Buprenorphine Dispensed by Pharmacies and Administered in Emergency Departments in Urban and Rural Areas — United States, 2019–2025

Drug overdose deaths remain a major public health concern in the United States. Although buprenorphine is approved by the Food and Drug Administration to treat opioid use disorder and reduces overdose risk and deaths, the medication remains underused in the United States, and many persons who could benefit from treatment lack access. This report describes 2019-2025 trends in buprenorphine dispensing by pharmacies, treatment initiation among persons newly receiving buprenorphine, treatment retention, pharmacy availability, and emergency department (ED) administration by urban-rural county classification using IQVIA data on buprenorphine dispensed by pharmacies and the Premier Healthcare Database. Dispensing rates increased from 2019 to 2021, before declining thereafter, and remained consistently higher in rural counties than in urban counties. The number of patients per prescriber and prescriptions per prescriber declined in both urban and rural counties. Initiation and retention were higher in rural counties; initiation declined in urban counties, and retention declined over time in both urban and rural counties. Pharmacy availability of buprenorphine increased in both urban and rural counties. Adoption and administration of ED buprenorphine increased in both urban and rural counties but remained lower in rural counties. These findings highlight differences between urban and rural areas in buprenorphine access and treatment, with more reliance on pharmacies dispensing buprenorphine in rural counties and higher ED-based administration in urban counties. Opportunities to improve access include use of a low threshold for prescribing buprenorphine, strengthening pharmacy availability of buprenorphine, and (particularly in rural areas) supporting ED-based treatment and sustaining telehealth flexibilities.