Intervention
Barriers and facilitators (sometimes called "contextual determinants") are factors that make it harder or easier to implement buprenorphine. These factors span multiple levels. Click the buttons on the left to read more about common barriers and facilitators for buprenorphine. In addition, view the RASC guides on Contextual Determinants Affecting Implementation and the Inventory of Factors Affecting Successful Implementation and Sustainment (IFASIS) to learn practical ways to assess these constructs.
Barriers and facilitators often relate to the way in which naltrexone is formulated as a medication for opioid use disorder or how it works in the body to produce its intended effect.
Barriers
Naltrexone is a long-acting medication that blocks the effects of opioids in the brain and body. If it is administered when an individual has opioids in their system, it will cause a sudden state of prolonged opioid withdrawal. Before receiving naltrexone for the first time, individuals must either undergo a period of medically supervised withdrawal or already be abstinent from opioids for a period of time. This can be a substantial barrier to naltrexone initiation, with a success rate of 63% for individuals undergoing medically supervised withdrawal and 85% for individuals already abstinent from opioids.
Naltrexone injections must be administered by trained healthcare professionals and cannot be administered at home. This can make it inconvenient for individuals to find and schedule an appointment for naltrexone at a clinic and difficult for non-healthcare settings to offer naltrexone due to the complexity of ordering, storage, and administration processes.
Naltrexone is more costly than other medications for opioid use disorder, both to the individual receiving the medication and the provider administering the medication. This is because of multiple factors, including the lack of a generic formulation of injection naltrexone, limited formulary coverage, and higher overhead required to order, store, and administer naltrexone injections properly.
Facilitators
Naltrexone is a long-acting medication that blocks the effects of opioids in the brain and body. Because naltrexone injections last for one month, this can be more convenient than taking a medication that must be taken daily.