Access to treatment for opioid use disorder (OUD) is a challenge in rural settings and for communities of color, partly because it can be hard to find providers who are able and willing to prescribe medications for OUD (MOUD).
Pharmacists have been suggested as one way to enhance access to MOUD, as they’re often more available in rural and other underserved communities than primary care physicians or other prescribers.
A key question, however, is whether pharmacies are adequately prepared to distribute medications and other resources to people with OUD. This study, CTN-0124, Assessment and Design of a Cost-Effective Collaborative MOUD Delivery System, aimed to answer that question by examining the potential role of pharmacies in MOUD delivery, looking at what barriers exist, and proposing strategies for improvement.
To address this issue, the study team developed a 9-month “engineering systems analysis,” a problem-solving approach that breaks a system into its individual parts, analyzes how well those parts work together to accomplish their purpose, and creates a proposed design for the future.
To perform this analysis, the study team, made up of 5 systems analysis, as well as experts in pharmacy systems and law, worked together with a regional chain of over 70 independent pharmacies serving rural and underserved communities in Wisconsin and Michigan to assess MOUD distribution processes, regulation, staffing, data systems, training, and reimbursement. They also interviewed 43 subject matter experts (community pharmacists, members of pharmacy associations, and addiction experts), and, finally, looked for opportunities for process improvement.
When the project began, the study team believed pharmacy roles related to MOUD distribution could easily expand. However, after the study, the team changed its mind, now believing that while this may be possible in large population centers, dramatic expansion in rural and underserved areas will be impractical without significant systemic change.
For pharmacies to take a greater role in MOUD access, the study team says, they need to take advantage of a range of technological innovations to try to overcome all the barriers they and their staff would face.
The team’s specific recommendations, presented in the paper, are based on 9 themes that came up in their analysis: 1) mindset and stigma, 2) simplified and powerful prescription drug monitoring programs (PDMPs), 3) innovations in technology, 4) work simplification, 5) family education and support, 6) integration with other health providers, 7) regulatory reform, 8) reimbursement, and 9) integrated demonstration.
The findings of this system analysis reveal plenty of potential for pharmacies to play a significant role in expanding access to MOUD in underserved communities. However, this expansion will be more complicated than originally expected. Significant systemic changes will be necessary, and challenges like thin profit margins, staff shortages and burn-out, and the stigma surrounding addiction and mental health disorders are all major barriers to widespread adoption.
In light of these findings, the conversation may need to change to one more focused on the crucial role of regulatory, reimbursement, workflow, and technological innovations needed to support pharmacies and their staff in this new role and help them overcome these barriers and challenges.