Setting
Barriers and facilitators relating to the inner setting primarily relate to naltrexone’s requirements for detoxification and the need for a trained healthcare professional to administer the injection.
Barriers
Before receiving naltrexone for the first time, individuals must either undergo a period of medically supervised withdrawal or otherwise already be abstinent from opioids for a period of time. This can be a substantial barrier to naltrexone initiation in many settings that do not have the ability to observe or support individuals for the required period of medically supervised withdrawal before starting naltrexone for the first time.
Naltrexone injections must be administered by a trained healthcare professional such as a nurse, advanced practice provider, or physician. Clinics must also have processes in place for medication storage in a refrigerated and secure environment and have systems in place for safe syringe use and disposal. This can be a substantial barrier to implementing naltrexone in non-healthcare settings.
Facilitators
Settings that already have the infrastructure in place for medication ordering, storage, administration, and syringe disposal (such as hospitals and clinics) may find it easier to offer naltrexone, as this infrastructure is often a substantial barrier when not present.
Hospital-based providers have cited that the successful implementation of medication initiation in other departments and hospitals or for similar medication offerings has increased their confidence that they would be able to overcome barriers in their setting and for naltrexone.