More than a quarter of people who received a first prescription for buprenorphine, one of the most effective medications for opioid use disorder, never picked it up from a pharmacy, and the share walking away empty-handed has nearly doubled in five years.
The finding comes from a retrospective cohort study in JAMA Network Open. Researchers identified 1,428 adults who received a first buprenorphine prescription for opioid use disorder between January 2020 and September 2024 and checked whether it was dispensed within 30 days. In total, 369 patients, or 25.8 percent, had a first prescription that was never filled.
The trend is the part that should concern anyone with a family member entering treatment. Abandonment climbed steadily across the study period, from 19 percent of first prescriptions in 2020 to 37 percent in 2024, a statistically significant increase.
Trend Line That Moved in the Wrong Direction
The direction matters because federal policy moved the opposite way during the same years. In 2023, the requirement that clinicians complete special training and obtain a waiver before prescribing buprenorphine was eliminated, a change intended to widen access.
More prescribing does not automatically mean more treatment. The study describes the pharmacy counter as a distinct point of failure that occurs after a prescriber has already done everything right, and it is a point that federal prescribing reform did not address.
This is also not new. Prior research found that 32 percent of buprenorphine prescriptions written between 2015 and 2019 were never dispensed. The problem was known, and by this measure it is getting worse rather than better.
Study design limits how far these numbers travel. This was a retrospective cohort analysis drawn from records, which means it can document that a prescription went unfilled but cannot directly observe why in any individual case. It also cannot capture people who never received a prescription at all.
Pharmacy Counter as a Documented Failure Point
Three barriers appear repeatedly in the wider research literature: cost at the register, whether the pharmacy stocks the drug, and pharmacist discretion about dispensing a controlled substance.
Stocking is the most measurable. A Health Affairs analysis of prescription claims data found buprenorphine was regularly dispensed at 39 percent of retail pharmacies in 2023, up from 33 percent in 2017. Availability in that study meant a pharmacy filled at least one buprenorphine prescription each month it was open, which is a proxy for reliable stocking rather than a direct inventory count.
The distribution was uneven. Pharmacies in predominantly Black neighborhoods (18 percent) and Latino neighborhoods (17 percent) were far less likely to dispense it than those in predominantly white neighborhoods (46 percent). Nationally, availability fell significantly in five states and the District of Columbia over that period, and in 73 hard-hit rural counties fewer than a quarter of pharmacies carried the medication.
Dima Mazen Qato of the USC Mann School of Pharmacy and Pharmaceutical Sciences, senior researcher on that work, said in a news release that relaxing prescribing rules was an important step, but "too many patients lack a nearby pharmacy that carries it," according to the University of California, Berkeley.
A separate survey of 601 adults in telemedicine treatment across Florida, Michigan, New Jersey, Ohio and Texas found that about one third missed doses over a year because of a pharmacy-related barrier, with the most common problem being that the pharmacy did not have the medication and needed to order more stock. Readers should weigh one caveat: the survey was led by a telemedicine company that treats these patients, and some authors disclosed equity in it.
Groups Most Likely to Leave Without the Medication
The new analysis found Hispanic patients made up a larger share of the abandoning group, 10.6 percent, than of those who filled, 4.8 percent. The authors suggest language barriers and pharmacy-level access may contribute, pointing to research showing fewer dispensing pharmacies in Hispanic and Black neighborhoods.
The study did not find statistically significant differences by sex or race overall. Patients who did fill were more likely to have a documented opioid use disorder or overdose, another substance use disorder, or a mental health diagnosis in the prior six months. In plain terms, prescriptions written for people already connected to the treatment system were more likely to be picked up.
That points toward a specific vulnerability: the person receiving a first prescription after an emergency department visit or a single primary care appointment, without an established treatment relationship, is the person most likely to fall out at the counter.
The window matters because relapse risk is highest in exactly that period. Buprenorphine and methadone are approved medications with substantial evidence behind them, and an unfilled first prescription is a treatment episode that never started.
Steps for Patients and Families Starting Treatment
Anyone starting buprenorphine can reduce the chance of a failed first fill with a few practical moves, none of which require medical expertise.
Call the pharmacy before going, and ask specifically whether they have the prescribed formulation and dose in stock. If they do not, ask whether they can order it and how long that takes, then call a second pharmacy while waiting. Ask the prescriber's office whether they know which nearby pharmacies reliably stock it, since clinics that treat opioid use disorder often keep an informal list.
Ask about cost before arriving. Coverage varies, and a prescription that is unaffordable at one pharmacy may be covered differently elsewhere or through a manufacturer or state assistance program. Prescribers can sometimes switch to a covered formulation.
If a pharmacist declines to fill a valid prescription, that is worth reporting back to the prescribing clinician, who may be able to intervene directly or redirect the prescription.
The federal SAMHSA National Helpline at 1-800-662-4357 is free, confidential, and available around the clock, and can help locate treatment and prescribers. No one should stop or adjust buprenorphine without talking to a clinician.
The bottom line: the newest finding is that first-prescription abandonment rose from 19 percent to 37 percent between 2020 and 2024; the people most affected are those newly entering treatment without an established care relationship; and the most useful step is confirming stock and cost before the pharmacy trip.
If you or someone close to you is struggling with substance use, support is available. The SAMHSA National Helpline (1-800-662-4357) and the 988 Suicide and Crisis Lifeline can connect you with help.
Frequently Asked Questions
What did the study find? Among 1,428 adults given a first buprenorphine prescription for opioid use disorder between 2020 and 2024, 25.8 percent never had it dispensed within 30 days.
Is the problem getting worse? Yes by this measure. Abandonment rose from 19 percent of first prescriptions in 2020 to 37 percent in 2024.
Why do people leave prescriptions unfilled? The wider research points to cost at the register, pharmacies not stocking the medication, and pharmacist discretion over dispensing a controlled substance. This study documents the outcome rather than the reason in each case.
How many pharmacies actually carry buprenorphine? Claims-data research found it regularly dispensed at 39 percent of United States retail pharmacies in 2023, with far lower rates in Black and Latino neighborhoods.
What can someone do before going to the pharmacy? Call ahead to confirm the exact formulation and dose is in stock, ask about cost and coverage, and ask the prescriber which nearby pharmacies reliably fill it.
What if a pharmacist refuses to fill it? Tell the prescribing clinician, who may be able to contact the pharmacy directly or send the prescription elsewhere.
Where can someone find treatment help? The SAMHSA National Helpline at 1-800-662-4357 is free, confidential and available 24 hours a day.
