Few Pharmacies Carry This Key Opioid-Addiction Treatment. San Francisco Wants To Change That

Less than half of all San Francisco pharmacies carry one of the most powerful medications used to treat opioid addiction, according to San Francisco’s Department of Public Health.

The lack of availability of buprenorphine, a medication that can curb cravings and withdrawal symptoms associated with opioid addiction, comes as San Francisco recently experienced its worst year for overdoses on record in 2023.

And despite efforts to make medication-assisted treatments like buprenorphine more available, access is still so scarce that some people seeking these medications have had to turn to street-level dealers for it.

“It is critical that people in recovery have easy access to effective and life-saving medications such as buprenorphine and methadone if they are going to be successful entering and staying in treatment,” says Dr. Grant Colfax, Director of the San Francisco Department of Public Health, in a press statement. “With treatment and support, recovery from opioid use disorder is possible for every individual.”

San Francisco is not an outlier when it comes to the availability of buprenorphine or other medications that help reduce opioid cravings, like methadone. Just 47% of retail pharmacies across California carried buprenorphine, according to a 2023 study published in JAMA Network Open.

In San Francisco, where more than 3,000 people have died of overdose since 2020, only 44% of pharmacies carried buprenorphine and were able to fill a two-week prescription within the same day, according to a DPH survey of 84 responding pharmacies.

The Food and Drug Administration has approved three medications to treat opioid use disorder: buprenorphine, methadone and naltrexone. All three have been found to reduce opioid cravings and withdrawal and are widely considered to be powerful tools for recovery when combined with counseling and other social support.

However, experts say that significant barriers to taking the medication exist. For example, people who take methadone, which has been used to treat opioid addiction since the 1970s, historically have had to meet strict prescriber regulations compared to most medications. This includes having to visit clinics daily in person to access their prescriptions under supervision and take frequent drug tests.

Those rules are slowly starting to shift.

This year, the federal government agreed to expand access to methadone by removing a requirement for practitioners to complete additional training and obtain a special waiver before prescribing the medication.

The regulations change also allows for take-home medications rather than showing up daily when appropriate, as well as the option to prescribe larger doses as the potency of opioids in the illicit drug market has changed. For instance, fentanyl, which was involved in the majority of overdose deaths in San Francisco in 2023, is 50 times stronger than heroin.

At the state level, Assemblymember Matt Haney, who represents San Francisco, has proposed a bill that aims to align California law with federal regulations to reduce barriers to treatment for opioid use disorder.

Despite those efforts and having more people available to prescribe buprenorphine, utilization of the medication has not dramatically changed, according to one 2024 study. That’s led lawmakers and health experts to seek other ways to expand access.

This week, a handful of city leaders announced they want to require pharmacies to stock the medication.

“If San Francisco will be successful in incentivizing long-term recovery from addiction, we need to make sure that buprenorphine is available at pharmacies,” Supervisor Matt Dorsey told KQED. “I don’t know what the excuse is for not carrying it, but we need to end that excuse and make sure it’s a requirement to carry.”

Supervisors Rafael Mandelman, Hillary Ronen and Dean Preston are co-sponsoring the legislation, which SFDPH believes is the first of its kind in the country. The new law would update the city’s health code so that any pharmacy that carries controlled substances must stock buprenorphine for at least two new prescriptions.

“When my office worked with DPH to create the city’s first Overdose Prevention Plan, expanding access to buprenorphine and other medications was identified as a key area of need,” Supervisor Dean Preston told KQED, referring to the city’s 2022 blueprint to combat overdoses. “I am proud to co-sponsor this sensible and important legislation to ensure that buprenorphine is available in every neighborhood for anyone who needs it.”

Last year, Dorsey proposed legislation that would require all pharmacies to carry Naloxone, a nasal spray that can reverse an opioid overdose. The FDA approved over-the-counter Naloxone in 2023.

Experts say making buprenorphine available as soon as someone decides they want to change their drug use patterns is essential to helping people move into and through recovery.

People who used medication-assisted treatments such as methadone or buprenorphine were 80% less likely to die of an opioid overdose compared to people in treatment without the medications, according to a 2020 study in the medical journal Addiction.

San Francisco is already building out new pathways to access buprenorphine, such as home delivery programs for people living in the city’s permanent supportive housing and expanding hours for the public behavioral health pharmacy. But leaders on both sides of the political aisle say there’s still plenty of work to do.

“In today’s fentanyl era, anyone who makes the brave choice to seek recovery from opioid use disorder is really in a race against the clock on overpowering cravings and debilitating withdrawal symptoms,” Dorsey told KQED. “If that medication is not readily available to offer relief, we know life-threatening drugs are available on the streets.”