Barriers and facilitators to methadone dispensing for opioid use disorder in community pharmacies: A scoping review

Background: Methadone, an evidence-based medication for opioid use disorder (MOUD), is available through prescription at community pharmacies in countries like Canada, Australia, and the United Kingdom, but not in the United States (U.S.). The objective of this scoping review was to summarize barriers and facilitators related to dispensing methadone in community pharmacies to inform future implementation efforts in the U.S. Methods: A scoping review was conducted using PubMed, Embase, SCOPUS, and CINAHL. Original research articles related to barriers and/or facilitators around community pharmacy-based methadone dispensing were included. No search limits (year of publication, geographic boundaries) were applied to the search strategy. Two independent researchers screened all articles for eligibility, extracted data, and met to reach consensus. Data were extracted on 12 items, with a particular focus on barriers and facilitators to dispensing methadone in community pharmacies. Results: Forty-one articles were included in the review. The most common barriers to methadone dispensing were workload (n = 14), safety concerns for staff and property (n = 13), concern about patient behavior and interactions (n = 12), financial hardship (for pharmacists and patients) (n = 11), and stigma and discrimination towards patients (n = 11). The most common facilitators were pharmacist training and education (n = 14), positive pharmacist-patient relationships (n = 14), and privacy (n = 10). Conclusions: The findings from this review can be used to address barriers and incorporate known facilitators into future protocols or practice of pharmacy-based methadone dispensing. Further research is needed to identify U.S. and state-specific anticipated needs for pharmacy-based methadone dispensing.