“Methadone at the pharmacy like Suboxone®?… It would untangle a lot of tangles.” Perspectives of North Carolinians with lived experience of opioid use on potential benefits of methadone dispensing at community pharmacies

BACKGROUND: Medications for opioid use disorder (MOUD), including methadone, reduce overdoses, overdose deaths, hospitalizations, and all-cause mortality. Yet existing literature widely documents barriers to methadone access for people with opioid use disorder (OUD) in the U.S. and aspects of methadone treatment that U.S. patients find challenging, including inconvenient hours, limited locations, and clinic policies and staff treatment sometimes experienced as arbitrary or stigmatizing. To date, three U.S. studies explored patient interest in opioid treatment program (OTP)-pharmacy collaborations that could offer methadone for OUD dispensing through community pharmacies, but all were conducted in Northern and/or urban U.S. areas. METHODS: Using purposive sampling to recruit a diverse sample of 24 people with lived and living experience (PWLLE) of opioid use and/or use of MOUD from rural and urban areas of Eastern and Western North Carolina (in the U.S. South), this interview study produced qualitative data that we thematically analyzed. RESULTS: Southern U.S. PWLLE unanimously endorsed the idea of community pharmacy dispensing of methadone for OUD, describing anticipated benefits especially for rural patients. Participants perceived benefits of pharmacy methadone dispensing that they anticipated would address known OTP barriers, such as stigma, lack of privacy, limited dosing hours, lack of access following climate events, such as hurricanes, and ability to switch back to methadone from buprenorphine if desired. CONCLUSIONS: PWLLE anticipated that pharmacy dispensing of methadone would likely increase privacy and convenience in MOUD access, compared to OTPs, particularly for rural U.S. patients.