Abstract
Access to medications for opioid use disorder (OUD) in the pharmacy is internationally accepted; however, in the US, methadone treatment for OUD can only be provided by opioid treatment programs (OTPs). Under current US law, OTPs and pharmacies can partner to offer methadone in the pharmacy through "medication units." Changes to federal law could permit pharmacies to fill methadone prescriptions for OUD. To identify the advantages, disadvantages, barriers, and facilitators of pharmacy-based methadone treatment, we conducted interviews from April through July 2024 with thirty-one key informants, representing people with methadone treatment experience, OTP and pharmacy leadership, payers, and policy makers. Pharmacy-based methadone treatment was viewed favorably by all groups. People receiving OUD treatment embraced pharmacy-based methadone over models perpetuating restrictive OTP practices. Key facilitators included support for change, sustainable payment models, and clear regulations. Barriers included stigma, financial obstacles, and unclear regulations. Legislative and regulatory changes could expand access to methadone.