Barriers and Facilitators to Community Pharmacist-Provided Injectable Naltrexone for Formerly Incarcerated Individuals During Community Reentry in Wisconsin

Abstract

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, as individuals receiving MOUD are 85% less likely to die due to drug overdose in the first month post-release and have a 32% lower risk of rearrest. 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. While 84% of Wisconsin jails offering MOUD offer naltrexone, less than half provide linkage to community treatment for reentering individuals. In Wisconsin, community pharmacists have the authority to provide naltrexone injections. However, they have not been explored as a resource for improving access to this medication for formerly incarcerated individuals. As a first step, the goal of this study was to understand the barriers and facilitators impacting access to community pharmacist-provided injectable naltrexone for this patient population during community reentry period. The researcher conducted semi-structured interviews with 18 individuals representing five stakeholder groups. Deductive and inductive content analysis were used to identify barrier and facilitator categories across the five levels of the Socioecological Model. 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 MOUD services. 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 society.