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Nearly a third of telemedicine patients with opioid use disorder had to go without buprenorphine because they had trouble filling their prescription at a pharmacy, according to a new study.

The study, published in the medical journal JAMA Network Open this month, surveyed 600 telemedicine patients across five states: Florida, Michigan, New Jersey, Ohio and Texas. The U.S. Food and Drug Administration has approved buprenorphine for treatment of opioid use disorder. The drug reduces a patient’s cravings for opioids and reduces the likelihood of a fatal overdose.

The most common reason that patients had trouble was that buprenorphine was unavailable at the pharmacy, followed by coverage-related issues and the pharmacy’s hesitancy in filling a telemedicine prescription.

Previous research has shown that some pharmacists, fearing scrutiny, hesitate to dispense buprenorphine, which is a controlled substance. The U.S. Drug Enforcement Administration and the U.S. Department of Health and Human Services say people with opioid use disorder “who need buprenorphine [should be] able to access it without undue delay,” the authors note.

Roughly half of the patients who participated in the survey were covered by Medicaid. A majority of patients had been in treatment for at least six months, and half lived in rural areas.

The analysis didn’t find statistically significant differences between patients in rural and non-rural areas. But the authors noted that the study only surveyed participants from those five states, and results might be different in other ones.

In general, they noted, patients living in rural areas might have a harder time finding buprenorphine and other opioid use disorder drugs at a pharmacy because there are fewer pharmacies in rural areas.

The study underscores recent data suggesting a lack of access to opioid use disorder medication. An analysis released last year by the federal Centers for Disease Control and Prevention found that in 2022, only a quarter of people with opioid use disorder received recommended medications. About 4% of U.S. adults have opioid use disorder.

Other research has shown many pharmacies lack buprenorphine. Two studies found that between 42% and 51% of U.S. pharmacies did not have buprenorphine in stock, and availability varied widely across states.

The JAMA Network Open study was led by Workit Health, a telemedicine addiction treatment app that operates in four of the states included in the survey. Researchers from the University of Pittsburgh, Johns Hopkins University, and Geisinger Commonwealth School of Medicine in Pennsylvania also contributed. In their conflict of interest disclosures, some of the authors reported holding equity in Workit Health.