Barriers and facilitators to community pharmacist-provided injectable naltrexone for formerly incarcerated individuals during community reentry

Abstract

Introduction

Medications for opioid use disorder (MOUD), including injectable naltrexone, are a key component in the treatment of opioid use disorder (OUD). These medications are especially important for individuals transitioning out of correctional facilities and back into their communities. Unfortunately, few formerly incarcerated individuals have access to MOUD upon reentry, incurring a 40-fold greater likelihood of overdose following release compared to the general population. In Wisconsin, community pharmacists have the authority to administer naltrexone injections. However, they have not been explored as a resource for improving access to this medication for this patient population.

Objective

As a first step, the goal of this study was to understand the barriers and facilitators impacting the use of community pharmacist-provided injectable naltrexone by formerly incarcerated individuals during community reentry period.

Materials and methods

The researcher conducted semi-structured interviews with 18 individuals representing five stakeholder groups, including four MOUD prescribers, three community pharmacists, four correctional staff, four community organization or non-profit staff, and three individuals or family members/caregivers of individuals with a history of OUD and incarceration. Deductive and inductive content analysis were used to identify barrier and facilitator categories across the five levels of the Socioecological Model.

Results

Overall, participants discussed factors at every level, and many barriers and facilitators confirmed findings from existing literature focused on MOUD access for formerly incarcerated individuals. Participants also identified factors more specific to community pharmacies, including 1) lack of interagency collaboration between pharmacists, prescribers, and correctional facilities and 2) lack of awareness of community pharmacist-provided injectable naltrexone services.

Conclusions

Future research should explore interventions to address the barriers identified in this study and improve connections between community pharmacists and formerly incarcerated individuals. This work can help ensure that these individuals are given the chance to successfully reintegrate into their communities.