Harm Reduction during Pregnancy: Access to Evidence-Based Modalities of Care in Appalachia
Barriers to Care, Reproductive Justice, People Who Use Drugs
This project was a collaboration with Hellbender Harm Reduction, led by community researcher and Hellbender organizational director Lesly-Marie Buer, to examine access to the medication for opioid use disorder (MOUD), buprenorphine, during pregnancy in Appalachian Tennessee and North Carolina. This study was undertaken because harm reduction participants in Central and Southern Appalachia had alerted harm reduction staff to barriers they were facing when trying to access MOUD while pregnant. They cited discriminatory providers, but also discriminatory pharmacists who refused to fill their prescriptions for buprenorphine after they were written. While there is evidence in the literature of the role pharmacists play in people’s access to MOUD, there is nothing published about how pregnancy may affect pharmacist interactions. Further, there are very few educational materials available for service providers and pregnant people about accessing MOUD prescriptions and getting those prescriptions filled at local pharmacies.
During the Fall 2025 Appalachian Justice Research Lab, students engaged in an analysis of patient, provider, and pharmacist rights and responsibilities in relation to MOUD access, prescribing, and distribution. Law students provided information and drafted fact sheets about statutes around conscience laws and buprenorphine. Public health and social science students examined the literature behind MOUD access, which informed the research study and fact sheets on MOUD access.
The research project focused on a phone audit that examined the practices of pharmacists in filling, or refusing to fill, prescriptions for the MOUD buprenorphine during pregnancy in East Tennessee and Western North Carolina. Stark differences were found between Tennessee and North Carolina, indicating that pharmacist education campaigns in North Carolina may decrease barriers to care. Students have thus far presented their findings to the Tennessee Department of Health and at the 2026 Appalachian Studies Association conference in Huntington, WV. Buer is working with students past the semester to author a peer-reviewed journal article and is working with state agencies and other harm reduction programs to distribute the student-drafted factsheets.