1 SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 

SAMHSA/DEA Virtual Town Hall:

Expanding Buprenorphine Access in 

Pharmacies to Treat Opioid Use Disorder 

1 . For an overview of the MDL and related settlements, see https://crsreports.congress.gov/

product/pdf/LSB/LSB10365 and https://www.justice.gov/opa/pr/department-justice-filesmotion-multi-district-opioid-case/

As overdose deaths involving opioids remain at historically high levels in the United States 

and gaps in treatment for opioid use disorder (OUD) persist, the need to increase access 

to buprenorphine is critical. Pharmacists are well positioned to play a key role in expanding 

access to this life-saving treatment, but regulatory-, market-, and provider-level barriers 

hinder their potential. These barriers include manufacturer/distributor-imposed thresholds 

on pharmacists’ ability to dispense buprenorphine, which became significantly stricter as a 

result of the opioid Multidistrict Litigation (MDL) settlement and other recent settlements 

with opioid manufacturers, wholesalers, and distributors;1

 financial and other disincentives 

for pharmacists to dispense buprenorphine; limitations on the role pharmacists can play 

as prescribers; and the tenacious influence of stigmatization at the individual, provider, and 

community levels.

Seeking to better understand the interconnected challenges with ensuring buprenorphine 

availability in pharmacies, in August 2022, the Substance Abuse and Mental Health Services 

Administration (SAMHSA) with the Office of the Assistant Secretary of Health convened 

pharmacy community members in a Policy Priority Roundtable on Buprenorphine Access 

and Availability in Pharmacy Settings. Among the views that emerged from that meeting 

was a call for continued opportunities for participants to bring concerns and solutions 

directly to the Drug Enforcement Administration (DEA) and other federal agencies.

As a step toward responding to feedback from that meeting, SAMHSA’s Office of the 

Chief Medical Officer, the Office of the Assistant Secretary of Health, and the DEA hosted 

a virtual town hall on March 29, 2023, bringing together participants from the DEA and 

the U.S. Department of Health and Human Services (HHS), as well as from pharmacy 

organizations, and manufacturers/distributors. Town Hall participants discussed barriers to 

increasing the availability of buprenorphine in pharmacies, and they brainstormed solutions. 

Participants also shared their views on strengthening communication pathways. This report 

shares themes from the Town Hall discussions. To encourage participants to speak freely, 

participants were promised anonymity. Therefore, no names or specific organizations are 

associated with the opinions shared below.

Note: This report represents the opinions of the participants in the Town Hall meeting and 

does not reflect an official position or policy of any federal or state agency.
SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 2

2. For DEA guidance on reporting suspicious orders of controlled substances, go to https:// www.deadiversion.usdoj.gov/GDP/(DEA-DC-065)(EO-DEA258)_Q_A_SOR_and_Thresholds_

(Final).pdf; A suspicious order Q&A is at https://www.deadiversion.usdoj.gov/faq/sors_faq.htm

Among the most important barriers identified by pharmacy participants concern limits on 

supply that threaten their ability to consistently order, receive, and dispense buprenorphine 

prescriptions. 

Manufacturers/distributors establish supply thresholds as a part of their anti-diversion 

efforts, and pharmacies who surpass these thresholds have reported being cut off from 

ordering buprenorphine without warning. 

Pharmacists attending the Town Hall meeting said they often do not know what their 

thresholds are or how close they are to approaching their thresholds with each order. 

Without this information, they can’t take steps to mitigate a potential disruption in supply. 

Complicating the matter, each manufacturer/distributor may have a different threshold.

One participant reportedly asked a distributor directly about their pharmacy’s threshold 

and was told that, because the information was a regulatory issue, the distributor was not 

allowed to share the specific threshold with the pharmacy. In the meantime, the participant 

said community members were dying from a lack of buprenorphine. In another case, a 

pharmacy had to undergo the expense and disruption associated with an audit triggered by 

a stop from the manufacturer, which took about a month to resolve.

Several pharmacy participants confirmed confusion around manufacturer/distributor 

thresholds. Although supply must be monitored, the DEA does not require manufacturers or 

distributors to establish thresholds or apply algorithms to trigger holds on buprenorphine.2

 

However, in light of the MDL agreements in place, one participant suggested that 

distributors may be interpreting each manufacturer’s guidance in an especially risk-adverse 

light. Another observed that guidance on suspicious monitoring programs may not be 

specific or direct enough to allow pharmacists to change a practice or to know exactly what 

they’re allowed to do.

“We’re dealing with a very frightened [buprenorphine] 

supply chain at this point.”

Unclear Manufacturer/Distributor Thresholds 

Participant views related to barriers or challenges to buprenorphine supply are organized 

under the following topics:

• Unclear manufacturer/distributor thresholds.

• Supply and demand.

• Lengthy resolution processes.

• Pharmacist hesitation. 

• Red flags/trigger alerts.

Barriers
3 SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 

A pharmacy participant said that although there are indeed systems to request an increase 

in the threshold, it’s a tedious, time-consuming process that doesn’t necessarily result in a 

favorable outcome for patients. Other participants concurred that the process for resolving 

a stop in supply was lengthy. One participant said that manufacturers/distributors take 

months to respond to a request for a threshold increase, and often the request is still denied. 

Another agreed, saying that resolving an issue with the manufacturer/distributor took about 

3 months of back-and-forth communication.

Box 1. Federal-Level Commitment to Increasing Access to Buprenorphine

Since its approval as a scheduled substance to treat OUD in 2002, regulatory barriers 

to accessing buprenorphine continue to be incrementally addressed. Most recently, 

in December 2022, the Biden Administration removed the need for providers to 

obtain a DATA-waiver (commonly known as an X-waiver) to prescribe buprenorphine 

to patients, a measure that had been in place since 2000. The removal of the DATAwaiver means there is no longer a federal limit on the number of patients a provider 

can treat with buprenorphine at any one time. While many challenges remain, federal 

agencies are seeking ways to address regulatory barriers to accessing buprenorphine 

while ensuring the system adequately discourages diversion.

Lengthy Resolution Processes

Some pharmacy participants indicated they were concerned about thresholds in part 

because they anticipate an increased need for buprenorphine as a result of the removal of 

the DATA-waiver requirement (see box 1). If the repeal of the DATA-waiver works as intended, 

the number of buprenorphine prescribers could potentially increase. Such an increase could 

result in pharmacies needing to fill more buprenorphine prescriptions, which could trigger 

stops in supply. 

Pharmacists in attendance noted that, in addition to filling scripts from new prescribers, 

other factors could significantly and suddenly influence the volume of buprenorphine 

they need, such as the closure of a nearby pharmacy, or the recently mandated access to 

medication-assisted treatment in correctional facilities in some states. Pharmacists question 

whether manufacturer/distributor thresholds have accounted for the anticipated increase in 

buprenorphine scripts and whether suppliers can adjust their thresholds rapidly to changing 

market circumstances.

Manufacturers/distributors, in contrast, said they have not seen a corresponding increase in 

buprenorphine orders to the degree it has challenged their threshold systems. Others noted 

that states may have their own limitations in place that affect buprenorphine supply, such 

as approving only the buprenorphine mono-product for pregnant women. While orders 

that are unusual in size, frequency, or pattern will raise a red flag, manufacturer/distributor 

participants said that there are systems in place for the legitimate expansion of thresholds, 

including requests from pharmacies to increase thresholds. 

Supply and Demand
SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 4

A pharmacy participant stated that, although pharmacists can ask for increases, the 

burden remains on the pharmacist to communicate with manufacturers/distributors 

when questions arise. For instance, pharmacists typically make a phone call to solve most 

pharmacy issues. But pharmacists may not know whom to call to resolve a threshold issue. 

Email processes set up by manufacturers/distributors are slower, and a pharmacist can’t 

be sure if or when their email is read. Pharmacy participants said it would be helpful if 

pharmacists could call suppliers directly and let them know, for example, that they will have 

new buprenorphine prescriptions from a new provider and resolve the issue in real time. 

Pharmacy participants want a convenient, streamlined process for increasing thresholds 

that reduces the burden on pharmacists, such as a hotline to call to immediately resolve 

supply issues. 

Another participant stated that pharmacists may feel that even if they did get a threshold 

increase, it would not be timely, and patients would still be without treatment. Several 

pharmacy participants noted the need for timely increases. As one participant said, 

pharmacists operate under a sense of urgency in providing medication, so “timely” means 

the same day or the next day, not months.

Likewise, if there is a need for an audit or investigation, pharmacy participants said patients 

on scheduled substances shouldn’t have to pay the price. Pharmacists asked for a way to 

reach their supplier quickly to ensure patient medications continue to be supplied while 

the investigation is underway. This is particularly important in the context of buprenorphine 

treatment for OUD, where discontinuations in treatment are strongly linked to increased 

overdose risk. 

A system that allowed a pharmacist to know where they are in relation to meeting their 

thresholds was also suggested, such as a green–yellow–red warning system if specific 

numbers cannot be provided. Better yet, some said, since buprenorphine is not commonly 

diverted, some stated it should not be subject to thresholds at all or be treated differently 

from stronger opioids that are used to treat pain.

Pharmacist Hesitation 

Pharmacists in attendance offered some insights as to why manufacturers/distributors 

may not be seeing more requests for increased thresholds as a result of the DATA-waiver 

repeal. Many pharmacy participants said that pharmacists would like to dispense more 

Manufacturer/distributor participants acknowledged the need to better understand 

pharmacy concerns around thresholds. The MDL holds signatories to strict provisions on 

how they handle suspicious orders and thresholds for controlled substances.

Manufacturers/distributors reflected on increasing thresholds by specific percentages. 

While that wouldn’t solve all the issues, manufacturers/distributors in attendance said they 

would be more assured that they could increase access to buprenorphine while upholding 

their efforts to prevent diversion. Pharmacists agreed with the need to mitigate unintended 

consequences of the MDL. 

“It’s not about one pharmacy hitting a threshold; it’s about 

one or more persons dying.”
5 SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 

Red Flags/Trigger Alerts

buprenorphine prescriptions but are concerned about the consequences of exceeding 

their thresholds. One participant said that, because reaching a threshold could threaten the 

pharmacy’s ability to fill prescriptions for all scheduled substances for all the pharmacy’s 

patients, pharmacists may be hesitant to take on new patients with buprenorphine 

prescriptions. One participant noted that since the MDL settlement, suspicious order 

monitoring programs have become much more stringent, to the point that manufacturers/

distributors are looking at individual patient pharmacy records and doses prescribed. Others 

concurred, noting that the risk to pharmacists and pharmacies is significant, so some 

pharmacists choose to turn away patients.

Some participants said that the pharmacy profession in general is risk averse; pharmacists 

like to know exactly where the legal lines are so they can be sure to work inside them. Some 

participants suggested having guidelines and clear documentation to guide practice. Yet, as 

someone else pointed out, a pharmacist’s knowledge of when they’ll be cut off still doesn’t 

help the patient get their life-saving medicine. If a pharmacy is cut off mid-month, it can be 

especially hard on under-resourced individuals.

Reimbursement is another reason that simply removing the DATA-waiver may not have 

resulted in an immediate increase in demand for buprenorphine. Pharmacists may lose 

money on dispensing buprenorphine due to low reimbursement rates. Participants 

suggested that reimbursement strategies could be adjusted to make dispensing 

buprenorphine profitable for pharmacists. 

One participant noted that their State Board of Pharmacy publishes a list of red flags that 

can trigger warnings or cut-offs, and some professional associations warn that dispensing 

buprenorphine in the presence of a red flag puts a pharmacist at risk of losing their license.

Pharmacy participants identified several factors associated with buprenorphine 

prescriptions that complicate how thresholds are met. One issue was how manufacturers/

distributors differentiate between the single-entity buprenorphine and the combination 

product, as they are both ordered under the same drug code. 

Macrodosing at induction is another confounding factor. As one participant noted, given 

the prevalence of illicit fentanyl and increasing threats of xylazine found in conjunction, 

inductions above the standard may be indicated. If providers increase the practice of 

macrodosing—say, inducing at 64 mg instead of 8 mg or 12 mg—from a threshold 

perspective, that is equivalent to four or five standard patients. Participants pointed out 

that, although macrodosing is not yet an evidence-based practice, high-quality research 

suggests benefits and minimal risk with higher dosages of buprenorphine for induction. 

“With new legal and voluntary reductions in insulin costs, we should see 

increases in insulin orders and prescribing [for people with diabetes]. But unlike 

buprenorphine, [patients with diabetes] are unlikely to have gaps in care that 

may result in morbidity and mortality.”
SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 6

Summary of Barriers to Buprenorphine 

Access in Pharmacies

• Pharmacists’ supply of 

buprenorphine may be cut off 

without warning when thresholds 

are reached.

• Manufacturers/distributors do not 

share their threshold algorithms 

and triggers with pharmacists.

• Interruptions in medications 

present lethal risks to patients.

• It may take weeks or months to 

resolve issues.

• Manufacturer/distributor 

thresholds may not be adjusted to 

keep up with increasing need.

• Pharmacists are concerned that 

increased dispensing could raise 

red flags that could stop orders.

• Supply concerns leave pharmacists 

hesitant to take on new 

buprenorphine patients.

• Pharmacists lose money because 

payment is tied to dispensing 

a medication, not to providing 

services.

• Manufacturers/distributors lack 

clear and transparent guidance 

from state regulators about 

their obligations under the MDL 

settlement and how they differ 

from existing requirements in the 

Controlled Substances Act.

• Pharmacists’ potential to expand 

access to buprenorphine remains 

untapped.

“Perhaps the need for thresholds at all for buprenorphine 

products right now could be reassessed.”

Another red flag is dispensing prescriptions 

for patients who live sometimes hundreds 

of miles away, as this may be interpreted 

as medication diversion/mis-monitoring. 

During the COVID-19 pandemic, this practice 

was regarded as a benefit, particularly 

for patients in rural areas. Public health 

emergency (PHE) flexibilities put in place 

during the COVID-19 pandemic allowed 

prescribers to initiate and prescribe 

buprenorphine without an in-person 

examination. The telehealth rules that will 

be in place following the end of the PHE are 

under review as of August 2023. Pharmacists 

expressed concern about their ability to 

confirm that in-person requirements have 

been met if they are mandated by law. 

Patients who pay cash for their medicines 

may also raise a red flag because they 

may be perceived as trying to avoid 

having their case flagged as suspicious. 

However, in states that have not expanded 

Medicaid, underinsured patients who 

are not Medicaid eligible have no other 

choice. Other patients may prefer to pay 

cash for their OUD medication for privacy 

reasons. If their treatment is billed against 

a company insurance plan, they risk having 

their employer find out about it. Pharmacy 

participants suggested looking at payment 

systems and other data sources to avoid 

triggering audits from regulators based 

simply on cash payment.

A pharmacist said that flags may also be 

raised if the patient is also taking another 

controlled substance, such as Adderall, as 

this may elevate perception of co-occurring 

substance use disorders.
7 SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 

Pharmacist Scope of Practice 

Potential Improvements

Participant views about ways to address barriers to buprenorphine access are presented 

under the following topics:

• Pharmacist scope of practice. 

• State policies and practices.

3. Krawczyk, N., et al. (2022, December). Has the treatment gap for opioid use disorder 

narrowed in the U.S.?: A yearly assessment from 2010 to 2019. International Journal of Drug 

Policy, 110. doi:10.1016/j.drugpo.2022.103786

One participant said that the current system has failed to meet patient needs, citing a 

December 2022 paper finding that 87 percent of individuals with OUD are not receiving 

evidence-based treatment.3

 Several participants identified the benefits of facilitating an 

expanded role for pharmacists in increasing access to buprenorphine.

One stated that pharmacists are arguably the most accessible healthcare providers in 

the nation. Pharmacies offer convenient hours and convenient locations: 90 percent of 

Americans live within 5 miles of a pharmacy. Accessibility is especially significant for rural 

and racial and ethnic minority communities, with whom pharmacists have built trusted 

relationships.

As the nation’s medication experts, pharmacists are reimbursed for dispensing products 

rather than providing clinical services. Several participants noted that this may not be an 

optimal model for patient care. An alternative, they said, is to pay pharmacists for providing 

services, not dispensing products.

One strategy that was suggested by a participant would be to relax regulatory requirements 

and allow pharmacist to provide clinical services such as urine screening, as well as 

buprenorphine induction and management. A participant mentioned a recent pilot project 

that supports a role for pharmacists in buprenorphine induction and management (see box 

2). Providing bridge therapy is another potential role for pharmacists.

By expanding the scope of practice to include clinical services, one participant stated, 

pharmacies would be recognized as effective care sites and not merely as dispensaries, 

and pharmacists would be reimbursed the same as other providers for providing the 

same services. However, expanded scopes of practice for pharmacists would need to be 

implemented in tandem with changes in payment policy so that pharmacists can be 

directly reimbursed for the provision of clinical services.

Against the backdrop of recent research showing that, despite regulatory changes, the 

number of providers prescribing buprenorphine and the number of buprenorphine 

prescriptions have not appreciably accelerated, one person said that providers have had two 

decades to expand access, and the only time access jumped is when prescribing rights were 

expanded to include nurse practitioners and physician assistants. The participant said that 

extending prescribing authority to pharmacists is a promising prescriber-level strategy to 

increase access. 
SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 8

State Policies and Practices

To tap the potential of pharmacists to help address the opioid crisis, participants called for 

supporting state policies such as those in Rhode Island, Kentucky, and Ohio that allow for 

an expanded role for pharmacists to connect patients to OUD treatment services and to 

prescribe buprenorphine. At the same time, participants said that policymakers should avoid 

passing laws and implementing regulations that impede pharmacists’ ability to dispense 

buprenorphine. An expanded scope of practice would need to ensure that pharmacists 

were able to be adequately compensated for their services and to require public and private 

insurance coverage for OUD treatment services delivered by pharmacists.

 

Another person called for the National Alliance of State Pharmacy Associations (NASPA) to 

work with the DEA to expand the Mid-Level Practitioners lists so that more pharmacists are 

able to be licensed by the DEA. Currently it’s allowed on a state-by-state basis, so federal 

leadership/NASPA may be required to meet with state Boards of Pharmacy.

Several participants said that red flags that are appropriate for other scheduled substances, 

such as oxycodone, are not necessarily appropriate for buprenorphine. Some participants 

felt that if buprenorphine were removed from the list of scheduled substances, the issue 

would be resolved.

While many participants saw an expanded scope of practice as an important strategy for 

addressing the opioid crisis, some participants noted that many pharmacists are already 

stretched thin in their current roles. One participant said that pharmacists need to be able 

to provide adequate care before thinking about expanding into new services. State policies 

have a large effect on pharmacy operations, and states may impose a variety of restrictions 

on pharmacists that can impede their ability to work efficiently. For instance, some 

Box 2. Physician-Delegated Unobserved Induction With Buprenorphine in 

Pharmacies

In a 15-month randomized trial with 6 pharmacies and 21 pharmacists in Rhode 

Island, researchers sought to compare pharmacy-based medication for OUD with 

usual addiction care. In a collaborative practice arrangement, pharmacists assessed 

patient histories and, working with a physician, induced buprenorphine treatment in 

100 patients. Following induction, 58 stabilized patients were randomly assigned to 

continue their follow-up at a pharmacy or with a typical addiction services provider. 

Patients visited the pharmacy once or twice a week and received counseling, 

monitoring, and other medical care. Findings showed that 89% of patients who 

received follow-up care in pharmacies continued care at 1 month, compared with 17% 

of those receiving usual care.

Source: Green, T., et al. (2023). Physician-delegated unobserved induction with 

buprenorphine in pharmacies. New England Journal of Medicine, 388(2), 185–186. 

doi:10.1056/NEJMc2208055
9 SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 

4 . This guidance was later published; see footnote 2.

Strengthening Communication Pathways

Communication and Education

Participant views in this area are organized into the following topics:

• Communication and education

• Stigmatization

• Communication channels

Participants repeatedly noted the critical need for education within professions but also 

across disciplines. Suggested topics included educating industry members about thresholds 

and red-flag issues. Participants said that it’s important for larger manufacturers/distributors 

to ensure that messaging about thresholds gets communicated to their distribution centers. 

Pharmacists and manufacturers/distributors iterated that clear and specific guidance from 

HHS and DEA would be a big help in easing concerns.4

Participants voiced a desire to hear more guidance from DEA. Some participants suggested 

that the agency could partner with professionals who have direct clinical and pharmacy 

experience to conduct education; learners could benefit from those with direct clinical and 

pharmacy experience as well as from trainers in the field of addiction medicine. Participants 

concurred that it would be beneficial for DEA and professionals to continue to provide 

joint educational opportunities to pharmacists. Education was also seen as a way to help 

pharmacists be less risk averse and take up new opportunities as they arise.

states severely limit the pharmacist-to-technician ratio. Such policies may not support an 

expanded role for pharmacists in addressing the opioid crisis, in their view. 

Pharmacy participants suggested ways to reduce some of the administrative burden on 

pharmacists, such as the need to document the reason for dispensing buprenorphine. A 

simple solution would be for providers to indicate on the prescription whether it is for pain 

or OUD. More integrated electronic health records or other secure communication platforms 

would also help, they said.

Other participants raised the fact that buprenorphine care is part of a larger approach to 

care and harm reduction that includes access to fentanyl test strips where not prohibited 

by law; over-the-counter and behind-the-counter syringes; naloxone availability, including 

over-the-counter naloxone and other medicine to reverse opioid overdose; mental health 

services; and substance use navigators/peer recovery specialists.

A participant mentioned that Medicaid is the number one payer for substance use disorder 

and OUD and said that millions of people will lose insurance coverage this year as the 

COVID-19 public health emergency flexibilities related to Medicaid coverage come to an 

end. However, the participant felt the nation is still in a public health emergency—the opioid 

crisis—which is a sound reason to allow pharmacists to be prescribers and fill the gaps. 
SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 10

Communication Channels

Pharmacy participants said that messaging sources that carry authority with pharmacists 

include:

• State Boards of Pharmacies, since these boards license and regulate pharmacies and 

pharmacists.

• State public health organizations. 

• DEA.

• National Association of Boards of Pharmacy.

• Pharmacy organizations and channels.

• Federal agencies and field offices.

• State-level associations.

Multidirectional communication was also raised by participants as a need. Participants 

stressed the importance of communication from pharmacy participants back to key entities, 

particularly DEA, Centers for Medicare & Medicaid Services, and SAMHSA. SAMHSA was 

encouraged to continue to find opportunities to keep the conversation going. 

Stigmatization

Several participants noted that even the best systems and policies can be rendered 

ineffective because of stigmatization. One participant said that access will remain a 

challenge unless stigmatization is addressed. For example, stigmatization can make it 

more difficult for pharmacies to become accessible care sites. At the same time, reducing 

stigmatization is a long-term effort; it can take generations. So, stigmatization has to be 

addressed concurrently with other educational activities.

Participants noted that one way to reduce stigmatization is to normalize the use of 

buprenorphine. A person noted that a study from Finland from 10 years ago suggested 

that pharmacists who dispensed buprenorphine had a matter-of-fact approach to it; it was 

viewed as just another part of their role. In the United States, a participant said, normalizing 

buprenorphine was hindered by the fact that, until very recently, providers needed a waiver, 

which gave it an aura of being difficult to manage. That requirement resulted in reluctance. 

Providers, in fact, can and routinely do manage buprenorphine like they manage other 

medications. 

Communication was identified as a way to reduce stigmatization, and pharmacy 

participants noted that there are hundreds of ways to reach pharmacists, including through 

numerous professional meetings and webinars. To reduce stigmatization, a participant said, 

it’s important to start normalizing early on, such as in pharmacy school. Participants noted 

that it’s important to hear consistent messaging through several entities and events.
11 SAMHSA/DEA Virtual Town Hall: Expanding Buprenorphine 

Access in Pharmacies To Treat Opioid Use Disorder 

Summary of Participant Views on Potential Ways Forward 

• Remove thresholds for 

buprenorphine.

• Develop a system to ensure 

pharmacists know their ability to 

order controlled substances in relation 

to thresholds.

• Create a system to allow continuation 

of service during an audit or 

investigation, including a real-time 

system to show thresholds and 

request approvals for increases.

• Expand types of prescribers to include 

pharmacists.

• Improve reimbursement strategies for 

dispensing and providing services.

• Allow for remote/telehealth 

prescribing beyond the COVID-19 

emergency.

• Encourage collaborative care between 

prescribers and pharmacists.

• Increase multidisciplinary provider 

education to include pharmacists 

on medication for OUD as part of 

the Medication Access and Training 

Expansion Act.

• Establish efficient, bidirectional, realtime communication pathways across 

professions.

• Provide manufacturers/distributors 

with clear and specific guidance on 

thresholds and suspicious orders 

through DEA communication 

channels. 

• Increase provider education on 

medication-assisted treatment 

expansion.

• Address stigmatization while 

addressing other needs.

• Invite payers into the conversation.

• Launch public informational 

campaigns to increase patient 

and provider knowledge about 

buprenorphine and normalize its use.