ArticleThe International journal on drug policy2022
'Red Flags' and 'Red Tape': Telehealth and pharmacy-level barriers to buprenorphine in the United States.
Article in The International journal on drug policy, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 25 papers, 1 of them a synthesis that pooled it.
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Who cites it
25 citing papers in PubMed, 1 synthesis or guideline pooled it, 59 citations in OpenAlex.
- Patient and provider experiences with opioid use disorder care delivered via telehealth: A systematic mixed-studies review.Drug and alcohol dependence · 2025Pooled it
- Pilot evaluation of a pharmacist-led technical assistance program to address buprenorphine dispensing in community pharmacies.Exploratory research in clinical and social pharmacy · 2026Article
- Global perspectives on telemedicine-enabled medications for opioid use disorder: Practices, priorities, and barriers.Journal of telemedicine and telecare · 2026Article
- Risk of opioid overdose during buprenorphine treatment for opioid use disorder in the fentanyl era.Addictive behaviors · 2026Article
- Narrative Review of Opioid Use Disorder Treatment Changes During the COVID-19 Pandemic and Their Impact on American Indian/Alaska Native Communities.Nursing open · 2026Review
- Leveraging pharmacy partnerships and Grant funding to improve access to medications for opioid use disorder.Exploratory research in clinical and social pharmacy · 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
- A multi-method spatial examination of factors associated with changes in geographic accessibility to buprenorphine providers in HEALing communities study states Kentucky, Massachusetts, and Ohio.Preventive medicine reports · 2025Article
- Patient and clinician experiences with the implementation of telemedicine and related adaptations in office-based buprenorphine treatment during the COVID-19 pandemic: a qualitative study.Addiction science & clinical practice · 2025Article
- Early findings on home delivery of buprenorphine and retention in treatment for opioid use disorder.Addiction science & clinical practice · 2025Article
- Barriers and facilitators to implementing CareConnect: A telehealth, low-barrier buprenorphine bridge clinic in Philadelphia.The International journal on drug policy · 2024Article
- "You might be nice, but where you take me, they're not gonna be": Preferences for field-based post-overdose interventions.Drug and alcohol review · 2024Article
- Impact of Perceived Access and Treatment Knowledge on Medication Preferences for Opioid Use Disorder.Substance use & addiction journal · 2024Article
- Patients' and Clinicians' Experiences with In-person, Video, and Phone Modalities for Opioid Use Disorder Treatment: A Qualitative Study.Journal of general internal medicine · 2024Article
- Patient and Clinician Experiences with the Implementation of Telemedicine and Related Adaptations in Office-Based Buprenorphine Treatment During the COVID-19 Pandemic: A Qualitative Study.Research square · 2024Article
- Leveraging prescription monitoring program data to evaluate the implementation of buprenorphine telehealth flexibilities: An interrupted time series analysis in Texas.Drug and alcohol dependence reports · 2024Article
- Assessing suboxone access in community pharmacies: Secret shopper model.Exploratory research in clinical and social pharmacy · 2023Article
- Adaptation of the Tele-Harm Reduction intervention to promote initiation and retention in buprenorphine treatment among people who inject drugs: a retrospective cohort study.Annals of medicine · 2023Article
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Corrections and comments
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Authors and funding
3 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundStructural vulnerabilities for people who use drugs (PWUD) were exacerbated by the COVID-19 pandemic. In this context, federal lawmakers in the United States (U.S.) invoked an exemption to the 2008 Ryan Haight Act requiring in-person evaluation to prescribe buprenorphine for treatment of opioid use disorder (OUD), which allowed for the initiation and maintenance of buprenorphine via telehealth. Despite the potential for telehealth to address some of the geographic disparities in OUD treatment access, recent research has suggested that significant barriers to buprenorphine also exist at the pharmacy level. The purpose of this study was to qualitatively assess how efforts to increase access to buprenorphine via telehealth are implemented by prescribers and pharmacists and experienced by patients.
methodsParticipant observation and semi-structured interviews focused on telehealth for OUD treatment and buprenorphine prescribing and dispensing were conducted with patients (n = 19), prescribers and clinic staff (n = 24), and pharmacists (n = 10) in Pennsylvania and California between May 2020 - May 2021.
findingsWhile participants stated that telehealth for OUD treatment was a welcome option, pharmacy-level barriers to buprenorphine persisted. Geographical distance from patient to provider or pharmacist continued to serve as "red flags" for pharmacists, leading to pharmacy-level "red tape:" gatekeeping measures including geographic restrictions, telephone prescription "confirmations," prescription cancellations and refusals. Patients' unmet expectations of buprenorphine access in some cases led to unanticipated risks including a return to injection drug use.
conclusionChallenges to increasing buprenorphine access persist in the U.S. even in settings where telehealth is implemented, and telehealth may inadvertently produce new barriers for some patients. Despite national support for policies aimed at increasing access to treatment for substance use disorders rather than punishment, policy shifts from punishment to treatment have not permeated evenly across all geographic areas and populations. Perceived threats of Drug Enforcement Administration (DEA) enforcement, and self-defensive institutional practices in pharmacies, reinforce ideologies of drug law enforcement, leading to poor patient outcomes including lack of buprenorphine access.
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