Feasibility of Implementing a Pharmacist-Integrated Collaborative Model for Opioid Use Disorder: A Nonrandomized Clinical Trial

BACKGROUND: Addressing the opioid crisis requires an interdisciplinary approach. Pharmacists may provide medication expertise to primary care addiction teams. OBJECTIVE: To determine whether implementing a pharmacist-integrated model of care for opioid use disorder (PrIMO) was feasible and acceptable. DESIGN: Nonrandomized mixed-methods longitudinal feasibility/implementation trial conducted from March 2022 to October 2024. PARTICIPANTS: Four primary care sites with retail pharmacies and clinical pharmacists. Participants were adults employed by the clinics and adult patients receiving medications for opioid use disorder (MOUD) exposed to PrIMO for at least 2 weeks. Site staff (provider, pharmacists, leadership) were surveyed for 15 months (80.6% follow-up completion) and patients for 6 months (75.5% follow-up completion). INTERVENTION: Pharmacist-integrated MOUD. MAIN MEASURES: Primary: Feasibility (PrIMO launch). Secondary: acceptability (survey and interview data) and impact (electronic health record data). KEY RESULTS: All sites launched PrIMO (100%) and maintained it for at least 1 year. From 3 months pre- to 1 year post-launch, site staff reported fewer barriers to providing MOUD (m [SD] 2.2 [0.8] to 1.8 [0.5], 1-4-point scale), increased knowledge of MOUD (3.8 [0.4] to 4.0 [0.5], 1-5-point scale), and steady acceptability by providers/pharmacists (2.1 [0.3] to 2.0 [0.4], 0-3-point scale) and leadership (2.1 [0.3] to 2.0 [0.4], 0-3-point scale). Patients reported less stigma (3.1 [1.1] to 2.8 [1.1], 1-5-point scale) and steady acceptability (2.2 [0.4] to 2.2 [0.4], 0-3-point scale). Electronic health records data demonstrated increases in the rate of patients retained in MOUD (m [SD] 59.5 [34.81] to 60.2 [35.35] proportion of days covered), adherence to MOUD (38.6 to 40.9%), clinic visits for MOUD (+ 100 encounters), and total patients treated per prescriber (m [SD] 12.9 [32.49] to 13.7 [35.07]) 1 year pre- vs 1 year post-launch, although statistical significance was not assessed. CONCLUSIONS: Integrating pharmacists into MOUD care teams may improve feasibility and acceptability of MOUD in primary care. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT05310786, March 14, 2022.