Role of pharmacies in buprenorphine treatment

Background: Buprenorphine, an opiate replacement treatment for opiate dependence prescribed by generalist physicians in their offices, is a novel approach which promises to increase access to treatment, to reduce stigma, and pose less risk of abuse than methadone due to its combination with opiate antagonist naloxone. However its dissemination has been slow and has been primarily limited to more affluent white patients with prescription opiate addiction rather than low-income heroin addicts. In contrast to methadone, buprenorphine treatment relies on pharmacies to dispense buprenorphine prescriptions. This study describes barriers to treatment that pharmacy dispensing creates for low-income patients. Method: geotemporal mapping of buprenorphine prescription filling patterns in New York City, semi-structured interviews with 15 pharmacists sampled purposively based on geotemporal prescription map, semi-structured interviews with 10 health administrators involved in buprenorphine dissemination in New York City. Observations of patients in an urban public hospital primary care buprenorphine clinic will also be analyzed and guide the understanding of how low-income heroin users deal with the challenges pharmacies pose. Preliminary Findings: Many patients have difficulty finding pharmacies that stock buprenorphine. For the uninsured the cost of buprenorphine is prohibitive, for others restrictions on their Medicaid benefits erect barriers to continuity of care. For pharmacists, an extensive buprenorphine regulation system, as well as negative attitudes toward opiate dependent patients, may discourage them from stocking buprenorphine. Discussion: Low-income patients seeking buprenorphine treatment may need assistance and education in navigating the pharmacy and insurance system.