Experts agree that medications for opioid use disorder (MOUD), such as the use of buprenorphine, are the “gold standard” in treating opioid use disorders (OUD). However, access barriers to vital MOUD medications containing buprenorphine (e.g., Suboxone) remain. In late 2022, the Behavioral Health Foundation conducted an independent statewide secret shopping study to assess access to prescribed buprenorphine for MOUD at Tennessee pharmacies. Our Chief Executive Officer, Elliot Pinsly, was invited to present the results to an audience of leading addiction medicine professionals at the 2023 Mid-South Addiction Conference at Vanderbilt University. Slides are available for download here.

Despite the known effectiveness of MOUD and calls to expand access to buprenorphine prescriptions, significant access barriers remain. A 2021 national study assessing pharmacy-level access found that “pharmacies in the South were significantly more likely to refuse buprenorphine dispensing (26%) relative to pharmacies in other regions (11-18%).” Our study aimed to examine the accessibility of buprenorphine through Tennessee pharmacies.

"Conclusive evidence shows that medications are the gold standard of treatment for OUD. Buprenorphine continues to be an important mainstay of recovery for many individuals in Tennessee."


The Behavioral Health Foundation conducted secret shopper calls to licensed pharmacies in Tennessee to examine if pharmacies were able to fill a new patient prescription for buprenorphine. We assessed for name brand Suboxone, generic buprenorphine/naloxone films, and buprenorphine/naloxone tablets. When creating our sample, we used random selection to identify one independent and one chain pharmacy in every county, where possible. For counties that had either chain or independent pharmacies, but not both, we randomly selected two of the available pharmacy type. One county had zero licensed pharmacies. Using a standardized script, we called 183 pharmacies, representing 94 out of the 95 counties in Tennessee, asked if they could fill a buprenorphine prescription, and recorded responses.

Our Findings

Of the 183 TN pharmacies we called, 176 provided clear information regarding whether or not they could fill a buprenorphine prescription for a new patient.

  • 53% said NO (N=94)
  • 34% said YES (N=59, 4 of which required 3+ days to fill the Rx)
  • 13% said IT DEPENDS – only if certain conditions were met (N=23; e.g., requiring a patient interview, transferring non-controlled medications, proof of local residence, and/or a local or specific doctor)

Our findings showed remarkably similar results across chain and independent pharmacies in Tennessee – a unique result differing from similar studies in other states that found higher rates of “no” responses at independent pharmacies.

  • No: 53% of chains and 54% of independents
  • Yes: 34% of chains and 33% of independents
  • It Depends: 13% of chains and 13% of independents

Our qualitative analysis identified four primary themes:

  • Limit of Patients: 53 pharmacies mentioned a limit on the number of patients they were allowed to have on buprenorphine. Three main sub-themes emerged: 1) prioritizing existing patients only, 2) a general limit on number of patients for that medication, 3) having a waiting list.
  • Supply Related Issue: 30 pharmacies mentioned having issues on the supply side, such as distributors supply shortages or ordering limits. Top sub-theme: the DEA.
  • Preferences & Attitudes: 33 pharmacies mentioned pharmacist/pharmacy preference or attitudes toward buprenorphine. Four main sub-themes emerged: 1) Buprenorphine was bad for business/not profitable, 2) pharmacy needs to maintain ratio of controlled vs. non-controlled substances, 3) it was the pharmacists/pharmacy’s personal choice, and 4) no interest in dispensing that medication.
  • Restrictions: 23 pharmacies mentioned at least one restrictive requirement. These included: A patient interview with the pharmacist, needing to transfer/fill at least one other prescription other than buprenorphine, requiring a local/specific doctor and/or proof of local address, etc.

To read more and view actual comments from pharmacy staff that were captured in our qualitative data, please download the full presentation by clicking on the button below.