Pharmacists Play Key Role in Rapid Induction, Retention for Opioid Use Disorder Treatment

In an interview with Pharmacy Times®, Rajinder Shiwach, MD, MRCPsych, a board-certified psychiatrist and medical director at Hickory Trail Hospital in DeSoto, Texas, emphasizes the essential role of pharmacists in supporting retention and adherence during early stages of opioid use disorder care. He advises pharmacists to maintain strong professional relationships, educate patients on injection-site care, and counsel on available administration options. Shiwach further encourages expanding awareness and institutional adoption of rapid induction approaches, highlighting their FDA approval, ability to reduce attrition, and life-saving potential for patients at high risk of fentanyl-related relapse.

This transcript was lightly edited for flow and clarity using artifical intelligence.

Pharmacy Times: How can pharmacists involved in opioid use disorder treatment support patient retention and adherence during the early, high-risk phase of care?

Rajinder Shiwach, MD, MRCPsych: Yeah, it’s very similar to what we clinicians experience in our patients. The mental health disorder and chemical dependency groups share similar patterns—one of them being retention. I think the key there is the relationship with the patient, professional rapport, education, and availability of the clinician or staff involved in treatment for any questions or concerns. If you fulfill those 3 main criteria, you’ll have better retention.

Pharmacy Times: Given that extended-release buprenorphine is an injectable formulation, what practical considerations or counseling points should pharmacists emphasize when discussing this option with patients?

Shiwach: Yes, we have seen in some patients aesthetic complaints about having the injection in, say, the abdominal wall—it looks unseemly when they’re swimming in the summer. I think pharmacists should educate patients and let them know there are 4 possible sites: the gluteal, thigh, abdomen, and back of the upper arm. Knowing that there are multiple options and the ability to rotate sites helps, because evidence shows the pharmacokinetic levels are the same regardless of site. Patients should also be advised not to disturb the injection site. As long as the procedure is done properly, infection risk is negligible, but if patients scratch or peel the scab, issues can arise. So, general hygiene and site care are key counseling points.

Pharmacy Times: What do you see as the next steps for integrating rapid induction strategies into broader OUD treatment settings, and where do pharmacists fit into that evolution?

Shiwach: I think there are various injection sites, and as a clinic we can provide it under the REMS protocol. Awareness is key—letting your colleagues know that this option is now FDA-approved. I believe since February of this year, rapid induction has been available. It reduces attrition because the standard 7-day protocol is too long for some patients. You might give them a prescription for sublingual buprenorphine and they disappear, but this way you get the drug inside them right away. It helps prevent mortality by reducing respiratory depression risk. So, spread the word to colleagues. If you’re in a hospital setting, make sure it’s on the formulary with administrative approval. Educate peers that it’s a better option and involves less diversion risk compared with sublingual formulations.

Pharmacy Times: Is there anything else that you would like to add?

Shiwach: Just to emphasize that it really can be life-saving in some cases. As a clinician, I’ve lost patients to fentanyl—we detox them, send them home, and then they relapse with oral sublingual use and don’t survive another day. This treatment benefits a very vulnerable population. Despite government efforts to slow the influx of fentanyl, it’s everywhere, so I think this is hopefully a clinical advance that will help many people and save lives.