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More than 6 million people in the United States had an opioid use disorder (OUD) in 2022, according to the Substance Abuse and Mental Health Services Administration's (SAMHSA) National Survey of Drug Use and Health (NSDUH).Yet, less than 4 in 10 who needed treatment for OUD actually received any treatment at all.
While OUD treatment options include pharmacotherapy with one of three medications—methadone, buprenorphine, or extended release injectable naltrexone—evidence suggests that too many people are not able to access these lifesaving medications, particularly buprenorphine which is the only medication of these three that are available at pharmacies. Addiction Specialist Physicians (ASPs) and other clinicians have reported increasing difficulties filling prescriptions for buprenorphine at pharmacies and research studies have bolstered these reports.
Buprenorphine is an evidence-based treatment for OUD. As a partial opioid agonist, buprenorphine’s pharmacological properties help to diminish the effects of physical dependency to opioids, decrease cravings, increase safety in cases of overdose, and lower the potential for opioid misuse. Yet, prescribers continue to face obstacles getting this medication to their patients.
This page will provide updates on ASAM's advocacy efforts, communications from the federal agencies and Congress, select research, and a form to report access issues at pharmacies for clinicians experiencing issues.
Communications from Federal Agencies and Congress
- March 11, 2024: Joint letter from the Drug Enforcement Administration (DEA), US Department of Health and Human Services, and the US Department of Justice reinforcing support for medications to treat opioid use disorder and urging distributors to reexamine any quantitative thresholds that may inhibit access to medications.
- February 8, 2024: Bipartisan US Senate letterto the Food and Drug Administration (FDA) requesting that buprenorphine be added to the agency's essential medicines list.
- December 2023: SAMHSA Policy Priority Roundtable Summary Report:In August 2022, SAMHSA convened a Policy Priority Roundtable with pharmacy organizations, state health departments, nonprofit associations, academic institutions, and people with lived experiences where pharmacy organizations called for an opportunity to engage directly with federal agencies about challenges affecting buprenorphine supply.
- December 2023: SAMHSA Virtual Town Hall Report:SAMHSA joined other federal partners to jointly host a town hall where participants, including pharmacy organizations involved in buprenorphine distribution, discussed challenges and solutions to increase access to this life-saving medication.
- May 5, 2023:Senators Hassan, Heinrich & Colleagues Call on DEA to Remove Barriers to Lifesaving Opioid Treatment. The letter calls attention to reports of patients unable to get their buprenorphine prescriptions at pharmacies. Read the full letter here.
- March 23, 2023: Congressman Paul Tonko and colleagues sent a letter to DEA recommending additional actions to remove barriers to buprenorphine, especially at US pharmacies. Read the full letter here.
- January 20, 2023: Letter from DEA noting that agency regulations nor the Controlled Substance Act establish quantitative thresholds or place limits on the volume of controlled substances DEA registrants can order and dispense. The letter also noted a requirement to establish systems to identify and report suspicious orders of controlled substances, including for MOUD.
Select Research
- Cooper HL, Cloud DH, Freeman PR, et al. Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky.Int J Drug Policy. 2020;85:102701. doi:10.1016/j.drugpo.2020.102701
- Hill, L. G., Light, A. E., Green, T. C., Burns, A. L., Zadeh, P. S., & Freeman, P. R. (2023). Perceptions, policies, and practices related to dispensing buprenorphine for opioid use disorder: a national survey of community-based pharmacists.Journal of the American Pharmacists Association, 63(1), 252-260.
- Hill, L. G., Loera, L. J., Torrez, S. B., Puzantian, T., Evoy, K. E., Ventricelli, D. J., ... & Reveles, K. R. (2022). Availability of buprenorphine/naloxone films and naloxone nasal spray in community pharmacies in 11 US states.Drug and alcohol dependence, 237, 109518.
- Kazerouni NJ, Irwin AN, Levander XA, Geddes J, Johnston K, Gostanian CJ, Mayfield BS, Montgomery BT, Graalum DC, Hartung DM. Pharmacy-related buprenorphine access barriers: An audit of pharmacies in counties with a high opioid overdose burden.Drug Alcohol Depend. 2021 Jul 1;224:108729. doi:
- Ostrach B, Carpenter D, Cote LP. DEA Disconnect Leads to Buprenorphine Bottlenecks. Journal of Addiction Medicine. 2021;15(4):272-275. doi:10.1097/ADM.0000000000000762
- Ostrach B, Potter R, Wilson CG, Carpenter D. Ensuring buprenorphine access in rural community pharmacies to prevent overdoses.Journal of the American Pharmacists Association. 2022;62(2):588-597.e2. doi:10.1016/j.japh.2021.10.002
- Qato, D. M., Watanabe, J. H., & Clark, K. J. (2022, August). Federal and state pharmacy regulations and dispensing barriers to buprenorphine access at retail pharmacies in the US. In JAMA Health Forum (Vol. 3, No. 8, pp. e222839-e222839). American Medical Association.
- Textor L, Ventricelli D, Aronowitz SV. ‘Red Flags’ and ‘Red Tape’: Telehealth and pharmacy-level barriers to buprenorphine in the United States.International Journal of Drug Policy. 2022;105:103703. doi:10.1016/j.drugpo.2022.103703
- Trull G, Major E, Harless C, Zule W, Ostrach B, Carpenter D. Rural community pharmacist willingness to dispense Suboxone® - A secret shopper investigation in South-Central Appalachia.Exploratory Research in Clinical and Social Pharmacy. 2021;4:100082. doi:10.1016/j.rcsop.2021.100082
- Weiner SG, Qato DM, Faust JS, Clear B. Pharmacy Availability of Buprenorphine for Opioid Use Disorder Treatment in the US. JAMA Netw Open. 2023 May 1;6(5):e2316089. doi: 10.1001/jamanetworkopen.2023.16089. PMID: 37234009; PMCID: PMC10220511.
ASAM Resources
If you or your patient is experiencing issues obtaining buprenorphine prescriptions from pharmacies, please let ASAM know by completing this survey. If you have questions about the survey, please reach out to ASAM at advocacy@asam.org.
