The Pharmacy Access to Resources and Medication for Opioid Use Disorder
(PhARM-OUD) Guideline
Authors: Varisco Tyler , Fish Hannah , Bolin Joshua , Dadiomov David , Hill Lucas , Essien Ekere , Wanat Matthew , Ginsburg Diane , Waggener Jeanne , Thornton Douglas 
Published: September 2024

Buprenorphine is the only agonist medication for opioid use disorder
that may be dispensed directly to patients from a community pharmacy
pursuant to a prescription from any Drug Enforcement Administration (DEA)
licensed prescriber in all fifty states. The potential accessibility,
efficacy, and relative safety of buprenorphine makes it an ideal therapeutic
option for the management of opioid use disorder. Still, around half of
community pharmacies in the United States do not maintain buprenorphine in
their inventory. Community pharmacists must contend with a convoluted
meshwork of state and federal laws and regulations that complicate the
wholesale purchase and dispensing of buprenorphine. Additionally, stigma
toward persons with opioid use disorder often interferes with the quality of
care delivered at the pharmacy counter. Prevailing clinical practice
guidelines for the medical management of OUD do not address the complexities
of pharmacy practice, creating a clear and present need for direct
pharmacist guidance. The Pharmacy Access to Resources and Medication for
Opioid Use Disorder Guideline was created to provide actionable steps to
improve access to buprenorphine in community pharmacies. A steering
committee led by the National Community Pharmacists Association, National
Association of Boards of Pharmacy, and the University of Houston College of
Pharmacy recruited and empaneled a 22-member expert panel to draft and
refine recommendations to address barriers to buprenorphine dispensing
identified through focus group interviews with community pharmacist in
Texas, California, and West Virginia. The panel’s recommendations were
generated through a four-round, Delphi process that occurred between
November 2023 and March, 2024. Nine main recommendations and 35 supporting
recommendations were generated. After drafting the document, the National
Association of Boards of Pharmacy hosted a public comment period between
April 15, 2024, and June 1, 2024. A second, thirteen-member review panel was
convened to revise the recommendations at the National Pharmacists
Association headquarters in Mount Prospect, Illinois on June 11, 2024. The
central message of the final document, which was endorsed by several leading
medicine, pharmacy, and advocacy organizations, is that pharmacists should
dispense buprenorphine under most circumstances pursuant to a valid
prescription from a DEA licensed prescriber. The document urges caution in
applying quantitative thresholds to buprenorphine dispensing decisions and
encourages pharmacists to rely on their professional judgement rather than
arbitrary decision rules designed to reduce liability at the cost of patient
health and safety. In many parts, the guidance reminds pharmacists that OUD
is a chronic disease that responds to medical management. Community
pharmacists and pharmacies are encouraged to incorporate this guidance into
their practice to ensure that they are adequately meeting the needs of the
patients that they serve.