Most U.S. Pharmacists Back Methadone in Pharmacies, but Barriers Loom Large, Nationwide Survey Finds

A nationwide survey of licensed pharmacists has revealed a striking gap between willingness and readiness when it comes to one of the most promising strategies for expanding access to methadone treatment for opioid use disorder. The study, led by Li-Tzy Wu of Duke University School of Medicine and colleagues, surveyed 585 pharmacists across all 50 states and the District of Columbia and found that while a majority see clear benefits in allowing community pharmacies to dispense methadone on behalf of opioid treatment programs, only a small fraction currently possess the regulatory knowledge or hands-on experience needed to make that vision a reality. The findings, published in the journal Addiction Science & Clinical Practice, arrive at a moment when the United States continues to grapple with tens of thousands of opioid-related deaths each year and policymakers are actively searching for ways to bring lifesaving medications to the people who need them most.

Methadone remains one of the most effective treatments for opioid use disorder, reducing illicit opioid use, overdose risk, and mortality when taken consistently under medical supervision. Yet in the United States, access to methadone is tightly constrained by a regulatory architecture unlike that governing any other medication. Patients must typically travel daily to a specialized opioid treatment program, often called a methadone clinic, to receive their doses under observation. These clinics are concentrated in urban areas, leaving large swaths of rural America effectively unserved. The result is a treatment system in which the medication with the strongest evidence base is also the hardest to obtain, a paradox that has drawn increasing criticism from addiction medicine specialists and public health researchers alike.

One proposed solution is the pharmacy medication unit, a model in which a licensed pharmacy partners with an opioid treatment program to administer or dispense methadone at the pharmacy’s location. Under this arrangement, known formally as pharmacy administration and dispensing of methadone for opioid use disorder, the opioid treatment program retains medical responsibility for the patient while the pharmacy serves as a convenient, community-embedded point of access. Federal regulations permit such arrangements, and they have been used in other countries for decades, but the model remains rare in the United States. The Duke-led survey was designed to answer a deceptively simple question: are American pharmacists ready to take on this role?

The answer, in many respects, is cautiously encouraging. Of the 585 pharmacists surveyed, 57.2 percent expressed confidence in their ability to develop a partnership with an opioid treatment program to establish or participate in a pharmacy methadone medication unit. Meanwhile, 39.2 percent believed that most of their peers would be interested in participating in such a program, and 25.1 percent said they themselves were likely to build a partnership with an opioid treatment program to take part. These numbers suggest a meaningful reservoir of professional goodwill that could be tapped if the structural obstacles were addressed.

But the survey also exposed profound gaps in awareness and experience. Only 6.2 percent of respondents reported having ever worked at an opioid treatment program, and just 37.9 percent were aware that federal and state regulations already allow pharmacy-based methadone medication units. In other words, most pharmacists have never encountered the model, and most do not know it is even legal. That combination of unfamiliarity and regulatory opacity represents a formidable barrier, because pharmacists who do not know a practice exists are unlikely to advocate for it, pursue training in it, or negotiate the partnerships it requires.

The statistical analysis uncovered patterns in who felt most prepared. Pharmacists who were male, who identified with a racial category other than White or Asian, who practiced in the Western United States rather than the Northeast, who worked at an independent pharmacy rather than a hospital or clinic pharmacy, and who were owners, partners, or managers rather than staff pharmacists reported higher odds of feeling confident in their ability to forge a partnership with an opioid treatment program. Similar demographic patterns emerged for stated intention to participate, with male pharmacists, Asian pharmacists, and those in the other race category showing increased odds of expressing willingness to build such partnerships. The findings on practice setting and role are particularly telling: pharmacists with greater autonomy and decision-making authority, such as independent pharmacy owners, appear more inclined to embrace the model, suggesting that institutional flexibility matters as much as individual attitude.

When asked about barriers, the surveyed pharmacists were candid. Concerns about workload topped the list, reflecting the daily dosing schedule that methadone treatment typically demands and the staffing pressures already straining community pharmacies. Regulatory complexity and liability exposure also weighed heavily, as did a lack of training specific to methadone dispensing and the needs of patients with opioid use disorder. These concerns are not trivial. Methadone carries a narrow therapeutic window, and dispensing it safely requires knowledge of drug interactions, overdose risk, and the clinical protocols that opioid treatment programs follow. Pharmacists accustomed to filling prescriptions for chronic conditions would need structured education and clear practice guidelines before taking on the responsibility.

Yet the perceived benefits were equally compelling. Pharmacists pointed to improved access to treatment as the primary advantage, noting that pharmacies are often open extended hours, located in neighborhoods far from any clinic, and already trusted by the communities they serve. Expanding the number of dispensing points could reduce the daily travel burden that forces many patients to choose between holding a job and receiving their medication. Pharmacists also highlighted the potential to serve more patients overall and, notably, to reduce the stigma that many patients associate with standing in line at a methadone clinic. Receiving treatment at a neighborhood pharmacy, alongside neighbors picking up blood pressure medication or antibiotics, could normalize addiction treatment in a way that specialized clinics cannot.

The study’s authors argue that translating this latent willingness into actual practice will require coordinated action. They call for collective efforts among state pharmacy boards, pharmacist associations, and opioid treatment-related authorities to develop feasible program designs and to establish clear guidelines and training requirements for pharmacies and pharmacists wishing to participate in methadone medication units. Continuing pharmacy education could address the knowledge gap, while regulatory clarification could ease liability concerns. The survey was funded by the National Institute on Drug Abuse and approved by the Duke University Health System Institutional Review Board, and the authors report no competing interests.

As the opioid epidemic continues to claim lives across the country, the survey offers both a warning and an invitation. The warning is that good intentions alone will not build a pharmacy-based methadone system; without training, regulatory guidance, and deliberate partnership structures, the model will remain a footnote in addiction treatment policy. The invitation is that a substantial share of the pharmacy profession is already prepared to say yes, waiting only for the systems, education, and institutional support that would allow them to do so safely. If policymakers and professional bodies respond to that readiness, the corner pharmacy could soon become one of the most important front lines in the fight against opioid overdose, bringing a proven medication to patients in the communities where they live and work rather than behind the doors of distant clinics.

Subject of Research: Pharmacist readiness for pharmacy-based methadone dispensing for opioid use disorder in the United States

Article Title: Pharmacy administration and dispensing of methadone for opioid use disorder: a survey of U.S. pharmacists

Article References: Wu, L.-T., Easter, M., Gilbert, A., Hagemeier, N., & Schwartz, R. P. (2026). Pharmacy administration and dispensing of methadone for opioid use disorder: a survey of U.S. pharmacists. Addiction Science & Clinical Practice. https://doi.org/10.1186/s13722-026-00724-9

Image Credits: AI Generated

DOI: 10.1186/s13722-026-00724-9

Keywords: methadone, opioid use disorder, pharmacists, opioid treatment program, medication unit, pharmacy practice, survey research, opioid epidemic, treatment access, harm reduction, drug policy, Duke University