ASSESSING COMMUNITY PHARMACIST PREPAREDNESS TO IMPLEMENT METHADONE DISPENSING AND OBSERVATION

Introduction

Methadone is an evidence-based treatment for opioid use disorder (OUD), however access to methadone for the treatment of OUD in the United States is largely restricted to federally licensed opioid treatment programs (OTPs). Proposed and emerging legislation aim to allow for pharmacy-based methadone dispensing. Community pharmacies are well-positioned to increase patient access to methadone for OUD; however, limited research has evaluated the perceived barriers and facilitators to pharmacy-based methadone dosing and dispensing among pharmacists.

Methods

From April to June 2025, we conducted qualitative semi-structured interviews with a purposive sample of 20 North Carolina community pharmacists who had previously completed a survey on pharmacy-based methadone dosing and dispensing. Pharmacists were purposively sampled based on the rurality of their practice site as well as their attitudes toward pharmacy-based methadone dispensing. Interviews assessed the barriers and facilitators to the implementation of pharmacy-based methadone access through two models: 1) Medication unit model with an OTP; and 2) Modernizing Opioid Treatment Access Act (MOTAA) dispensing of methadone, which would allow pharmacists to dispense methadone like any other controlled substance.

Results

Participants believed pharmacy-based dispensing would increase patients’ methadone access and potentially reduce stigma associated with treatment. The biggest concern was the potential for increased misuse and diversion. Most pharmacists preferred the MOTAA model of methadone dispensing over the medication unit model because it could be more easily implemented into the workflow; however, concerns related to wholesaler ordering thresholds emerged. Pharmacists identified a lack of time and a lack of physical space to observe dosing as barriers to the medication unit model. Across both models, pharmacists identified inadequate financial reimbursement, increased communication demands with prescribers, and insufficient training as primary implementation challenges. Conclusion/ Importance: Community pharmacists view pharmacy-based methadone dispensing as both promising and complex, with feasibility shaped by workflow, space, reimbursement, regulatory, and training considerations. Targeted education on workflow integration and communication with patients and prescribers, alongside policy and payment reforms, will be critical to support pharmacist-led or pharmacist-integrated models of methadone treatment for OUD.