Community Pharmacist Perspectives on Observing and Dispensing Methadone for Opioid Use Disorder: Cross-sectional Survey Study

OBJECTIVES: To document community pharmacists' perceptions of the acceptability, appropriateness, and feasibility of dispensing methadone and observing methadone doses; willingness to dispense and observe doses; and perceived benefits, barriers, and negative consequences of methadone dispensing. METHODS: A convenience sample of community pharmacists completed a cross-sectional survey from February to April 2025 that assessed pharmacists' perceived acceptability, appropriateness, and feasibility of observing methadone doses and dispensing methadone on a 5-point scale, with 3 being a neutral midpoint. T tests compared unadjusted scores, and linear regressions assessed whether pharmacist role, years in practice, pharmacy type, and rurality were associated with scores. Descriptive statistics were calculated for newly developed measures of willingness, benefits, barriers, and negative consequences of methadone dispensing. RESULTS: The response rate was 21.9% (n=875). Pharmacists' mean acceptability, appropriateness, and feasibility scores were slightly negative to neutral, ranging from 2.75 to 3.10. Scores were significantly lower for observed dosing compared with dispensing. Urban pharmacists, independent pharmacists, pharmacy owners, and pharmacists newer to practice had more positive acceptability, appropriateness, and feasibility perceptions. Most pharmacists (71.7%) were willing to dispense take-home doses weekly; 48.6% were willing to observe doses daily. However, logistical barriers related to time and staffing and negative attitudes towards patients with opioid use disorder were also reported. CONCLUSIONS: Despite slightly negative to neutral perceptions of acceptability, appropriateness, and feasibility, many pharmacists are willing to implement methadone services, particularly dispensing take-home doses. Workflow integration tools and stigma reduction training may be needed to support implementation of pharmacy-based methadone services in the future.