Supportive Alternate Site Provision of Buprenorphine: Overcoming Barriers and Improving Patient Outcomes

Abstract

Background

Improving access to medications for opioid use disorder (MOUD) is a national priority; however, these efforts commonly focus on the provider. Access to buprenorphine through retail pharmacies and stigma associated with filling prescriptions for MOUD pose additional barriers for patients when embarking on their road to recovery.

Methods

This study performed a pre-post retrospective chart review to evaluate the potential positive impact on patient retention when providing buprenorphine at office visits instead of at pharmacies. Study staff reviewed electronic medical records to document patient retention in treatment at 6 months as the primary outcome. The study evaluated as secondary outcomes missed office visits, medication adherence, illicit drug use (that drug testing results identified), and drug-related emergency department (ED) utilization. Study staff documented outcomes for patients given their buprenorphine medication at their office visit (n = 154) compared with randomly selected patients prescribed buprenorphine from the same office-based opioid treatment clinic who had to go to retail pharmacies to fill their prescriptions (n = 154).

Results

Patients receiving buprenorphine at their office visit demonstrated a 52.2% higher retention rate after 6 months compared to the control group (p = .005). Patients were more likely to attend scheduled office visits (p = .046), less likely to test positive for nonprescribed/illicit drugs (p < .001), and less likely to utilize the ED for drug-related reasons (p = .018) when the program alleviated the need to fill buprenorphine prescriptions at retail pharmacies and began to offer the pharmacy services at office visits.

Conclusions

Provision of buprenorphine to patients at their treatment visit was associated with higher patient retention rates and better health outcomes compared with patients who filled their buprenorphine at pharmacies prior to the program's integration of medication provision at patient office visits. Understanding how alleviating barriers to medication access impacts retention in care has meaningful implications for opioid use disorder patients and treatment providers.