Chladek Jason S, Chui Michelle A
Grossman School of Medicine, New York University, 180 Madison Ave, New York, NY 10016, United States of America.
Division of Social and Administrative Sciences, University of Wisconsin-Madison School of Pharmacy, 777 Highland Ave, Madison, WI 53705, United States of America.
Explor Res Clin Soc Pharm. 2025 Jan 6;17:100561. doi: 10.1016/j.rcsop.2025.100561. eCollection 2025 Mar.
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.
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.
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.
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.
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.
用于治疗阿片类物质使用障碍（MOUD）的药物，包括注射用纳曲酮，是治疗阿片类物质使用障碍（OUD）的关键组成部分。这些药物对于从惩教机构过渡回社区的个人尤为重要。不幸的是，很少有曾经被监禁的人在重新进入社区后能够获得MOUD药物，与普通人群相比，他们获释后过量用药的可能性要高出40倍。在威斯康星州，社区药剂师有权进行纳曲酮注射。然而，尚未将他们作为改善该患者群体获得这种药物机会的资源进行探索。
作为第一步，本研究的目标是了解在社区重新融入期间影响曾经被监禁的个人使用社区药剂师提供的注射用纳曲酮的障碍和促进因素。
研究人员对代表五个利益相关者群体的18个人进行了半结构化访谈，这五个群体包括四名MOUD开处方者、三名社区药剂师、四名惩教工作人员、四名社区组织或非营利组织工作人员，以及三名有OUD和监禁史的个人或其家庭成员/照顾者。采用演绎和归纳内容分析法，在社会生态模型的五个层面上确定障碍和促进因素类别。
总体而言，参与者讨论了每个层面的因素，许多障碍和促进因素证实了现有文献中关于曾经被监禁的个人获得MOUD药物的研究结果。参与者还确定了更具体针对社区药房的因素，包括1）药剂师、开处方者和惩教机构之间缺乏机构间合作，以及2）对社区药剂师提供的注射用纳曲酮服务缺乏认识。
未来的研究应探索干预措施，以解决本研究中确定的障碍，并改善社区药剂师与曾经被监禁的个人之间的联系。这项工作有助于确保这些人有机会成功重新融入他们的社区。
