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Red Flags and Red Tape Hinder Access to Treatment for Opioid Use Disorder

Overdose deaths have increased sharply during the COVID-19 pandemic—surpassing 100,000 per year in 2021. Efforts to prevent these deaths include allowing providers, for the first time, to prescribe buprenorphine through telehealth. This allowance, enabled by a pandemic-driven exemption to the 2008 Ryan Haight Act, was an important step to addressing the ongoing opioid epidemic, but was it enough to overcome barriers to treatment?

In a recent study, Penn Nursing’s Shoshana Aronowitz, PhD, MSHP, Assistant Professor in the Department of Family and Community Health, Senior Fellow at Penn’s Leonard Davis Institute of Health Economics, and colleagues conducted interviews with prescribers, pharmacists, and patients to determine how telehealth was being used to prescribe buprenorphine. They found that patients and prescribers welcomed the use of telehealth, but pharmacists often “red flagged” these prescriptions resulting in pharmacy-level “red tape” that delayed or prevented the prescriptions from being filled.

Buprenorphine is a heavily regulated medication. Many pharmacists fear investigation by the Drug Enforcement Agency (DEA) for dispensing it and some believe they may be penalized and risk losing their license. So, they look for certain “red flags” including new patients, patients who have traveled more than 5 miles to reach them, patient desire or need to pay cash rather than using insurance, seeking a combination of controlled substances from different prescribers, and using slang to describe medication. Any of these “red flags” can lead to extra steps—such as requirements for diagnostic codes on prescriptions and verbal confirmation over the phone from the prescriber, refusals for early refills, and denials to prescribers and patients that they stock buprenorphine.

Lauren Textor, BA, of the David Geffen School of Medicine and Department of Anthropology at the University of California, Los Angeles, and Daniel Ventricelli, PharmD, MPH, of the Philadelphia College of Pharmacy at the University of the Sciences, served as co-authors on this paper.

This is an excerpt from a longer LDI blog post. It was written by Kaday Kamara, Health Policy Coordinator.