Perspectives from opioid treatment program staff on community pharmacy-based methadone dispensing in North Carolina.

INTRODUCTION

Methadone is an effective medication for the treatment of opioid use disorder, yet barriers to treatment access exist. Community pharmacies are more accessible than opioid treatment programs (OTPs) and are utilized in countries other than the United States to observe methadone dosing and dispense take-home doses. The purpose of this study was to assess North Carolina OTP staff perceptions towards community pharmacy-based methadone dispensing.

METHODS

A cross-sectional online survey was used to assess the perceived acceptability, appropriateness, and feasibility of community pharmacy-based methadone dispensing among OTP staff using validated measures. Survey distribution occurred from April to June 2025. Descriptive statistics were used to identify potential benefits, negative consequences, and barriers to pharmacy-based methadone dispensing.

RESULTS

The response rate was 72.7% (56 of 77). Perceived acceptability, appropriateness, and feasibility of observed dosing and dispensing methadone take-home doses in the community pharmacy were low among OTP staff. Perceived negative consequences of pharmacy-based methadone dispensing were loss of counseling and care coordination provided by the OTP. Lack of community pharmacist training on methadone dispensing and community pharmacist stigma were the greatest perceived barriers to pharmacy-based dispensing. Over 25% of respondents did not think there were any potential benefits to pharmacy-based methadone dispensing.

CONCLUSION

OTP staff in North Carolina are, in general, not supportive of pharmacy-based methadone dispensing. With low perceived appropriateness, acceptability, and feasibility of observed methadone dosing and dispensing methadone take-home doses in the community pharmacy, further work to implement pharmacy-based methadone dispensing may be stifled by OTP resistance. If policy-based efforts to increase methadone access through community pharmacies continue to be pursued, researchers and other key informants should seek to mitigate concerns identified by OTP staff to ensure people with OUD can receive high quality, patient-centered care in the pharmacy setting.