DEA Disconnect Leads to Buprenorphine Bottlenecks

Objectives: To describe a buprenorphine dispensing bottleneck resulting from a pharmacist-perceived Drug Enforcement Administration "cap" on the amount of buprenorphine that can be ordered or stocked.

Methods: Expert review and preliminary fieldwork.

Results: We find no such cap exists, though medication distributors struggle to accurately understand and interpret regulatory guidelines, with implications for medication availability.In states where opioid overdose rates remain higher and efforts to increase the number of eligible health care providers prescribing medications to treat opioid use disorder are underway, patients prescribed buprenorphine products report difficult filling prescriptions and pharmacists perceive limits on how much medication they can order and stock.

Conclusions: We recommend Drug Enforcement Administration policy clarifications or changes to facilitate distributor interpretation; pharmacist workflow; and patient access to medication. We also advise continuing education with pharmacists and buprenorphine prescribers. These steps would facilitate greater access to lifesaving treatment for opioid use disorder.