Only about 1 in 3 pharmacies across the country are able to fill prescriptions for a critical treatment option for opioid addiction, according to a new study from the University of Southern California. 

Researchers at the USC Schaeffer Center for Health Policy and Economics found that only 39% of pharmacies in the United States were able to fill a prescription for the medication buprenorphine, a mild opioid used to treat opioid use disorder, according to a study published in the journal Health Affairs on Tuesday.

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Buprenorphine is prescribed to alleviate withdrawal symptoms and prevent relapse, similar to the more tightly regulated methadone. However, buprenorphine’s chemical profile makes it significantly less potent than methadone, meaning it minimizes withdrawal symptoms without the pain-numbing or euphoric sensations associated with a stronger opioid.

Although some studies suggest that methadone is slightly more effective in treating opioid use disorder, buprenorphine is widely considered safer in part because it does not cause slow breathing, and there is lower abuse potential.

In 2023, Congress removed federal requirements for practitioners to apply for waivers to prescribe buprenorphine to treat opioid use disorder, and the Department of Health and Human Services began more actively encouraging practitioners to treat patients with the medication.

The USC study examined pharmacy access to buprenorphine from 2017 to 2023. Nationwide, access increased from 33% in 2017 to 39% in 2023.

Researchers also found a significant race-based disparity in access to the medication, with less than 20% of pharmacies in 2023 located in black and Latino neighborhoods able to dispense buprenorphine, compared to 46% in predominantly white neighborhoods.

Dima Mazen Qato, chairwoman of the School of Pharmacy at USC and author of the new study, told the Washington Examiner that loosening these restrictions on physicians has been a positive step, but pharmacy access still is encumbered by tighter restrictions.

“A lot has focused on just these prescribing barriers. But what policy makers and regulators aren’t considering, I think, sufficiently is what’s happening after buprenorphine is described,” Qato said. “Are patients able to fill it? Are pharmacies carrying it?”

The idea for the study, funded by a grant from the Foundation for Opioid Response Efforts, which supports broader access to treatment for opioid addiction, sprang from anecdotal accounts of patients being unable to access buprenorphine even after obtaining a prescription.

“I think physicians and pharmacists are kind of concerned about this, especially if they see a lot of patients that they’re treating for opioid use disorder,” Qato said.

Buprenorphine is classified by the Drug Enforcement Administration as a Schedule III substance, meaning it has moderate or low dependence potential, alongside ketamine, anabolic steroids, and testosterone.

Pharmacies face high scrutiny from the Drug Enforcement Administration and state regulatory agencies for their dispensing of controlled substances. They also face steep legal liability for improper use of drugs they dispense, particularly opioids.

“Most of these problems around barriers to pharmacy access and availability are related to the fact that it’s controlled, so de-scheduling it may solve some of them because it kind of absolves them from these liability concerns and their responsibility for ensuring all their controlled substances are for a legitimate medical purpose,” Qato said.

Qato said 1 in 4 pharmacies that dispensed it at one point between 2017 and 2023 did not do so a year later.

OPIOID OVERDOSES HAVE FALLEN TO PRE-PANDEMIC LEVELS, CDC SAYS

Opioid overdose deaths have declined since the peak during the COVID-19 pandemic, in part due to improved access to the anti-overdose medication naloxone as well as buprenorphine and methadone.

The Centers for Disease Control and Prevention estimated in 2022 that more than 6 million people in the U.S. over age 12 struggle with opioid addiction.