By Mori Owens
A valid prescription for buprenorphine does not guarantee a patient can fill it. The medication is a first-line, FDA-approved treatment for opioid use disorder, yet whether it reaches a patient often depends less on the prescriber than on decisions made far upstream, by the drug wholesalers who supply the pharmacy counter.
Workit Health, a telehealth provider treating opioid and alcohol use disorder, has built part of its treatment model around that problem. After a video visit with a licensed prescriber, patients can have buprenorphine shipped to their homes through delivery pharmacies rather than hunting for a retail counter that keeps it in stock.
The scale of the shortage is documented. A 2025 study in Health Affairs by researchers at the University of California and the University of Southern California found that about 39 percent of U.S. retail pharmacies regularly dispensed buprenorphine in 2023, up from 33 percent in 2017. The supply was unevenly distributed: pharmacies in predominantly Black and Latino neighborhoods stocked it at roughly 18 and 17 percent, respectively, compared with about 46 percent in white neighborhoods.
Why Willing Pharmacies Still Run Dry
The gap is not only about pharmacies choosing not to carry the drug. Buprenorphine is a controlled substance, and the wholesalers that distribute it operate suspicious-order monitoring systems that flag and can halt unusually large shipments of opioids. Those systems, reinforced by the opioid settlement agreements that require distributors to track controlled substances, treat buprenorphine like the drug it is meant to help people stop using. A pharmacy whose orders climb can find its supply cut off, regardless of how legitimate the demand.
The result reaches patients directly. A study published in JAMA Network Open in August 2025, based on a survey of 601 adults receiving telemedicine treatment across Florida, Michigan, New Jersey, Ohio, and Texas, found that 31.9 percent went without buprenorphine at some point due to a pharmacy-related barrier. The most common obstacle was the plainest one: the pharmacy did not have the medication and had to order more, risking an interruption in treatment. For a condition where a lapse can mean a return to illicit opioids now frequently mixed with fentanyl, the stakes are not abstract. Opioid overdoses were linked to 54,743 deaths in 2024, according to federal mortality data, though the national toll has since begun to fall.
Routing Around the Counter
Workit Health’s delivery pharmacies are the company’s attempt to remove the counter from the equation. Medication ships in unmarked packaging after a prescriber visit, and because buprenorphine is controlled, the pharmacies add verification steps to confirm it reaches the intended patient. Early results suggest the route helps people stay in care. A February 2025 feasibility study in Addiction Science & Clinical Practice, led by Workit Labs researchers Marlene C. Lira and Lauren E. Hendy, followed 337 adults who began treatment in Texas. Among those who used delivery, 82.6 percent remained in treatment at three months and 78.6 percent at six months, compared with 58.9 percent and 45.5 percent among patients filling prescriptions in person.
The authors were careful with the findings. Fewer than 7 percent of the group used delivery in the first month. The study covered a single state, and it was framed as an early look rather than proof. Still, it points to a variable that treatment models often ignore: not whether a patient is approved for medication, but whether the medication physically arrives.
Where the Fix May Come From
Some of the pressure is now moving toward policy. Author Lauren Hendy, PhD, put the case plainly when the pharmacy-barriers study was released: “Telemedicine is expanding access to treatment, but pharmacy-level barriers are undoing that progress. Policy changes at the state or federal level are urgently needed to ensure buprenorphine is reliably available, just like other essential medications.”
Those changes have started to appear. San Francisco has enacted an ordinance requiring retail pharmacies to stock buprenorphine alongside overdose-reversal medication, and lawmakers in New Mexico and Michigan have introduced bills setting minimum stocking levels and expanding delivery. At the federal level, a proposal known as the BUPE for Recovery Act would remove buprenorphine from the DEA’s Suspicious Orders Report System during the overdose crisis, easing the monitoring that discourages pharmacies from keeping enough on hand.
None of those measures is settled, and delivery pharmacies do not erase the underlying supply problem. What Workit Health’s model and its research together argue is narrower and harder to dispute: a treatment works only when the medication arrives, and the surest way to keep patients in care is to make sure it does.
