Pharmacists Joining Primary Care Teams Prove Feasible for Treating Opioid Use Disorder

Medications for opioid use disorder save lives, yet in 2024 only about one in five people who needed them actually received them. Most treatment with buprenorphine happens in primary care, but the majority of primary care providers do not prescribe these medications at all, and those who do typically treat fewer than five patients per month. Against the backdrop of an increasingly potent and volatile illicit drug supply, researchers have been searching for practical ways to expand access. A new nonrandomized clinical trial published in the Journal of General Internal Medicine suggests a surprisingly simple answer may already be sitting inside the clinic: the pharmacist.

The trial, funded through the National Institute on Drug Abuse’s Clinical Trials Network, tested a model called PrIMO, short for pharmacist-integrated medication treatment for opioid use disorder. The model grew out of work at Penobscot Community Health Care, Maine’s largest federally qualified health center, which had previously woven clinical pharmacists into its primary care addiction services and seen reductions in overdose mortality alongside increases in prescribing. The new study asked whether that success could be replicated in four diverse primary care sites across the Northeast, Midwest, Northwest, and Southwest of the United States between August 2022 and July 2024.

PrIMO rests on six core components: collaborative communication among team members, weekly huddles with active clinical decision-making for all patients with opioid use disorder, provider education, patient education, comorbidity screening, and education for local partners. Pharmacists contribute medication expertise such as managing drug interactions, adjusting doses, and handling prior authorizations, while also consulting directly with patients in partnership with prescribers. Crucially, the model was designed to use existing pharmacists rather than requiring new hires, and a toolkit plus monthly meetings with model developers and external facilitators helped each site maintain fidelity while tailoring the approach to its own context.

The primary outcome was feasibility, measured with the Stages of Implementation Completion, an eight-stage tool tracking sixty-one milestones from initial engagement through site competency. All four sites, two federally qualified health centers and two based at academic medical centers, successfully launched PrIMO, a 100 percent launch rate, and all maintained it for at least one year. Launch times ranged from 381 days at the fastest site to 586 days at the slowest, and the clinics completed an average of 85.3 percent of milestones. Readiness planning proved the hardest stage, completed at only 62.8 percent, likely reflecting how busy clinical teams prioritize patient care over administrative infrastructure. By fifteen months post-launch, all but one site was still running the model, and two had expanded it to additional care teams.

Acceptability, assessed through surveys and interviews with 91 staff members and 56 patients, was moderate overall and held steady over time. Staff reported increased knowledge of medications for opioid use disorder, with mean scores rising from 3.8 to 4.0 on a five-point scale, and fewer perceived barriers to providing treatment, dropping from 2.2 to 1.8 on a four-point scale. Patients reported a decline in internalized stigma, from 3.1 to 2.8 on a five-point scale. Qualitative interviews reinforced the quantitative picture. Staff described the model as aligned with clinic values and uncomplicated, with one noting that breaking down silos made care easier for everybody. Patients reported few challenges starting or continuing treatment, with one saying their care had improved under the new model.

Fidelity monitoring showed the core components were delivered at levels sufficient for early-stage research. Weekly huddles occurred 82 percent of the time, 78 percent of patients were screened for comorbid conditions, and provider education was continuous. The cost of implementation was tracked using a method that maps staff hours to Bureau of Labor Statistics salaries. On average, sites invested 172.25 hours over fifteen months, at an estimated cost of $18,405, well below the roughly $40,778 average reported for similar collaborative care implementations. No new hires were needed, including pharmacists, and the model fit into existing workflows.

Electronic health record data from one year before versus one year after launch showed encouraging signals, though the exploratory design did not test statistical significance. The proportion of days covered, a measure of treatment retention, edged up from 59.5 to 60.2 percent, and the share of patients achieving adherence above 80 percent of days covered rose from 38.6 to 40.9 percent. Clinic visits for opioid use disorder increased by 100 encounters, and the average number of patients treated per prescriber rose from 12.9 to 13.7. Notably, two sites lost prescribers during the study yet maintained or increased patient volume, suggesting the model may build provider confidence and efficiency. Urine toxicology showed diminished co-occurring use of several substances, including fentanyl, which fell from 9.2 to 7.2 percent of tests.

The researchers are careful about limitations. The study involved only four clinics without a control condition, and all sites were established treatment providers with retail pharmacies, 340B drug pricing membership, and multiple medication offerings, characteristics that may have boosted acceptability scores. The observed drop in patient stigma, while encouraging, cannot be attributed to the model specifically. Enrollment was restricted to English speakers, urine testing protocols varied across sites, and the project’s time-limited nature prevented a true assessment of long-term sustainability. Still, the geographic, organizational, and size diversity of the sites strengthens the case that the model can travel beyond its rural Maine origins.

The implications are significant. Pharmacists are among the most accessible clinicians in the health care system, yet pharmacist-led interventions for opioid use disorder remain underutilized. This trial provides the first data demonstrating that integrating pharmacists into primary care addiction teams is feasible across varied settings, acceptable to both staff and patients, and achievable without new hires or workflow restructuring. As the overdose crisis continues to demand what researchers call an all-hands-on-deck response, PrIMO offers a pragmatic, relatively inexpensive blueprint for expanding the workforce capable of delivering lifesaving medication, with a more rigorous effectiveness trial planned to determine just how far these promising early results can go.

Subject of Research: A nonrandomized clinical trial evaluating the feasibility and acceptability of a pharmacist-integrated collaborative care model for opioid use disorder in primary care settings.

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

Article References: Feasibility of Implementing a Pharmacist-Integrated Collaborative Model for Opioid Use Disorder: A Nonrandomized Clinical Trial. (n.d.). https://doi.org/10.1007/s11606-026-10924-3

Image Credits: AI Generated

DOI: 10.1007/s11606-026-10924-3

Keywords: opioid use disorder, pharmacists, primary care, medications for opioid use disorder, buprenorphine, implementation science, PrIMO, collaborative care, feasibility trial, treatment retention, stigma, health services research