Clinical psychiatric pharmacist involvement in an outpatient buprenorphine program

Background: Approximately nineteen million individuals in the United States are diagnosed with a substance use disorder (SUD), including many veterans enrolled in the Veterans Health Administration (VHA). The prevalence of SUD within the veteran population has been steadily increasing, resulting in increased utilization of substance abuse services, such as buprenorphine programs for opioid dependence. As this population grows, there is an increased need for multidisciplinary services. Clinical psychiatric pharmacists do not have prescriptive authority for buprenorphine, but can play a vital role in outpatient buprenorphine programs. Description of Innovative Service: The clinical psychiatric pharmacist is involved in many aspects of the outpatient buprenorphine program. There are over 100 patients enrolled in the buprenorphine program at the White River Junction Veterans Affairs Medical Center (WRJVAMC). The clinical pharmacist devotes approximately ten hours per week to the program, which includes dispensing the medication, monitoring lab values, patient counseling and random medication counts. A spreadsheet is maintained and updated weekly to monitor doses, refill dates and urine toxicology results. The clinical pharmacist is also involved in the dispensing process in the outpatient pharmacy; this allows for open communication between the clinical pharmacist and patient. Impact on Patient Care: The clinical psychiatric pharmacist has been involved in the outpatient buprenorphine program at the WRJVAMC for approximately two years. Prior to this, the program included less than 100 patients, pharmacy wait times were over sixty minutes and early refills were frequent. Since clinical pharmacy involvement, the pharmacy wait time is approximately 30 minutes or less and early refills are infrequent. Patient satisfaction has also significantly improved. The clinical pharmacist has helped open the lines of communication between the patient, the pharmacy and the prescriber. Conclusion: Substance use disorder programs, such as buprenorphine programs, can benefit from clinical pharmacy involvement. Even with limited prescriptive authority, clinical psychiatric pharmacists can play an important and active role in outpatient buprenorphine programs.