Pharmacists' role in buprenorphine management for opioid use disorder: A narrative review

The continued rise in patients treated for opioid use disorder (OUD) has called for an increase in access to OUD therapies. Pharmacists, who have previously demonstrated their value in various disease states, have begun to address gaps in OUD care by facilitating buprenorphine treatment. The objective was to review current literature and characterize the pharmacists' role in buprenorphine collaborative care models for patients with OUD. PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and Google Scholar were queried through May 2021. Studies were included if a pharmacist was part of a care model in which buprenorphine was prescribed for OUD and excluded if there was a pain management indication, a limited pharmacist role, or a survey methodology was used. Eight care models were included in this review. Key characteristics identified were (1) pharmacist role, (2) collaborating prescriber type, (3) clinic setting, (4) pharmacist practice type, and (5) outcomes. All models were located within a variety of outpatient settings. No collaborative practice model involved autonomous buprenorphine prescriptive authority by pharmacists. The majority utilized a psychiatrist as a collaborating prescriber, alongside a psychiatry-trained pharmacist. Less than half utilized pharmacists to make dosing recommendations. Outcomes evaluating treatment retention and relapse rates were most reported. Most outcomes identified across each model were either improved or unchanged by pharmacist involvement. Pharmacists are valued members of buprenorphine care teams across a variety of settings, collaborate with various clinicians, and have a positive impact on patient outcomes such as treatment retention and relapse. Few published collaborative care models exist, suggesting pharmacists may be underutilized in caring for this growing patient population. The role of the pharmacist in buprenorphine management is not currently well-defined; however, pharmacists are well prepared to take a more active role to help address the opioid crisis.