Pharmacists’ Role in Reducing Stigma and Expanding Buprenorphine Access for Opioid Use Disorder

In this Pharmacy Times interview with Caroline Pearson, executive director at Peterson Health Technology Institute (PHTI), she discusses the urgent need for pharmacists to address stigma surrounding opioid use disorder (OUD) and ensure patients feel supported in continuing treatment. Pearson highlights the importance of maintaining strong insurance coverage for treatment programs, reducing financial barriers, and sustaining policy flexibilities—such as the removal of the X-waiver and expanded teleprescribing—that have improved access to buprenorphine. She emphasizes that pharmacists play a critical role in fostering recovery-friendly environments while advocating for policies that preserve patient access to these life-saving medications.

Pharmacy Times: For pharmacists and other healthcare providers, how clinically meaningful is an additional 13 days of treatment retention?

Caroline Pearson, Executive Director, PHTI: When we talk to clinical experts, they are very clear: every day that somebody falls out of treatment is a day that they are at risk of overdose. In fact, right after someone has been in treatment is one of the highest-risk periods, when some of the highest rates of overdose occur.

In that sense, 13 days is meaningful. When you talk to experts in the field, they point out that 13 days of improvement is more than they have seen from many other interventions. So, it is clinically meaningful, but it is not satisfactory. It is certainly not something that we can accept as good enough, given that we still see relatively modest rates of treatment retention.

We know that the OUD journey is long, and we need to continue pushing for longer-term, more effective treatment options for all people with addiction.

Pharmacy Times: Among the solutions you evaluated, were there any innovations or models that stood out as especially promising?

Pearson: I think virtual care, and particularly digital support services, is a really nice addition to treatment options. Folks benefit from many different approaches. For some people, the ability to have peer support and group conversations with others who are in recovery is very powerful.

Being able to move that out of the church basement, so to speak, and into a virtual Zoom room helps people continue to participate in those peer support programs in a way that is convenient, while building on models that have been trusted for decades.

Similarly, contingency management is a program where monetary rewards are used to keep people in treatment. As you continue to adhere to treatment, you accrue rewards. That is something that has been tested and proven to be effective across a number of substance use disorders, including opioid use, and it is something we want to explore more as well.

Pharmacy Times: What are the most important actions that pharmacists, providers, payers, and policymakers should take now to help virtual OUD solutions reach their full potential?

Pearson: First and foremost, I think it’s important that pharmacists recognize the magnitude of stigma that still exists around opioid use disorder. Pharmacies have been places where patients have expressed concerns about stigma in the past. Not all pharmacies want to stock buprenorphine because of concerns around the customer base and the stigma associated with it.

So, first, we need to take a look at ourselves and make sure that we are doing everything we can to invite people who are in recovery to continue their treatment and to help lower some of that stigma.

I would also say that making sure we have good coverage for treatment programs—across insurance and other public health agencies—is important. We know that financial barriers to care are a real concern and prevent people from being able to stick with treatment.

There is also a lot to do in the policy environment. We have already seen an evolution of DEA rules, such as the removal of the X-waiver, and some of the current temporary rules around teleprescribing of buprenorphine have really improved access to these clinically effective medications. Ensuring that policymakers continue some of the flexibilities we saw during COVID is critical to making sure buprenorphine access and prescribing remain available to every patient who needs it.

I think those are all important steps that we need to see as we continue on this journey.