Many local pharmacies don’t stock medications to treat opioid use disorder

June 21, 2023

Last year over 100,000 in the US died of drug overdoses.  Fentanyl mixed with xylazine is especially dangerous and increasing in frequency. Those with opioid use disorder continue to find it difficult to find effective treatment.

We know what works for opioid use disorder. Medication Assisted Treatment (MAT) cuts the risk of death in half! This is prescribing a medicine to relieve recovering addicts of the urge to use additional opioids. The most common drug used was once methadone, which generally required daily visits to a clinic so that a patient could be observed ingesting the drug, which might otherwise be sold on the street. Suboxone (Buprenorphine/naloxone) has an opioid agonist (attaches to those opioid receptors) and an antagonist (keeps users from getting a “high” if they inject other opioids). It is associated with fewer overdose deaths than methadone, and can be prescribed monthly so that patients on this medication are able to keep their jobs. Restrictions on prescribing this drug, which is available generically, were reduced during the pandemic, with no evidence of an increase in overdose deaths.

But it’s not easy to get Medication Assisted Treatment.  A study in JAMA Network Open this week showed that 42% of community pharmacies contacted by an opioid use disorder telemedicine company did not stock buprenorphine/naloxone. Chain pharmacies were more likely to stock the medication (62%), and there were large geographic variations. Eighty four percent of pharmacies in Washington State had the drug available, compared to only 37% of pharmacies in Florida. Another study in JAMA this week showed that less than a quarter (24.4%) of inpatient facilities for opioid use disorder reached by secret shoppers prescribed buprenorphine/naloxone for adolescent patients, even though this is the only FDA approved therapy for opioid use disorder in patients under 18.

Implications for employers:

-       MAT is underused and is not nearly available enough to the health plan members who need it.

-       Employers can ask their carriers for reporting on the rate of MAT prescription, and for information about access to effective drug therapy at in-plan inpatient facilities.

-       While MAT for Substance Use Disorder is not a required preventive under the Affordable Care Act, some plan sponsors offer coverage of these drugs at no member cost share as a benefit enhancement.

-       Employers can plan now for communication around evidence-based treatment for substance use during National Recovery Month which is held in September.  

Tomorrow: Semaglutide associated with large weight loss in the “real world”