SAN FRANCISCO DEPARTMENT OF PUBLIC HEALTH AND SUPERVISOR MATT DORSEY INTRODUCE LEGISLATION TO REQUIRE BUPRENORPHINE MEDICATION FOR OPIOID DEPENDENCY IN PHARMACIES

San Francisco, CA – Today, the San Francisco Department of Public Health (SFDPH) and Supervisor Matt Dorsey introduced legislation requiring San Francisco pharmacies to stock buprenorphine, one of the three FDA-approved medications for treating opioid use disorder (OUD). This legislation, co-sponsored by Supervisors Rafael Mandelman, Hillary Ronen, and Dean Preston, and will make it easier for individuals to access addiction treatment when and where they need 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,” said Dr. Grant Colfax, Director of Health. “This legislation, as well as pending state legislation that SFDPH is sponsoring around methadone access, will advance our goal to increase treatment options in San Francisco and to get more people with substance use disorders into treatment and recovery. With treatment and support, recovery from opioid use disorder is possible for every individual.”

Buprenorphine is a gold-standard medication for OUD. It effectively reduces opioid use and cravings, alleviates uncomfortable withdrawal symptoms, facilitates long-term recovery, and reduces the risk of dying by 50 percent. This legislation, believed to be the first of such kind in the country, is the latest effort to improve treatment availability. If enacted, the proposed law would amend the municipal Health Code to require all retail pharmacies citywide that stock controlled substances prescription drugs to stock sufficient buprenorphine for at least two new prescriptions.

“If San Francisco is to succeed in supporting and incentivizing long-term recovery from addiction, ensuring the availability of buprenorphine at local pharmacies must be part of it,” said Supervisor Matt Dorsey. “In today’s fentanyl era, anyone who makes the brave choice to seek recovery from opioid use disorder is racing the clock on overpowering cravings and debilitating withdrawal symptoms. If life-saving medications aren’t readily available to offer relief, we know life-threatening street drugs abound as alternatives. It’s a moral imperative to expand access to medically assisted treatment in the midst of the drug overdose crisis we’re facing. That’s why I’m so grateful to the Department of Public Health for identifying local problems with buprenorphine availability, and for recommending this worthwhile approach to address it.”

Although buprenorphine has been successfully employed in the treatment of OUD worldwide for many years, obstacles to more patients using the medication have long been noted in medical literature with a 2019 study1 citing the need for “more effort to disseminate buprenorphine therapy across health systems.” In response to challenges of underuse and availability, in 2023 the federal government removed a requirement that practitioners complete additional training and obtain a special waiver prior to prescribing buprenorphine. By removing this requirement, the number of prescribers capable of prescribing buprenorphine increased nationally.

Yet efforts to increase prescribing buprenorphine will be insufficient if patients are unable to obtain it from their pharmacies, and pharmacy access has historically been limited. A 2023 study published in JAMA Network Open found that only 47 percent of retail pharmacies in California had buprenorphine in stock. And earlier this year the San Francisco Department of Public Health found that even fewer pharmacies - only 44 percent– in the city had buprenorphine in stock and were able to fill a new prescription that day. There is often a narrow window to start someone on treatment, and delays in accessing medication are missed opportunities to get someone on a path to recovery. Studies cited in the findings of the legislation introduced today reflect persistent barriers to access, which San Francisco’s proposed buprenorphine stocking mandate seeks to address.

This mandate is part of the ongoing programmatic, policy and legislative efforts to make treatment more accessible in San Francisco. Legislation recently passed to make it easier to procure public health beds and provide flexibility in obtaining mental health and/or substance use disorder beds. The San Francisco Department of Public Health and City and County of San Francisco is sponsoring State Assembly Bill 2115 introduced by Assemblymember Haney which would align California law with federal regulations to reduce barriers to treatment for OUD. In addition, SFDPH continues to increase hours of program operations, open additional sites, and types of services, and to bring treatment to people to support their entry into and retention in care.