Expert: How Psychiatric Pharmacists Strengthen SUD Care Through Team-Based Approaches

Ashley Maister, PharmD, BCCP, a clinical pharmacy practitioner in mental health at the US Department of Veterans Affairs, and Aaron Salwan, PharmD, MPH, BCCP, a clinical pharmacy specialist in behavioral health at Montefiore Nyack, discussed how psychiatric pharmacists collaborate closely with interdisciplinary teams to improve substance use disorder (SUD) care. These teams include physicians, case managers, social workers, and counselors.

In their continued conversation with Pharmacy Times, Maister and Salwan emphasized the value of team-based decision-making, particularly when medication changes may affect patient behavior or outcomes. They also highlighted policy barriers that limit pharmacists’ ability to support continuity of care, such as restrictions on prescribing authority and DEA licensure. Expanding prescribing privileges, reimbursement pathways, and access to harm reduction services could strengthen the role of psychiatric pharmacists in SUD treatment.

Pharmacy Times: How do psychiatric pharmacists collaborate with interdisciplinary teams to improve SUD care and patient outcomes?

Aaron Salwan, PharmD, MPH, BCCP: We certainly talked about how we interface with physicians or prescribers. Another aspect that I don’t know if anyone appreciates, or has the same experience in a different specialty, is that we work very closely with case managers, social workers, and counselors. We could have the best idea for what medicine could be helpful, but if the patient has no way to access it, then it’s not useful at all.

I have a close relationship with our counselors and discharge planners, trying to ensure that as patients move from one phase of treatment to another, there’s not a lapse in care. Another, more clinical approach is that if I observe a patient in a group and see their behavior is different or has changed, and I can link it to a medication that was newly started or adjusted, that turns into more of an interdisciplinary conversation.

Instead of going directly to the physician and saying, “Hey, I think you need to do this,” it involves other members of the care team. We ask questions like, “Did you notice this?” or “I think this patient has this type of issue—what do you think?” It becomes truly collaborative before we pull the trigger on a change like that.

Pharmacy Times: What changes in policy or practice are needed to expand the impact of psychiatric pharmacists in SUD treatment?

Ashley Maister, PharmD, BCCP: As someone who practices with a scope of practice, I think the ability to do things—not necessarily independently—but to prescribe and get medication to the patient faster is really important. Being able to follow through on what we’ve already discussed and agreed to with the patient is critical. With the removal of the X-waiver, allowing psychiatric pharmacists, especially those working in substance use disorder clinics, to prescribe buprenorphine or controlled substances would improve continuity of care.

At the VA, where I practice, the states where I hold pharmacist licenses don’t allow pharmacists to have DEA licenses, and the requirements are very specific. If you’re not at the VA and you’re working in a state like Pennsylvania, you can’t, for example, have an Idaho pharmacist license. The federal umbrella helps in some ways, but it also adds extra expense and upkeep.

If pharmacists, regardless of the state where they practice, were able to have DEA licenses and independently initiate and manage buprenorphine, I think that would expand their impact and strengthen their role in patient follow-up.

Salwan: That’s exactly where my mind went as well—the ability to prescribe and have a DEA license. It does seem that laws have changed so pharmacists in nearly every state are able to administer long-acting injectables. I don’t know what the uptake has been, but there’s a need for reimbursement, so pharmacists in any setting are inclined to offer that service.

Many of the skills pharmacists provide aren’t always billable or tied to a diagnostic code that would make adding a psychiatric pharmacist to a clinic seem profitable. That said, psychiatric pharmacists bring so much value that integration into health systems should clearly be beneficial and cost-saving overall. From a more structural or infrastructure point of view, there also needs to be greater support for addiction services and harm reduction services.

This includes sterile syringe programs, drug testing devices, and access to Narcan or naloxone. These are things we can never have enough of given the needs of our population. Overall, psychiatric pharmacists have a lot to offer, and that’s demonstrated by those working in the field every day.