Interviewees told researchers that although they wanted to access buprenorphine via telehealth, they couldn’t, mainly because pharmacists provided too much “red tape” in the form of geographic restrictions, telephone prescription “confirmations,” and actual cancellations of prescriptions and refusals to fill them. Patients expected to receive this medication, but when they didn’t, some returned to injection drug use, according to a study published last month in the International Journal of Drug Policy.
Because of the COVID-19 pandemic, the in-person visit which was required before the first prescription of buprenorphine was lifted, allowing initiation and maintenance of treatment to take place via telehealth. However, pharmacies themselves put up barriers to this process by in many cases refusing to fill the prescriptions if the patients lived what the pharmacies considered to be too far away (a “red flag”).
The study was conducted by observing patients and conducting interviews focused on buprenorphine prescribing and dispensing. There were 19 patients, 24 prescribers and clinic staff, and 10 pharmacists in the study, all in Pennsylvania or California. Data was collected between May 2020 and May 2021.
The researchers concluded that even in settings where telehealth is put into place, it produces barriers. One of the concerns of pharmacies was that they would be threatened by the Drug Enforcement Administration (DEA); and some pharmacies wanted to prevent any legal challenges to them in the era of increasing scrutiny of opioid dispensing over the years.
Textor L, Ventricelli D, Aronowitz SV: “Red flags” and “red tape”: Telehealth and pharmacy-level barriers to buprenorphine in the United States. Int J Drug Policy. 2022. Jul;105:103703. Epub 2022 May 10.