How Maryland is expanding access to addiction treatment

Which is easier to obtain in Maryland: illicit opioids such as fentanyl, or a prescribed medication such as buprenorphine used for treating opioid use disorder? The answer may surprise you. In many cases, accessing buprenorphine is actually more challenging. While illicit opioids are widely available, those seeking treatment often face delays, limited appointment availability and a shortage of nearby providers.

A person can decide they are finally ready to begin treatment, but because addiction treatment providers are concentrated in urban areas and many clinics are overwhelmed by demand, immediate appointments are often unavailable. For people seeking help, timing matters. Delays of even a few days can mean the difference between entering recovery and returning to opioid use, yet many Marylanders are still forced to travel long distances or wait days before they can initiate treatment.

Recognizing that these barriers can impede someone’s ability to access care, Maryland Gov. Wes Moore recently signed House Bill 838 and its companion Senate Bill 562. This legislation will allow pharmacists to prescribe buprenorphine, a common medication for opioid use disorder (MOUD), directly to patients. Under this new law, pharmacists who have a “pharmacist-prescriber agreement” with a physician or other medical practitioner with prescribing authority, would be allowed to initiate, adjust or continue MOUD therapy with a patient.

With 969 opioid-related deaths reported in Maryland this year, lawmakers have rightly identified access to this treatment as a major public-health issue. The legislation reflects a broader recognition that low-barrier, rapid access to these medications saves lives.

Moreover, the bills build on other previous bipartisan efforts to expand access through telehealth prescribing, state-mandated treatment of opioid addiction in jails, establishing the buprenorphine training grant program for EMT administration and directing hospitals to offer rapid access to medications. Each of these policies represents one step in a broader effort to curtail the opioid crisis.

Many Marylanders already rely on pharmacists for important healthcare services, such as securing prescriptions of overdose reversal medication, hormonal contraceptives and HIV pre- and post-exposure prophylaxis. This shows how pharmacists play a crucial role in the delivery of our healthcare, and by expanding their scope of practice to allow them to prescribe more medications, it will ensure that people who need medical assistance can access it quickly. There are over 1,000 pharmacies in Maryland, so allowing pharmacists to prescribe buprenorphine will greatly increase access to this life-saving care.

Obtaining treatment has many benefits, including reduced risk of overdose and death. Buprenorphine is one of the most effective treatments for opioid use disorder, and helps mitigate the harms — social, economic and health-related — commonly linked to opioid addiction.

The tangible costs of opioid addiction for Maryland taxpayers are estimated at over $2.2 billion in healthcare and criminal justice expenses annually, as well as lost productivity of those addicted to illicit opioids. Therefore, expanding access to evidence-based treatment is a sensible solution from a fiscal perspective as well. Patients receiving this medication are 60% less likely to experience overdose. Real-world experience shows that pharmacist-prescribing of buprenorphine helps people stay engaged in recovery, with nearly 87% of patients still receiving care after 90 days.

While some opponents worry that expanding access could lead to buprenorphine being distributed outside normal medical channels, such cases are relatively rare. When this does occur, it is often because people are trying to manage withdrawal symptoms because formal care is inaccessible. Even in those uncommon situations where people obtain buprenorphine outside the medical system, it is still far safer than illicit opioids like fentanyl and has been linked to lower overdose risk.

When drug users decide to seek help, it’s critical that the system doesn’t stand in the way of moving forward — by forcing them to wait days, travel for hours or navigate unnecessary hurdles. While this newly passed legislation is not a panacea, it represents an important step toward reducing barriers to care, improving public safety and saving lives.

By expanding the scope of practice for pharmacists in Maryland to allow them to prescribe buprenorphine for opioid use disorder, the state has moved closer to a basic principle: Treatment for opioid addiction should not be harder to obtain than the drugs fueling the epidemic.