding reinforces prior evidence that peer-to-peer implementation strategies and tailored interventions enhance credibility and uptake.26, 27 The ability of the pharmacist facilitator to provide context-specific problem-solving, like supporting negotiation of wholesaler thresholds, illustrates how tailored facilitation can address structural barriers that are unlikely to be resolved through an online training alone. Future studies should evaluate the cost-effectiveness and scalability of pharmacist-delivered TA models.

The potential scalability of this intervention may be limited by the participants' perceptions that the initial in-person visit at the pharmacy was essential for establishing rapport and identifying site-specific needs. To expand the training, a potential train-the-trainer model with regional hubs that has been successful elsewhere to disseminate knowledge widely within health systems may be utilized to deliver the TA provided in this pilot project while mitigating the resources required for in-person visits.²⁸ The relatively short duration of follow-up TA sessions (approximately 13–22 min) corresponded with participant reports that the intervention was feasible to integrate into workflow and manageable alongside dispensing responsibilities. The short duration also suggests that meaningful support can be delivered with relatively low ongoing time commitment once initial engagement is established. Future research should evaluate the personnel costs associated with pharmacist-led facilitation to see whether this intervention is financially viable and scalable.

Participants also highlighted the importance of engaging pharmacy technicians in training and TA to reduce stigma associated with buprenorphine dispensing. As pharmacy technicians and other staff often serve as the first point of contact for patients and may influence dispensing decisions through their attitudes and behaviors, they should be considered for inclusion in future iterations of the training. Incorporating team-based training components or tools to support pharmacists in addressing stigma within their broader practice environment may enhance the sustainability and impact of the intervention.

Limitations

Despite these promising findings, several limitations should be considered. This was a small pilot study with a convenience sample of five pharmacists in North Carolina, which may limit generalizability, particularly to chain pharmacies or other geographic regions. This pilot study did not assess patient-level outcomes such as successful buprenorphine dispensing, treatment retention, or patient satisfaction; therefore, the impact of the intervention on clinical outcomes is a key area for future research. The short duration and reliance on simulated SP encounters may not fully capture changes in real-world dispensing behavior or patient outcomes. Additionally, although shifts in communication style were observed, persistent use of stigmatizing language indicates that greater attitudinal change may require more intensive or prolonged intervention. One of the pharmacist facilitators also coded the interviews, which may impact the coding, to limit potential bias, they did not code the interviews with participants they supported. Future studies should incorporate larger samples, longer follow-up periods, and objective measures of dispensing practices to assess effectiveness.

Conclusion

This study suggests that combining pharmacist-specific training with peer-delivered, tailored TA is a promising strategy for addressing barriers to buprenorphine dispensing. By targeting both knowledge and practice-level challenges, this approach may support more consistent access to buprenorphine in community pharmacy settings, particularly in underserved regions such as the rural South. Future research should explore strategies to scale this model, integrate team-based components, and evaluate its impact on patient access and outcomes.

CRediT authorship contribution statement

Grace Marley: Writing – original draft, Methodology, Investigation, Data curation. Trish Mashburn: Writing – review & editing, Methodology, Investigation, Data curation. Paul Alebrande: Writing – review & editing, Data curation. Cheryl Viracola: Writing – review & editing, Methodology. Bayla Ostrach: Writing – review & editing, Methodology, Funding acquisition, Conceptualization. Delesha Carpenter: Writing – review & editing, Supervision, Methodology, Funding acquisition, Conceptualization.

Funding

This work was supported by the Dogwood Health Trust. The funding organization had no role in the design or conduct of this research.

Declaration of competing interest

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Appendix A. Table providing the responses by participants to the standardized patient interactions before and after technical assistance

	Pre- Technical Assistance	Post-Technical Assistance
Technician: “It just seems like we're legalized drug dealers, ESPECIALLY for buprenorphine. I just don't feel comfortable with patients like that. Why are we enabling drug users like that?”
Technician: But aren't we just replacing one addiction with another?
P01	What makes you feel uncomfortable about dispensing that prescription? [the medication itself with the people that come in, they look like drug users to me] Well we have to remember as healthcare providers, that we are providing a service to a patient that needs our assistance. So if they need help with their substance abuse problem, we need to be here to help them. And yes, there are going to be things that you are going to see and experience, and observe, but we need to make sure that we maintain our professionalism here, and not talk about patients, and remember that this is a substance abuse problem, and we are here to help them through dispensing the medication.	Well one thing we got to consider is that the opioid problem is a disorder, or a disease, and they are going to need ongoing treatment. So we're going to have to be a good support system for them, and help them get access to the medication, and help support them in their journey to get well. And we don't need to use negative words like drug abuser. We need to treat them like any other patient, not like one who just has a substance use issue.
	So the point of the medicine is to eventually get them to where they do not have to rely solely on the medication. So while yes, it might feel that we are replacing it with another drug, we are helping them fight their addiction so that they don't have to rely on the medication.	We actually are not. We are helping them with treatment, and the goal is to one day not rely on the medication, they are going to need the medicine for a while to be successful for their recovery.
P02	Honestly, buprenorphine is it's a form of harm reduction and yes people on buprenorphine still may use, but they are able to maybe use less or participate in society a little bit better it's kind of a lesser of two evils. It's do we want them strung out on whatever they were using before or do we want them to be able to function in Society, hold down a job, make some money to help their family out. Buprenorphine is a form of harm reduction.	We are not enabling. Opioid use disorder is a disease, and this is a treatment for the disease, just like hypertension is a disease, diabetes is a disease, we treat them with medications. This medication blocks the receptors that cause cravings for the opioid, so you're always going to have those cravings. So, just like a diabetic, once they can no longer produce insulin, they have to take medication for the rest of their life. People with OUD will always have cravings so they will always need to be on this medication.
	No, you've got to think of addiction as a disease. I mean you wouldn't tell a diabetic that oh I can't fill your metformin anymore because we've treated you for a year now, so we can just stop it because your diabetes went away. It's the same way with this. Once you have that addiction, you're always going to have it, you're always going to have the cravings; this is just a way to control the cravings, like metformin is a way to control the diabetes.	No because the buprenorphine allows them to be productive in society, hold down a job, provide for their family. They're not necessarily getting the high that they would get off the opiate, and it allows them to function in society.
P03	First of all, where are you getting your data from? *I would ask where they're getting their information from. To be honest with you I have had this talk with all my techs because we do have a suboxone buprenorphine clinic right beside us. From my standpoint these people are making a step to get better because this is to help them come off of what they're already on. So, no we're not enabling this, we are helping them stop what they're already on.* *Note: this participant didn't talk to the SP like a real patient in this scenario	Why do you feel that way? [you know I feel like we're just replacing one addiction with another] And in your opinion that's bad? [yeah], Okay where are they currently getting the medications that they are getting? On the street, correct? [uhh], Are they getting it off the street, or getting it from the doctor, or are they hooked on pain medications, or can you make that decision? [Because you know, we're dispensing them to them, the buprenorphine like we're just legal drug dealers] So there are two different things. First of all, it's being done in a controlled environment, um, so we can control if they're getting it off the street, who knows what they're getting. So, in that effect we're looking after the patient because we know what they're getting. Second of all, they're making a decision to stop, and I think that's very important because they've gone through the doctor. They're going through counseling with our local Clinic, do they have to go see the doctor they have to go to weekly counseling so they're making this decision to make your life better, so I don't see it as a legal drug dealer, I see us as a helper in helping them get over their addiction. Because the plan is to get them off the Suboxone, and the doctor can wean that in a clinical way that they cannot do that on the street.
	Ah yes but number one is legal. Number two they're not getting it off the street and number three who knows if what they're getting off the street is laced with fentanyl and that could kill them. The clinics that we deal with have mandatory weekly counseling with a counselor and meeting with a doctor to do this so as long as the doctors is okay with this, I am okay with filling this.	We are not. We are replacing one compound or one medication with another and we're doing it in a controlled way that is compassionate and that can hopefully get this person off of both of them. And if you feel that way, we need to sit down and have a coaching section because I'm not sure where you're getting your information from, but we need to give you the correct information about how these clinics run, and our place in helping these people.
P04	You know, it just seems like we're legalized drug dealers especially for buprenorphine. I just don't feel comfortable with patients like that. Why are we enabling drug users like that? So, the medications is not just to enable, you know, the medication itself is to help patients who are using the medication or using a different medication that they maybe have an addiction with, but it can be used for different indications as well it can be used for chronic pain, to prevent opioid overdose. There are many different uses for it so we can't paint everyone with a broad brush. Just because someone is on this medication, we can't assume that they are using it for a bad purpose. I have personally seen patients that have used these types of products who have over time been able to taper off of it and come off of it, and they've had positive life changes, so it's not appropriate to ever paint a group of customers with a broad brush.	I understand your concern about that. Why do you feel as though that's the case? Have you had any experience with this medication before? I can assure you that there is an intended medical purpose; not everyone is using this medication for that purpose; can be used for pain control. Need to not paint everyone with the same brush; we may know that the indicated use is for, but it's not always used for that purpose (i.e. metformin for diabetes can also be used for PCOS); we need to do everything that we can do to prevent diversion and abide by the law; however it's a useful medication.
	It is perfectly reasonable to assume that, but that is not the case. There's many times I mean you could almost assume that putting patients on cholesterol medication is replacing fatty foods; it's not. Tt's not Apples to Apples. You cannot make that assumption.	No, it can be used for other indications, not always used for addiction, can help with the cravings, and coming off of an addiction; it may be used sometimes for chronic pain; in some instances it can be thought of as replacing one addiction with another; whether it's illegal or legal activity you cannot necessarily know that.
P05	Well, I wouldn't look at it that way. Buprenorphine is likely the only thing that has been proven to work, and if we do it right, and they're on time, and we're looking at the big picture, it is keeping them from having breakthroughs where they're abusing harder drugs on the streets and potentially endangering other people in a more harmful way. Also, if they are consistently taking this, the step-down from buprenorphine is a lot easier than something harder off the street. So, it's a lot easier to get off of it, and that's the goal to hopefully get to a point where they can move forward with their life. Even if they have to do a crutch where they have to do it once a day for a few years. We have to look at it as it is a chronic problem in our country, and we are trying to help with that problem, and not increase the issue. We are keeping people's lives in order.	Well John, it's not that straightforward; I don't know if you've had anyone in your family that's had a drug problem, But buprenorphine is one of the few, if not the only thing that works to help people get off the opioids, off the street opioids, and it is safer for them because they're not taking something that could be laced with fentanyl; it also gives them a continuity where they get it weekly, they're followed with counseling and hopefully over time they can live a more functional life, and I've seen that with a lot of my patients. Now you're still going to have some that are working against it, but you have to look at the big picture of it. If you can save a dozen out of 100 people, that still makes a large difference, it's just something that we're working toward better treatment, but this is one of the best ways to go about it. It could be a friend, or family member that can come into the pharmacy next week. We still check everything to make sure they're not double-dipping or anything wrong, but we need to take care of them like family.
	Um, no. We are giving them a chance to replace something that is easier to come off of. Even if they do have to stay on it for 2–3 years, I've had patients come up to me and say, “With this medicine, even though I have to be on it, it keeps me from having the day that I break, and I go and get something off the street”. In the big picture, that's a lot better than someone breaking down and having to take something that may kill them, or endanger someone, or even your kid.	It's an easier medication to get off of eventually; but even if they don't they're able to see a doctor and be controlled; and have a functional job to get a job and functional family; and have some form of success; vs going from highs to lows bouncing around on the street; the bupe gives them a more steady duty of care; if the doctor feels comfortable; the doctor can reduce the treatment and get off the medication. But the success stories with patients on it for many years, one 1–2 doses a day that keeps patients from making a one day error and having a terrible day and end up taking an overdose because they haven't had it in 3 months and they lose their lives on the street. And to me that's a bigger risk than being on the maintenance dose.

Table note: The participant responses are divided in the middle where the standardized patient asked, “But aren't we just replacing one addiction with another?” for both the pre-and post TA facilitation.