Author: Lauren Sawyer

Medication-assisted treatment (MAT) has been a life-saving tool for so many people with opioid use disorder. In fact, the most popular medication used in MAT—Suboxone (buprenorphine/naloxone)—is approved and endorsed by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Federal Drug Administration (FDA), and the National Institute on Drug Abuse (NIDA).

Thousands of people say Suboxone literally changed their lives for the better. Surely we’d never see patients facing barriers and stigma related to such a well-researched and highly-endorsed medication – not in this day and age, right?

Wrong.

Despite all the supporting literature and data, clinicians hear horror stories on a weekly basis – stories about pharmacies preventing access to recovery by turning away patients presenting Suboxone prescriptions.

So, what’s the deal?

What is Medication Assisted Treatment?

Medication-assisted treatment (MAT) is the use of medications, in combination with behavioral therapies, to treat opioid addiction and alcohol dependence. These medications are critical because over two million Americans live with opioid use disorder, which includes prescription opioids and illicit drugs, like heroin.

According to SAMHSA, these medications can relieve withdrawal symptoms and reduce the psychological cravings that cause chemical imbalances in the body. MAT also helps to normalize brain chemistry, block the euphoric effects of alcohol and opioids, and normalize body functions without opioid use.

There are three main types of MAT that can be prescribed by a medical provider:

1. Medications for alcohol use disorder: the medications used to treat alcohol dependence include acamprosate, disulfiram, and naltrexone.
2. Medications for opioid dependence (also called opioid use disorder): these medications include buprenorphine, methadone, and naltrexone
3. Opioid overdose prevention medication: naloxone (commonly called its brand name, Narcan) is an opioid overdose drug that can be used to reverse the effects of opioids and save someone’s life.

How Effective is MAT?

MAT is clinically proven to be an effective treatment, with a number of positive outcomes. These medications:

• Reduce the need for detox
• Provide a comprehensive, but tailored, program combining therapy and medication that addresses most patients’ needs
• Improve patient survival
• Decrease illicit opioid use
• Decrease criminal activity
• Improve retention in treatment programs
• Increase a person’s ability to gain and sustain employment
• Improve birth outcomes among pregnant mothers with opioid use disorder.

Why Do Pharmacies Prevent Access to Recovery?

Given how effective and well-endorsed medication-assisted treatment is, you’d think that pharmacies would be happy to stock their shelves with more of the medications (and increase their bottom line). Instead, recent studies have shown that some pharmacies are refusing to stock one medication: buprenorphine.

In a recent AMERSA podcast (The Multidisciplinary Education and Research in Substance Use and Addiction), Dr. Jeffrey Bratberg and his colleagues decided to test the availability of MAT by hosting a phone-based “secret shopper.”

Bratberg, with researchers Dr. Lucas Hill, and Dr. Lindsey Loera, surveyed 800 pharmacies licensed by the state of Texas for the distribution of MAT. During their “secret shopper” experiment, Bratberg and colleagues asked pharmacies for the availability of the most prescribed MAT product, buprenorphine 8/2mg films. When medications were unavailable, researchers asked when it would come back in stock and  also asked about the availability of naloxone.

The findings were pretty alarming.

Bratberg and colleagues discovered that:

• Only 34 percent of pharmacies were willing to fill one week of buprenorphine and a naloxone kit
• Chain stores were more likely than independent pharmacies to fill Suboxone prescriptions
• Prescribing just one medication (buprenorphine) didn’t make a big difference, with 42 percent agreeing to fill the prescription
• Even if the medication was out of stock, only 62 percent of pharmacies were willing to order it (and it took more than two days for Suboxone delivery)
• Some pharmacists simply refused to dispense Suboxone altogether

Digging Into Each Pharmacy’s Excuses in Preventing Access to Recovery

Researchers wanted to understand why the medication was out of stock and why pharmacists were so unwilling to prescribe an FDA-approved medication and therefore prevent access to recovery.

Bratberg and colleagues found the reasoning was simple: stigma and misconceptions.

Some pharmacists held misconceptions, believing MAT could cause euphoria or even lead to misuse. They essentially believed that, since it was an opioid, patients would use it to get high –  even though that has been scientifically refuted. Other pharmacists pointed to cost issues saying that they could lose money if they had an excess supply on hand.

Critics say that the pharmacists’ perspectives are grounded in misconception and flawed arguments. Here’s why: Bratberg and colleagues pointed out in the podcast that surely all of these pharmacists had a supply of a highly addictive opioid, oxycodone, meaning the pharmacists’ reasoning was ill-founded.

Unfortunately, the lack of supply issues for MAT isn’t limited to Texas. A similar study in Kentucky found that pharmacists were terrified of DEA involvement. That reasoning does have more of a basis as wholesalers have been criticized for their part in the opioid epidemic by not reporting large orders of opioid medication.

Clearly the reasons that pharmacists prevent access to recovery are nuanced and Bratberg and colleagues say that the reasoning is complex and there needs to be a multidisciplinary approach that finds solutions and enables pharmacists to collaborate with other pharmacists, policy makers, and other MAT providers.

For information about treatment options for you or a loved one, call 800-934-1582(Who Answers?) today.