Implementation Strategies
Implementation strategies are the actions needed to implement naltrexone. Ideally, implementation strategies should be selected to address the barriers to implementation discussed in the "Common Barriers and Facilitators" tab. Click the buttons on the left to read more about implementation strategies people have used to implement naltrexone and to access educational resources. In addition, view the RASC guide Strategies Timeline, Activities & Resources (STAR) log to discover a practical way to track these strategies and The Partner Engagement Guide to access practical recommendations to engage partners in your implementation strategies.
Implementation efforts have largely focused on funding for dedicated support personnel to bring naltrexone treatment to clinics, hospitals, and jails/prisons.
Documented efforts to implement naltrexone for opioid use disorder (OUD) have primarily occurred in novel settings, such as during hospitalization or incarceration. Nearly all published reports of these implementation strategies have supported the implementation of multiple medications for opioid use disorder (buprenorphine, methadone, and naltrexone) simultaneously. As a result, we describe implementation strategies that have been used to promote uptake of medication for opioid use disorder more generally.
Implementation efforts most often fund dedicated support personnel, such as addiction medicine consult teams, nurse care managers, or patient navigators, to assist in prescribing medications for opioid use disorder during hospitalization or incarceration and facilitate linkage to ongoing care after discharge.
In the CATCH hybrid implementation trial, six public hospitals in New York were provided with resources to support a dedicated addiction medicine consultation team comprised of an addiction medicine physician, social worker, and peer counselor. The trial found that hospitals with more complete medical staffing were higher-performing than those with incomplete staffing.
The PRimary Care Opioid Use Disorders treatment (PROUD) trial evaluated implementation of a collaborative care model using a nurse care manager to support medication prescribing in primary care in six diverse health systems across five US states. Results of the trial indicated that the collaborative care model was effective in improving the reach of opioid use disorder treatment, and qualitative data suggested that having a straightforward pathway for patients to access nurse care managers was a key success factor.
A recent trial in New Mexico evaluated naltrexone with and without patient navigation following release from jail. Patient navigators provided one-on-one assistance with overcoming barriers to community re-entry and adhering to recommended medical management. This trial did not find beneficial effects of extended-release naltrexone with or without patient navigation relative to an enhanced treatment as usual condition.
Project ECHO (Extension for Community Healthcare Outcomes) is a telementoring network that links local clinicians with experts in the management of complex conditions; it features intensive didactic training, case conferences, and question-and-answer sessions with subject matter experts. Organizational coaching is a related strategy that involves training and support on change management to guide local clinicians in effective implementation. A recent randomized trial compared high and low dose external coaching with and without the ECHO telementoring model among jails seeking technical assistance with implementing or expanding medication for opioid use disorder practices. Results of this trial indicate that external coaching was a more effective implementation strategy than ECHO for increasing the reach of medications for opioid use disorder, although high-dose coaching was not more effective than low-dose coaching.