ArticleThe International journal on drug policy2020
Buprenorphine dispensing in an epicenter of the U.S. opioid epidemic: A case study of the rural risk environment in Appalachian Kentucky.
Article in The International journal on drug policy, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 59 papers.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
59 citing papers in PubMed, 110 citations in OpenAlex.
- Providing medication for opioid use disorder and HIV pre-exposure prophylaxis at syringe services programs via telemedicine: a pilot study.Harm reduction journal · 2024Trial
- "I'm not going to lay back and watch somebody die": a qualitative study of how people who use drugs' naloxone experiences are shaped by rural risk environment and overdose education/naloxone distribution intervention.Harm reduction journal · 2023Trial
- Pilot evaluation of a pharmacist-led technical assistance program to address buprenorphine dispensing in community pharmacies.Exploratory research in clinical and social pharmacy · 2026Article
- "The alternative is they're not getting care at all": a qualitative interview study of opioid use disorder treatment providers' perspectives on quality and appropriateness of telehealth for buprenorphine access.Harm reduction journal · 2026Article
- Comparing Buprenorphine Treatment Outcomes Among Kentucky Medicaid Patients by Prescriber Specialty and Type.Substance use & misuse · 2026Article
- Pharmacy-level barriers to opioid overdose prevention: availability and accessibility of naloxone and buprenorphine-naloxone in high-risk Texas counties.Harm reduction journal · 2026Article
- "I wasn't scared of the dope I had anymore because I could test it myself:" A qualitative study among rural Appalachians who use drugs about experiences with a fentanyl test strip intervention.Research square · 2026Article
- County health rankings, provider shortages, and the health of incarcerated women with opioid use disorder.The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association · 2026Article
- "If he did it, I can do it, too. I can change my life around": The social model of recovery within the context of recovery homes accepting residents prescribed medications for opioid use disorder.Journal of substance use and addiction treatment · 2026Article
- "They should be like penicillin": barriers to the integration of medications for opioid use disorder in specialty treatment programs.Addiction science & clinical practice · 2025Article
- Pharmacists' Knowledge and Perceptions of Buprenorphine at New York State Pharmacies: Identifying the Extent of Pharmacy-Level Barriers to Access Buprenorphine.Clinical therapeutics · 2025Article
- Addressing wholesale distributor barriers to buprenorphine access: Consensus recommendations from the PhARM-OUD expert panel.Drug and alcohol dependence reports · 2025Article
- Pharmacy Barriers to Receiving Buprenorphine Among Patients Undergoing Telemedicine Addiction Treatment.JAMA network open · 2025Article
- Discreet but accessible: a qualitative study with people who use drugs and service staff about the optimal design of a harm reduction vending machine in rural Kentucky.Harm reduction journal · 2025Article
- Community pharmacy attitudes and behaviors following a buprenorphine best practices dissemination.The mental health clinician · 2025Article
- Different forms of stigma and rural primary care professionals' willingness to prescribe buprenorphine.Journal of substance use and addiction treatment · 2025Article
- Development of a brief stigma and perceptions questionnaire for pharmacists: An exploratory factor analysis approach in New York state counties enrolled in the healing communities study.Journal of substance use and addiction treatment · 2025Article
- Understanding MAT access in the context of unused MAT capacity in the United States: when increasing rural MAT capacity is not enough.Substance abuse treatment, prevention, and policy · 2024Observational
- The War on Drugs, Racialized Capitalism, and Health Care Utilization Among White People Who Use Drugs in 22 Rural Appalachian Counties.American journal of public health · 2024Article
- Association of economic and racial segregation with restricted buprenorphine dispensing in U.S. community pharmacies.Drug and alcohol dependence reports · 2024Article
Corrections and comments
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundBuprenorphine is a cornerstone to curbing opioid epidemics, but emerging data suggest that rural pharmacists in the US sometimes refuse to dispense this medication. We conducted a case study to explore buprenorphine dispensing practices in 12 rural Appalachian Kentucky counties, and analyze whether and how they were shaped by features of the rural risk environment.
methodsIn this case study, we conducted one-on-one semi-structured interviews with 14 pharmacists operating 15 pharmacies in these counties to explore buprenorphine dispensing practices and perceived influences on these practices. Thematic analyses of the resulting transcripts revealed three features of the rural risk environment that shaped dispensing. To explore these three risk environment features, we analyzed policy documents (e.g., Attorney General lawsuits) and administrative databases (e.g., incarceration data). Textual documents were analyzed using thematic analyses and administrative data were analyzed using descriptive statistics; memoes explored relationships among risk environment features and dispensing practices.
resultsTwelve of the 15 pharmacies limited dispensing, by refusing to serve new patients; limiting dispensing to known patients or prescribers; or refusing to dispense buprenorphine altogether. Concerns about exceeding a "Drug Enforcement Administration (DEA) cap" on opioid dispensing stifled dispensing. A legacy of aggressive and fraudulent marketing of opioid analgesics (OAs) by pharmaceutical companies and physician OA overprescribing undermined pharmacist trust in buprenorphine and in its prescribers. The escalating local war on drugs may have undermined dispensing by reinforcing stigma against people who use drugs.
conclusionsInitiatives to increase buprenorphine prescribing must be accompanied by policy changes to increase dispensing. Specifically, buprenorphine should be removed from opioid monitoring systems; efforts to de-escalate the war on drugs should be extended to encompass rural areas; initiatives to dismantle aggressive OA marketing should be strengthened; and efforts to re-build pharmacist trust in physicians are needed.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.