Patient Access to Buprenorphine at Community Pharmacies: A Scoping Review of Audit Studies.

Abstract

Buprenorphine is an evidence-based treatment for Opioid Use Disorder (OUD) that can be dispensed from community pharmacies. However, barriers like wholesale ordering thresholds and pharmacist stigma limit its availability. The objective of this review is to synthesize studies that utilized an audit study design to assess buprenorphine and buprenorphine/naloxone (BUP/NX) availability in US community pharmacies and to identify key access barriers patients may face when receiving buprenorphine at the pharmacy. A scoping review of PubMed, Embase, Scopus, and CINAHL databases was conducted. Included studies utilized an audit study design to evaluate buprenorphine availability in the US and were published in English. The search occurred in June 2025. Three independent researchers screened articles for eligibility and extracted key information on methods and results. Seven articles met eligibility criteria. There was variation in methodology, including auditor training, measures of availability, and outcomes assessed. Buprenorphine/naloxone (BUP/NX) availability at pharmacies ranged from 31% to 70% at audited pharmacies, and availability was lower in nonmetropolitan areas and in independent pharmacies when compared with chain pharmacies. Collectively, audit studies documented suboptimal buprenorphine availability at community pharmacies, with relatively lower availability at independent and nonmetropolitan pharmacies. These results underscore the need for implementation strategies that improve pharmacy-based access to buprenorphine, particularly in settings where availability appears most limited. Future work should standardize audit study design to strengthen comparability across studies and inform interventions to reduce pharmacy-level barriers to treatment.