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Background: Timely and reliable dispensing of buprenorphine is critical to accessing treatment for opioid use disorder (OUD). Racial and ethnic inequities in OUD treatment access are well described, but it remains unclear if inequities persist at the point of dispensing. Methods: We analyzed data from a U.S. telephone audit that measured restricted buprenorphine dispensing in community pharmacies, defined as inability to fill a buprenorphine prescription requested by a “secret shopper.” Using the Index of Concentration at the Extremes (ICE), we constructed county-level measures of racial, ethnic, economic, and racialized economic (joint racial and economic segregation) segregation. Logistic regression models evaluated the association of ICE measures and restricted buprenorphine dispensing, adjusting for county type (urban vs. rural) and pharmacy type (chain vs. independent). Results: Among 858 pharmacies surveyed in 473 counties, pharmacies in the most ethnically segregated and economically deprived counties had 2.66 times the odds (95 % CI: 1.41, 5.17) of restricting buprenorphine dispensing, compared to pharmacies in the most privileged counties after adjustment. Pharmacies in counties with high racialized economic segregation (quintile 2 and 3) also had higher odds of restricting buprenorphine dispensing (aOR 3.09 [95 % CI 1.7, 5.59]; aOR 2.11 [95 % CI 1.17, 3.98]). Similar associations were observed for economic segregation (aOR: 2.18 [95 % CI: 1.21, 3.99]), but not ethnic (0.59 [0.34, 1.05]) or racial (0.61 [0.35, 1.07]) segregation alone. Conclusions: Restricted buprenorphine dispensing was most pronounced in socially and economically disadvantaged communities, potentially exacerbating gaps in OUD treatment access. Policy interventions should target both prescribing and dispensing capacity to advance pharmacoequity.

Background: As the US opioid-involved morbidity and mortality increase, uptake and implementation of evidence-based interventions remain key policy responses. Respond to Prevent was a multi-component, randomized trial implemented in four states and two large pharmacy chains with the aim of improving the pharmacy’s capacity to provide naloxone, dispense buprenorphine, and sell nonprescription syringes (NPS). We sought to provide context and assess how policies and organizational practices affect communities and pharmacies across the study states. Methods: Using a multi-method approach we: 1) conducted an environmental scan of published literature and online materials spanning January 2015 to June 2021, 2) created timelines of key events pertaining to those policies and practices and 3) conducted semi-structured interviews with stakeholders (key informants) at the state and local levels (N=36) to provide further context for the policies and practices we discovered. Results: Key informants discussed state policies, pharmacy policies and local practices that facilitated access to naloxone, buprenorphine and NPSs. Interviewees from all states spoke about the impact of naloxone standing orders, active partnerships with community-based harm reduction organizations, and some federal and state policies like Medicaid coverage for naloxone and buprenorphine, and buprenorphine telehealth permissions as key facilitators. They also discussed patient stigma, access in rural settings, and high cost of medications as barriers. Conclusion: Findings underscore the important role harm reduction-related policies play in boosting and institutionalizing interventions in communities and pharmacies while also identifying structural barriers where more focused state and local attention is needed.