RACHEL MARTIN, HOST:
With America in the throes of a drug addiction epidemic, there's been a big push to make a crucial treatment drug easier to get. It's called buprenorphine, and people who take it are more likely to stay in treatment and less likely to die from an overdose. But there's a problem. Pharmacists are the gatekeepers for filling the prescriptions. And as Nina Feldman at WHYY in Philadelphia explains, not all pharmacies want that role.
NINA FELDMAN, BYLINE: Louis Morano was sick of being in and out of rehab. He was a dad now and wanted to be at home more with his son in northeast Philly. This time, he was determined to make his recovery stick.
LOUIS MORANO: My plan is to go and show that, like, I don't want to do this anymore. I can't do this anymore.
FELDMAN: In all his stints in rehab, Morano says he had never been prescribed buprenorphine, a drug that staves off withdrawal symptoms and ongoing cravings. But he had bought it off the street before.
MORANO: I would use it so I wasn't sick while I was at work, and then I would get high after work.
FELDMAN: So he knew the drug would work to curb his cravings. Morano heard he could get a prescription from a bus that housed a mobile medical clinic. It's usually parked on a corner in Kensington, the Philadelphia neighborhood at the center of the opioid epidemic. People there just call it the bupe bus, for buprenorphine.
BEN COCCHIARO: Hello. Dr. Ben Cocchiaro - it's nice to meet you.
FELDMAN: The bus belongs to the syringe exchange Prevention Point. It's one of Philadelphia's latest efforts to help more people get buprenorphine. Doctors with Prevention Point see patients in a tiny, peaceful consult room at the back of the bus. Morano and a doctor talk about what he'll need to make recovery work for him this time. The doctor gives him instructions for taking the drug, and then he calls in the script.
COCCHIARO: Hi, there. It's Ben from the MAT van.
FELDMAN: The bus parks right outside a Walgreens, but Morano's doctor doesn't bother calling it in there. And Morano won't be filling the script at a nearby independent pharmacy either.
Richard Ost, the owner there, says his pharmacy was one of the first in the neighborhood to stock buprenorphine. But after a while, Ost started noticing that people were not using the medication as directed. They were selling it instead.
RICHARD OST: We started seeing people doing it in our store in front of us. Ethically, we should not be dispensing their prescriptions. And once we saw that with a patient, we terminated them as a patient.
FELDMAN: Ost says the illegal market for buprenorphine, also known as Suboxone, didn't just bring unwanted foot traffic. It also meant customers trying to stay sober were being continually targeted and tempted.
OST: So if we were having a lot of people that were in recovery coming out of our stores, the people who were dealing illicit drugs knew that. And they would be there to talk to them. And they would say - well, I'll give you this, or I'll give you that. Or I'll buy your Suboxone, or I'll trade you for this.
FELDMAN: Ost says, eventually, his staff didn't feel safe, and neither did the customers. He understands the value of bupe, but it just wasn't worth it. He's mostly stopped carrying it.
Another problem is that sometimes pharmacists have trouble stocking buprenorphine, even if they want to. Wholesalers set limits on how many controlled substances a pharmacy can order at a time. If you're in a high-needs area like Kensington, you might max out, especially if you stock other prescription opioids. And lots of pharmacists get different information about buprenorphine compared to doctors.
DAN VENTRICELLI: It's not even that they're on different pages; they're reading completely different books.
FELDMAN: Dan Ventricelli is a professor at the Philadelphia College of Pharmacy.
VENTRICELLI: There's this perception in the pharmacy community that if you're using this medication for a year and you haven't started tapering, that you are doing something wrong - or maybe the provider is doing something wrong.
FELDMAN: But lots of doctors prescribe buprenorphine for longer than a year, and that's consistent with recent guidelines. If a pharmacy doesn't have buprenorphine or the pharmacist won't fill it, the stakes are high. Silvana Mazzella of Prevention Point says when it's not available, patients struggle and can turn back to heroin or fentanyl.
SILVANA MAZZELLA: We're in a situation where, if you are in withdrawal, you're sick - you need to get well. You want help today, and you can't get it through medication-assisted treatment. Unfortunately, you will find it a block away - very quickly and very cheaply.
FELDMAN: Doctors with Prevention Point have found a pharmacy that will reliably dispense buprenorphine to their patients. It's called Pharmacy of America.
UNIDENTIFIED PHARMACY EMPLOYEE: Can I have your birthday please?
UNIDENTIFIED PHARMACY CUSTOMER: (Unintelligible) - '78.
UNIDENTIFIED PHARMACY EMPLOYEE: OK. You can sign for me when you're ready.
FELDMAN: Anthony Shirley is head pharmacist there. He says he's comfortable filling the scripts because of his relationship with the doctors at Prevention Point.
ANTHONY SHIRLEY: Trust is an issue. You know? You have to kind of know what their processes are and make sure that, you know, they're not just giving prescriptions to patients that don't need the medication. It's a very controlled environment at Prevention Point.
FELDMAN: He says he tries to connect with the patients, too.
SHIRLEY: I've heard firsthand from patients - that saved my life. You know, that's something that, you know, you can't really put a price tag on.
FELDMAN: Shirley says, for him, it's simple. His store is in an area where lots of people need buprenorphine. That means it's his job to get it to them. For NPR News, I'm Nina Feldman in Philadelphia.
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MARTIN: This story comes from a reporting partnership between NPR, WHYY and Kaiser Health News.
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