Pharmacists in Primary Care Teams Expand OUD Treatment, Trial Finds

A four-site clinical trial has found that placing a pharmacist inside primary care addiction teams is workable in markedly different health systems, and that it can be done without hiring anyone new — the central obstacle the model was designed to address.

The study, published October 14 in the Journal of General Internal Medicine, tested a model called PrIMO, for pharmacist-integrated medication treatment for opioid use disorder. It was funded through the National Institute on Drug Abuse's Clinical Trials Network and followed sites in the Northeast, Midwest, Northwest and Southwest between August 2022 and July 2024.

Two of the four sites were federally qualified health centers and two were based at academic medical centers. All four launched the model — a 100 percent launch rate — and all kept it running for at least a year.

The gap the model was built around

Medications for opioid use disorder reduce overdose death, but in 2024 only about one in five people who needed them received them. Most treatment with buprenorphine happens in primary care, yet the majority of primary care providers do not prescribe it at all, and those who do typically treat fewer than five patients a month.

PrIMO grew out of work at Penobscot Community Health Care, the largest federally qualified health center system in Maine, which had already woven clinical pharmacists into its primary care addiction services and seen overdose mortality fall while prescribing rose. The trial asked whether that arrangement would travel.

The model has six components: collaborative communication among team members, weekly huddles with active clinical decision-making for every patient with opioid use disorder, education for providers, education for patients, screening for co-occurring conditions, and education for local partners. Pharmacists handle drug interactions, dose adjustments and prior authorizations, and consult with patients alongside prescribers.

Crucially, the design called for using pharmacists already on staff rather than creating positions, and gave each site a toolkit plus monthly meetings with the model's developers to hold the approach steady while allowing local adaptation.

What "feasible" actually measured

The primary outcome was implementation, tracked with an eight-stage tool covering 61 milestones from first engagement through site competency. Clinics completed an average of 85.3 percent of those milestones. Readiness planning was the weakest stage at 62.8 percent, which the researchers attribute to clinical teams prioritizing patient care over administrative groundwork.

Launch took 381 days at the fastest site and 586 at the slowest. By 15 months after launch, three of the four sites were still running the model and two had extended it to additional care teams.

The study also measured whether the model was tolerable to the people inside it, surveying 91 staff members and 56 patients. Staff knowledge of medications for opioid use disorder rose from 3.8 to 4.0 on a five-point scale and perceived barriers to providing treatment fell from 2.2 to 1.8 on a four-point scale. Patients reported internalized stigma declining from 3.1 to 2.8.

Interviews echoed the surveys. Staff described the model as consistent with clinic values and uncomplicated, with one saying that breaking down silos made care easier for everyone. Patients reported few problems starting or continuing treatment.

Fidelity checks found weekly huddles took place 82 percent of the time and 78 percent of patients were screened for co-occurring conditions.

Cost, and what the early numbers show

Implementation was tracked by mapping staff hours onto Bureau of Labor Statistics salaries. Sites invested an average of 172.25 hours over 15 months, at an estimated $18,405 — well below the roughly $40,778 average reported for comparable collaborative care rollouts. No new hires were needed, including pharmacists.

Electronic health record data from the year before and the year after launch showed movement in a favorable direction, though the exploratory design did not test for statistical significance. Days covered by medication, a retention measure, edged from 59.5 percent to 60.2 percent, and the share of patients above 80 percent adherence rose from 38.6 to 40.9 percent. Clinic encounters for opioid use disorder increased by 100, and the average number of patients treated per prescriber went from 12.9 to 13.7.

Two sites lost prescribers during the study and still maintained or increased their patient volume. Urine toxicology showed co-occurring fentanyl use falling from 9.2 percent to 7.2 percent of tests.

The limits the authors state

The trial had no control group and involved only four clinics, so it cannot establish that the model improved outcomes rather than coinciding with them. All four sites were established treatment providers with retail pharmacies, 340B drug pricing membership and multiple medication options, characteristics the authors say may have lifted their acceptability scores. The drop in patient stigma cannot be attributed specifically to PrIMO. Enrollment was limited to English speakers, urine testing protocols varied by site, and the project was time-limited, which prevented an assessment of long-term sustainability.

The authors present the geographic, organizational and size diversity of the sites as the strongest argument that the approach can travel beyond its rural Maine origins.

Pharmacists remain among the most accessible clinicians in the health care system, and the paper describes the trial as the first data showing that integrating them into primary care addiction teams is feasible across varied settings at low cost. The researchers say a more rigorous effectiveness trial is planned to determine how far the early results hold. The findings arrive alongside separate work on where medication for opioid use disorder is dispensed, including a national survey of methadone pharmacy practices published earlier this month.

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