Buprenorphine physician-pharmacist collaboration in the management of patients with opioid use disorder: results from a multisite study of the National Drug Abuse Treatment Clinical Trials Network

Abstract

Background and aims: Physician and pharmacist collaboration may help address the shortage of buprenorphine-waivered physicians and improve care for patients with opioid use disorder (OUD). This study investigated the feasibility and acceptability of a new collaborative care model involving buprenorphine-waivered physicians and community pharmacists.

Design: Nonrandomized, single-arm, open-label feasibility trial.

Setting: Three office-based buprenorphine treatment (OBBT) clinics and three community pharmacies in the United States.

Participants: Six physicians, six pharmacists, and 71 patients aged ≥18 years with Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) OUD on buprenorphine maintenance.

Intervention: After screening, eligible patients' buprenorphine care was transferred from their OBBT physician to a community pharmacist for 6 months.

Measurements: Primary outcomes included recruitment, treatment retention and adherence, and opioid use. Secondary outcomes were intervention fidelity, pharmacists' use of prescription drug monitoring program (PDMP), participant safety, and satisfaction with treatment delivery.

Findings: A high proportion (93.4%, 71/76) of eligible participants enrolled into the study. There were high rates of treatment retention (88.7%) and adherence (95.3%) at the end of the study. The proportion of opioid-positive urine drug screens (UDSs) among complete cases (i.e. those with all six UDSs collected during 6 months) at month 6 was (4.9%, 3/61). Intervention fidelity was excellent. Pharmacists used PDMP at 96.8% of visits. There were no opioid-related safety events. Over 90% of patients endorsed that they were "very satisfied with their experience and the quality of treatment offered," that "treatment transfer from physician's office to the pharmacy was not difficult at all," and that "holding buprenorphine visits at the same place the medication is dispensed was very or extremely useful/convenient." Similarly, positive ratings of satisfaction were found among physicians/pharmacists.

Conclusions: A collaborative care model for people with opioid use disorder that involves buprenorphine-waivered physicians and community pharmacists appears to be feasible to operate in the United States and have high acceptability to patients.

Keywords: Buprenorphine collaborative care; office-based buprenorphine treatment; opioid use disorder; pharmacist-provided care; pharmacy practice; primary care.

Conflict of interest statement

Declarations of interest: Li-Tzy Wu also has received research support from Patient-Centered Outcomes Research Institute and Centers for Disease Control and Prevention. Paolo Mannelli also received research support from Alkermes Inc. and is a consultant for Alkermes and Guidepoint Global. The other authors have no conflicts of interest to disclose.

© 2021 Society for the Study of Addiction.

Figures

Figure 1.

A summary of usual care and physician-pharmacist collaborative care model

Figure 2.

CONSORT flow diagram

Figure 3.. Opioid-positive urine drug screen (UDS) results during the maintenance phase with various imputation methods.

Note: The number of missing UDS samples at each month: Month 1 (n=0), Month 2 (n=1), Month 3 (n=1), Month 4 (n=3), Month 5 (n=6), and Month 6 (n=7). Complete cases was defined as those with all 6 UDSs collected during the 6-month maintenance phase (n=61). Positive UDS results at Month 6: complete cases (3/61, 4.9%), no imputation (3/64, 4.7%), impute missing as negative (3/71, 4.2%), and impute missing as positive (10/71, 14.1%). At Month 5, only 4 of the opioid-positive participants provided a urine sample, and the other 6 opioid-positive participants were only positive due to imputation (early termination). At Month 6, only 3 participants provided an opioid-positive urine sample, and the other 7 participants required imputation as opioid-positive.