ArticleJournal of the American Pharmacists Association : JAPhA
Qualitative study of blister pack use during buprenorphine low dose initiation.
Article in Journal of the American Pharmacists Association : JAPhA. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
Funding
Abstract
backgroundBuprenorphine low-dose initiation (LDI) protocols can reduce the risk of precipitated withdrawal by initiating buprenorphine at low doses without needing to be in opioid withdrawal when starting. However, they are challenging for patients to implement in outpatient settings, in part because they involve splitting doses and following a multi-day regimen with dynamic daily instructions. Blister packs offer a structured approach to completing LDI by providing prepackaged, presplit buprenorphine doses with simplified instructions; however, there are limited data of buprenorphine blister pack implementation and experiences with their use.
objectiveTo explore attitudes of health care providers and patients with outpatient buprenorphine LDI blister packing to provide insight into their use in real-world settings and inform blister-packing implementation.
methodsA qualitative study of interviews with buprenorphine prescribers, pharmacists, and patients with opioid use disorder who had attempted LDI in the past 3 months to explore attitudes about using blister packs during LDI. Participants were recruited from 2 safety-net substance use clinics and Community Behavioral Health Services Pharmacy in San Francisco. Interviews were transcribed, coded, and analyzed using thematic analysis to identify major themes.
resultsA total of 33 participants were interviewed (9 buprenorphine prescribers, 5 pharmacists, and 19 patients). Major themes included 1) blister packing facilitated ease of LDI and reduced medication errors; 2) close collaborations with a public health pharmacy, along with dedicated workflows and protocols, facilitated implementation; 3) challenges with blister pack preparation and packaging were identified as barriers for further expansion to other pharmacies.
conclusionBlister packing was identified as a tool to allow patients to successfully complete outpatient buprenorphine LDI. Standardized protocols and collaboration with pharmacists at a public health pharmacy were key facilitators. Partnering with local pharmacies to inform implementation strategies and identify barriers, along with pharmacist education, may help expand use of buprenorphine LDI blister-packing.
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