Four models of pharmacist‐integrated office‐based opioid treatment

Purpose In 2019, one point six million Americans had opioid use disorder (OUD), yet only 18% of those patients received treatment with evidence-based medications. Office-based opioid treatment (OBOT) is the provision of care for OUD with buprenorphine, in various formulations including combination with naloxone, and naltrexone. Currently, there are few reports of physician-pharmacist collaborative practice models for OBOT. The purpose of this study was to identify common roles, clinical backgrounds, and barriers of pharmacists within four pharmacist-integrated OBOT services in one community. Methods Four pharmacists implemented OBOT services in a family medicine (FM) residency, obstetrics-gynecology residency, a physician-owned FM practice, and a Federally Qualified Health Center. Each pharmacist detailed the evolution of OBOT models at their respective sites. Using a 21-item questionnaire comprised of closed and open-ended questions, the four pharmacists describe: the setting's OBOT; the pharmacist's OUD-related training; pharmacist-related OBOT activities; and barriers to implementation. Results One pharmacist spends 10 to 20 h/wk on OBOT, while the others spend less than 10 h. In terms of patient care, two pharmacists conducted intake, group visits, collected vitals, and ensured naloxone access. All pharmacists counseled patients and conducted follow-up visits. For nonpatient care activities, three pharmacists developed OBOT policies/procedures, and four coordinated care and consulted on OBOT cases. To prepare for this, two pharmacists learned about OUD in pharmacy school, two pharmacists completed the buprenorphine waiver-training course, two pharmacists learned about OUD in residency, and three pharmacists attended continuing education. Barriers identified were lack of designated time, funding, and ability to prescribe buprenorphine. Conclusion Pharmacists can effectively integrate into many OBOT settings. Future work should standardize the optimal role of the pharmacist, expand OUD pharmacy education, and advocate for pharmacists as waivered providers.