Medications for opioid use disorder (MOUD), such as methadone and buprenorphine, are effective strategies for treatment of opioid use disorder (OUD) and reducing overdose risk. MOUD treatment rates continue to be low across the US, and currently, some evidence suggests access to evidence-based treatment is becoming increasingly difficult for those with OUD as a result of the 2019 novel corona virus (COVID-19). A major underutilized source to address these serious challenges in the US is community pharmacy given the specialized training of pharmacists, high levels of consumer trust, and general availability for accessing these service settings. Canadian, Australian, and European pharmacists have made important contributions to the treatment and care of those with OUD over the past decades. Unfortunately, US pharmacists are not permitted to prescribe MOUD and are only currently allowed to dispense methadone for the treatment of pain, not OUD. US policymakers, regulators, and practitioners must work to facilitate this advancement of community pharmacy-based through research, education, practice, and industry. Advancing community pharmacy-based MOUD for leading clinical management of OUD and dispensation of treatment medications will afford the US a critical innovation for addressing the opioid epidemic, fallout from COVID-19, and getting individuals the care they need.
SAMHSA. Key Substance Use and Mental Health Indicators in the United States: results from the 2018 National Survey on Drug Use and Health. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality; 2019.
BaoY, PanY, TaylorA, . Prescription drug monitoring programs are associated with sustained reductions in opioid prescribing by physicians. Health Aff (Millwood). 2016;35(6):1045–1051.
4.
WenH, SchackmanBR, AdenB, BaoY. States with prescription drug monitoring mandates saw a reduction in opioids prescribed to Medicaid enrollees. Health Aff (Millwood). 2017;36(4):733–741.
5.
LeslieDL, BaDM, AgbeseE, XingX, LiuG. The economic burden of the opioid epidemic on states: the case of Medicaid. Am J Manag Care. 2019;25(13 Suppl):S243–S249.
6.
SalonerB, LandisR, SteinBD, BarryCL. The Affordable Care Act in the heart of the opioid crisis: evidence from West Virginia. Health Aff (Millwood). 2019;38(4):633–642.
7.
PetersonC, XuL, MikoszCA, FlorenceC, MackKA. US hospital discharges documenting patient opioid use disorder without opioid overdose or treatment services, 2011–2015. J Subst Abuse Treat. 2018;92:35–39.
8.
PetersonC, XuL, FlorenceC, MackKA. Opioid-related US hospital discharges by type, 1993–2016. J Subst Abuse Treat. 2019;103:9–13.
9.
CochranG, GordonAJ, Lo-CiganicWH, . An examination of claims-based predictors of overdose from a large medicaid program. Med Care. 2016; 55(3):291–298.
10.
KeltyE, HulseG. Fatal and non-fatal opioid overdose in opioid dependent patients treated with methadone, buprenorphine or implant naltrexone. Int J Drug Policy. 2017;46:54–60.
11.
SordoL, BarrioG, BravoMJ, . Mortality risk during and after opioid substitution treatment: systematic review and meta-analysis of cohort studies. BMJ. 2017;357:j1550.
12.
MattickRP, BreenC, KimberJ, DavoliM. Buprenorphine maintenance versus placebo or methadone maintenance for opioid dependence. Cochrane Database Syst Rev. 2014;(2):CD002207.
13.
VolkowND, FriedenTR, HydePS, ChaSS. Medication-assisted therapies-tackling the opioid-overdose epidemic. N Engl J Med. 2014;370(22):2063–2066.
14.
VolkowND, CollinsFS. The role of science in addressing the opioid crisis. N Engl J Med. 2017;377(4):391–394.
15.
ThomasCP, FullertonCA, KimM, . Medication-assisted treatment with buprenorphine: assessing the evidence. Psychiatr Serv. 2014;65(2):158–170.
16.
ClausenT, AnchersenK, WaalH. Mortality prior to, during and after opioid maintenance treatment (OMT): a national prospective cross-registry study. Drug Alcohol Depend. 2008;94(1–3):151–157.
17.
TkaczJ, VolpicelliJ, UnH, RuetschC. Relationship between buprenorphine adherence and health service utilization and costs among opioid dependent patients. J Subst Abuse Treat. 2014;46(4):456–462.
18.
GowingL, FarrellMF, BornemannR, SullivanLE, AliR. Oral substitution treatment of injecting opioid users for prevention of HIV infection. Cochrane Database Syst Rev. 2011;(8):CD004145.
19.
GiacomuzziSM, ErtlM, KemmlerG, RiemerY, ViglA. Sublingual buprenorphine and methadone maintenance treatment: a three-year follow-up of quality of life assessment. ScientificWorldJournal. 2005;5:452–468.
20.
GiacomuzziSM, RiemerY, ErtlM, . Buprenorphine versus methadone maintenance treatment in an ambulant setting: a health-related quality of life assessment. Addiction. 2003;98(5):693–702.
21.
PonizovskyAM, GrinshpoonA. Quality of life among heroin users on buprenorphine versus methadone maintenance. Am J Drug Alcohol Abuse. 2007;33(5):631–642.
22.
PonizovskyAM, MargolisA, HeledL, RoscaP, RadomislenskyI, GrinshpoonA. Improved quality of life, clinical, and psychosocial outcomes among heroin-dependent patients on ambulatory buprenorphine maintenance. Subst Use Misuse. 2010;45(1–2):288–313.
23.
WuL-T, ZhuH, SwartzMS. Treatment utilization among persons with opioid use disorder in the United States. Drug Alcohol Depend. 2016;169:117–127.
24.
HaffajeeRL, LinLA, BohnertASB, GoldstickJE. Characteristics of US counties with high opioid overdose mortality and low capacity to deliver medications for opioid use disorder. JAMA Netw Open. 2019;2(6):e196373.
25.
JonesCM, McCance-KatzEF. Characteristics and prescribing practices of clinicians recently waivered to prescribe buprenorphine for the treatment of opioid use disorder. Addiction. 2019;114(3):471–482.
26.
JonesCM, CampopianoM, BaldwinG, McCance-KatzE. National and state treatment need and capacity for opioid agonist medication-assisted treatment. Am J Public Health. 2015;105(8):e55–e63.
27.
GreenTC, BratbergJ, FinnellDS. Opioid use disorder and the COVID 19 pandemic: A call to sustain regulatory easements and further expand access to treatment. Subst Abus. 2020;41(2):147–149.
28.
PriestK. The COVID-19 Pandemic: practice and policy considerations for patients with opioid use disorder. Health Affairs Blog. 2020.
29.
VolkowND. Collision of the COVID-19 and addiction epidemics. Ann Intern Med. 2020. doi:10.7326/M20-1212.
30.
BeckerWC, FiellinDA. When epidemics collide: coronavirus disease 2019 (COVID-19) and the opioid crisis. Ann Intern Med. 2020. doi:10.7326/M20-1210.
AlexanderGC, StollerKB, HaffajeeRL, SalonerB. An epidemic in the midst of a pandemic: opioid use disorder and COVID-19. Ann Intern Med. 2020. doi:10.7326/M20-1141.
33.
CerdaM, VlahovD, TracyM, GaleaS. Alcohol use trajectories among adults in an urban area after a disaster: evidence from a population-based cohort study. Addiction. 2008;103(8):1296–1307.
34.
KotarbaJA, FacklerJ, JohnsonBD, DunlapE. The melding of drug markets in Houston after Katrina: dealer and user perspectives. Subst Use Misuse. 2010;45(9):1390–1405.
35.
ShulerM, SuzukiS, PodestaA, Qualls-HamptonR, WallingtonSF. A post-hurricane katrina examination of substance abuse treatment discharges with co-occurring psychiatric and substance use disorders. J Dual Diagn. 2017;13(2):144–156.
36.
ShulerMN, WallingtonSF, Qualls-HamptonRY, PodestaAE, SuzukiS. Trend analysis of substance abuse treatment admissions in new orleans from 2000–2012: a population-based comparison pre- and post-hurricane Katrina. Subst Use Misuse. 2016;51(12):1542–1554.
37.
PhillippiSW, BeiterK, ThomasCL, . Medicaid utilization before and after a natural disaster in the 2016 Baton Rouge-area flood. Am J Public Health. 2019;109(S4):S316–S321.
38.
DunlopA, LokugeB, MastersD, . Challenges in maintaining treatment services for people who use drugs during the COVID-19 pandemic. Harm Reduct J. 2020;17(1):26.
39.
WilsonCG, RamageM, FaganEB. A primary care response to COVID-19 for patients with an opioid use disorder. J Rural Health. 2020. doi:10.1111/jrh.12438.
40.
MatusowH, BenoitE, ElliottL, DunlapE, RosenblumA. Challenges to opioid treatment programs after hurricane sandy: patient and provider perspectives on preparation, impact, and recovery. Subst Use Misuse. 2018;53(2):206–219.
41.
TofighiB, GrossmanE, GoldfeldKS, WilliamsAR, RotrosenJ, LeeJD. Psychiatric comorbidity and substance use outcomes in an office-based buprenorphine program six months following hurricane Sandy. Subst Use Misuse. 2015;50(12):1571–1578.
42.
McClureB, MendozaS, DuncanL, RotrosenJ, HansenH. Effects of regulation on methadone and buprenorphine provision in the wake of Hurricane Sandy. J Urban Health. 2014;91(5):999–1008.
43.
WilliamsAR, TofighiB, RotrosenJ, LeeJD, GrossmanE. Psychiatric comorbidity, red flag behaviors, and associated outcomes among office-based buprenorphine patients following Hurricane Sandy. J Urban Health. 2014;91(2):366–375.
44.
TofighiB, GrossmanE, WilliamsAR, BiaryR, RotrosenJ, LeeJD. Outcomes among buprenorphine-naloxone primary care patients after Hurricane Sandy. Addict Sci Clin Pract. 2014;9:3
45.
QatoDM, ZenkS, WilderJ, HarringtonR, GaskinD, AlexanderGC. The availability of pharmacies in the United States: 2007–2015. PLOS One. 2017;12(8):e0183172.
46.
American Pharmacists Association. n.d. Pharmacists’ Impact on Patient Safety. Washington DC: American Pharmacists Association.
47.
RiffkinR. Americans rate nurses highest on honesty, ethical standards. Gallup. http://www.webcitation.org/6hZbvKPDQ. Published 2014. Accessed May 17, 2016.
48.
KhanNS, NormanIJ, DhitalR, McCroneP, MilliganP, WhittleseaCM. Alcohol brief intervention in community pharmacies: a feasibility study of outcomes and customer experiences. Int J Clin Pharm. 2013;35(6):1178–1187.
49.
CochranG, RubinsteinJ, BacciJL, YliojaT, TarterR. Screening community pharmacy patients for risk of prescription opioid misuse. J Addict Med. 2015;9(5):411–416.
50.
CochranG, ChenQ, FieldC, . A community pharmacy-led intervention for opioid medication misuse: a small-scale randomized clinical trial. Drug Alcohol Depend. 2019;205:107570.
51.
MortonKJ, HarrandB, FloydCC, . Pharmacy-based statewide naloxone distribution: a novel “top-down, bottom-up” approach. J Am Pharm Assoc (2003). 2017;57(2S):S99–S106.e105.
52.
FischerB. Prescriptions, power and politics: the turbulent history of methadone maintenance in Canada. J Public Health Policy. 2000;21(2):187–210.
53.
ChaarBB, HanrahanJR, DayC. Provision of opioid substitution therapy services in Australian pharmacies. Australas Med J. 2011;4(4):210–216.
CalcaterraSL, BachP, ChadiA, . Methadone Matters: what the United States can learn from the global effort to treat opioid addiction. J Gen Intern Med. 2019;34(6):1039–1042.
56.
Methadone Maintenance Treatment Program Standards and Clinical Guidelines [press release]. Toronto: College of Physicians and Surgeons of Ontario; 2011.
57.
BerbatisCG, SunderlandVB, JoyceA, BulsaraM, MillsC. Enhanced pharmacy services, barriers and facilitators in Australia's community pharmacies: Australia's National Pharmacy Database Project. Int J Pharm Pract. 2007;15(3):185–191.
58.
NHS. Supervised Self Administration of Methadone and Buprenorphine Guidelines for Pharmacists and Pharmacy Technicians. Cumbria: National Health Service; 2010.
59.
StrangJ, SheridanJ, HuntC, KerrB, GeradaC, PringleM. The prescribing of methadone and other opioids to addicts: national survey of GPs in England and Wales. Br J Gen Pract. 2005;55(515):444–451.
60.
BachP, HartungD. Leveraging the role of community pharmacists in the prevention, surveillance, and treatment of opioid use disorders. Addict Sci Clin Pract. 2019;14(1):30–30.
61.
FischerB, KurdyakP, GoldnerE, TyndallM, RehmJ. Treatment of prescription opioid disorders in Canada: looking at the ‘other epidemic’?Subst Abuse Treat Prev Policy. 2016;11(1):12.
62.
DegenhardtL, CharlsonF, FerrariA, . The global burden of disease attributable to alcohol and drug use in 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet Psychiatry. 2018;5(12):987–1012.
63.
Austrailian Institute of Health and Welfare.National Opioid Pharmacotherapy Statistics Annual Data Collection 2019. Sydney, Australia: Austrailian Institute of Health and Welfare; 2020.
64.
HavensJR, WalshSL, KorthuisPT, FiellinDA. Implementing treatment of opioid-use disorder in rural settings: a focus on HIV and hepatitis c prevention and treatment. Curr HIV/AIDS Rep. 2018;15(4):315–323.
65.
RosenblattRA, AndrillaCH, CatlinM, LarsonEH. Geographic and specialty distribution of US physicians trained to treat opioid use disorder. Ann Fam Med. 2015;13(1):23–26.
66.
EiblJK, GomesT, MartinsD, . Evaluating the effectiveness of first-time methadone maintenance therapy across northern, rural, and urban regions of Ontario, Canada. J Addict Med. 2015;9(6):440–446.
67.
InsingerA. Methadone clinic lines and packed waiting rooms leave clients vulnerable to the coronavirus. In: STAT News; 2020. Boston.
68.
LevanderX, WakemanS. Covid-19 will worsen the opioid overdose crisis if we don't prepare now. In: STAT News; 2020. Boston.
69.
GriersonJ. Methadone to be supplied without new prescription during Covid-19 crisis. The Guardian. April 8, 2020.
70.
ClunR. Opioid addiction treatment must change during pandemic, experts say. The Sydney Morning Herald. April 24, 2020.
71.
TaitC, GeeM, WooA. Pandemic restrictions reshape opioid treatment as doctors sound alarm. The Globe and Mail: Alberta.2020.
72.
Controlled Drugs and Substances Act (CDSA), Subsection 56(1); Class exemption for patients, practitioners and pharmacists prescribing and providing controlled substances in Canada during the coronavirus pandemic, §5; Subsection 56(1) 2020.
73.
WyseJJ, GordonAJ, DobschaSK, . Medications for opioid use disorder in the Department of Veterans Affairs (VA) health care system: historical perspective, lessons learned, and next steps. Subst Abus. 2018;39(2):139–144.
74.
OlivaEM, MaiselNC, GordonAJ, HarrisAH. Barriers to use of pharmacotherapy for addiction disorders and how to overcome them. Curr Psychiatry Rep. 2011;13(5):374–381.
75.
LagisettyP, SmithA, AntokuD, . A physician-pharmacist collaborative care model to prevent opioid misuse. Am J Health Syst Pharm. 2020;77(10):771–780.
76.
MuzykA, SmothersZPW, CollinsK, MacEachernM, WuLT. Pharmacists’ attitudes toward dispensing naloxone and medications for opioid use disorder: a scoping review of the literature. Subst Abus. 2019;40(4):476–483. doi:10.1080/08897077.2019.1616349.
77.
VentricelliDJ, MathisSM, FosterKN, PackRP, TudiverF, HagemeierNE. Communication experiences of data-waivered physicians with community pharmacists: a qualitative study. Subst Use Misuse. 2020;55(3):349–357.
78.
YadavR, TaylorD, TaylorG, ScottJ. Community pharmacists’ role in preventing opioid substitution therapy-related deaths: a qualitative investigation into current UK practice. Int J Clin Pharm. 2019;41(2):470–477.
79.
LagisettyP, KlasaK, BushC, HeislerM, ChopraV, BohnertA. Primary care models for treating opioid use disorders: what actually works? A systematic review. PLOS One. 2017;12(10):e0186315
80.
MathesonC, ThiruvothiyurM, RobertsonH, BondC. Community pharmacy services for people with drug problems over two decades in Scotland: implications for future development. Int J Drug Policy. 2016;27:105–112.
81.
MessaadiN, PansuA, CohenO, CottencinO. Pharmacists’ role in the continued care of patients under opiate substitution treatment. Therapie. 2013;68(6):393–400.
82.
UosukainenH, BellJS, LaitinenK, TackeU, IlomäkiJ, TurunenJHO. First insights into community pharmacy based buprenorphine-naloxone dispensing in Finland. Int J Drug Policy. 2013;24(5):492–497.
83.
FDA. Guidance for Clinical Investigators, Sponsors, and Irbs Investigational New Drug Applications (Inds) — Determining Whether Human Research Studies Can Be Conducted Without an IND. Rockville, MD: Center for Drug Evaluation and Research, Food and Drug Administration; 2015.
84.
JunJK. The role of pharmacy through collaborative practice in an ambulatory care clinic. Am J Lifestyle Med. 2019;13(3):275–281.
85.
BachAT, GoadJA. The role of community pharmacy-based vaccination in the USA: current practice and future directions. Integr Pharm Res Pract. 2015;4:67–77.
86.
GreenTC, DauriaEF, BratbergJ, DavisCS, WalleyAY. Orienting patients to greater opioid safety: models of community pharmacy-based naloxone. Harm Reduct J. 2015;12:25–25.
87.
CDC. Collaborative Practice Agreements and Pharmacists’ Patient Care Services: A Resource for Pharmacists. Atlanta, GA: US Dept. of Health and Human Services, Centers for Disease Control and Prevention; 2013.
88.
JungnickelPW, DesimoneEM, KissackJC, AACP Special Committee on Substance Abuse and Pharmacy Education, . Report of the AACP special committee on substance abuse and pharmacy education. Am J Pharm Educ. 2010;74(10):S11.
89.
TommaselloAC. Substance abuse and pharmacy practice: what the community pharmacist needs to know about drug abuse and dependence. Harm Reduct J. 2004;1(1):3–3.
90.
BratbergJ. Pharmacy: Addressing substance use in the 21st century. Subst Abus. 2019;40(4):421–434.
GoodeJ-V, OwenJ, PageA, GatewoodS. Community-based pharmacy practice innovation and the role of the community-based pharmacist practitioner in the United States. Pharmacy. 2019;7(3):106.
93.
BabarZU, ScahillS, NagariaRA, CurleyLE. The future of pharmacy practice research - Perspectives of academics and practitioners from Australia, NZ, United Kingdom, Canada and USA. Res Social Adm Pharm. 2018;14(12):1163–1171.
94.
BacciJL, BerenbrokLA. Innovative advances in connectivity and community pharmacist patient care services: implications for patient safety. Pharmacotherapy. 2018;38(8):867–874.
95.
YapD. State provider status advances in 2017. Pharmacy Today. 2017;24:58.
