Barriers and facilitators to pharmacy-based methadone dosing and dispensing: Semi-structured interviews with pharmacists

BACKGROUND: Access to methadone for the treatment of opioid use disorder (OUD) in the United States is currently limited to opioid treatment programs (OTPs), although proposed legislation may allow for pharmacy-based dispensing. Community pharmacies are well-positioned to increase patient access to methadone for OUD; however, limited research has evaluated the anticipated barriers and facilitators to pharmacy-based methadone services among pharmacists. OBJECTIVES: The objective of this paper is to describe North Carolina community pharmacists' perceptions of and anticipated barriers and facilitators to pharmacy-based methadone treatment. METHODS: Semi-structured interviews were conducted from April to June 2025 with a nested sample of 20 North Carolina community pharmacists. Pharmacists were purposively sampled based on pharmacy rurality as well as their attitudes toward pharmacy-based methadone dispensing. Interviews assessed the barriers and facilitators to the implementation of pharmacy-based methadone access through 2 models: 1) medication unit model partnership with an OTP; and 2) the Modernizing Opioid Treatment Access Act (MOTAA), which would allow pharmacists to dispense methadone for OUD similar to other controlled medications. RESULTS: Participants believed pharmacy-based dispensing would increase patients' methadone access and potentially reduce stigma associated with treatment. The primary concern was the potential for increased misuse and diversion. Stigmatizing beliefs held by other pharmacists was identified as a major implementation barrier. Most pharmacists preferred the MOTAA model of methadone dispensing over the medication unit model because it could be more easily implemented into the workflow; however, concerns related to wholesaler ordering thresholds emerged. Pharmacists identified a lack of time and physical space to observe dosing as barriers to the medication unit model. In both models, pharmacists identified the following facilitators: 1) financial reimbursement, 2) increased communication with prescribers, and 3) training. CONCLUSION: Multiple factors influence pharmacists' perceptions of methadone dosing and dispensing for the treatment of OUD in community pharmacies. Pharmacists identified needs for implementation including increased training, financial reimbursement, as well as streamlined communication with prescribers.