(1317) Access to Vivitrol for Formerly Incarcerated Individuals During Community Reentry: Advancing the Role of Community Pharmacists in Wisconsin

Objectives: More than three million U.S. citizens previously or currently suffer from opioid use disorder (OUD). Over 20% of people with OUD have been involved in the criminal justice system. Medications for opioid use disorder (MOUD) are a key component in treating OUD. MOUD is especially important for individuals transitioning out of correctional facilities and back into their communities. Formerly incarcerated individuals receiving MOUD are 85% less likely to die from drug overdose in the first month after release and have a 32% lower risk of rearrest. However, few previously incarcerated individuals are able to access MOUD upon reentry, missing a critical tool for rehabilitation and incurring a 40-fold greater likelihood of overdose following release compared to the general population. Previous work has shown that in individuals released with doses of MOUD, less than 25% continue these medications in the community.

A potential solution that hasn’t been explored is connecting formerly incarcerated individuals with community pharmacists. Community pharmacists represent a promising resource, as they are the most accessible healthcare provider, can educate patients on the pharmacological aspects of MOUD, and are receptive to providing these medications. In Wisconsin, community pharmacists have the authority to administer non-vaccine injections, including injectable naltrexone (Vivitrol). Additionally, since 2021, Wisconsin pharmacists are recognized as non-physician providers under Medicaid, authorizing pharmacists to be reimbursed for medical services within their scope of practice. However, research on improving access to Vivitrol for formerly incarcerated individuals via community pharmacies in Wisconsin remains almost non-existent. The first step is to understand the barriers and facilitators to community pharmacist-provided Vivitrol from the perspectives of formerly incarcerated individuals and stakeholders in order to inform interventions, improve patient outcomes, and promote health equity.

Methods: This study will occur across two aims. Aim 1 will include interviews with stakeholders (n=12) who work in Wisconsin and are involved in the reentry process. Stakeholders will fall into one of three groups: 1) healthcare providers with experience providing Vivitrol and serving formerly incarcerated individuals, 2) professionals working in correctional settings who support reentry, or 3) members of community organizations that offer healthcare support for formerly incarcerated individuals. Aim 2 will include interviews with individuals (n=12) who were formerly incarcerated in Wisconsin and are utilizing Vivitrol for OUD treatment. All interview questions will be guided by the Social Ecological Model and ask participants to describe their perception of the barriers and facilitators that formerly incarcerated individuals face in accessing Vivitrol treatment from community pharmacies. All interviews will be recorded, transcribed, and analyzed via deductive and inductive content analysis.

Results: The expected results of this study include a comprehensive understanding of: 1) the barriers and facilitators that formerly incarcerated individuals face in accessing Vivitrol via community pharmacies upon reentry, 2) the barriers and facilitators that stakeholders face in supporting the access and use of community pharmacist-provided Vivitrol, 3) the contributing factors to the barriers and facilitators, 4) where the barriers and facilitators exist on the Social Ecological scale, and 5) any concordance or discordance between the perceptions of formerly incarcerated individuals and stakeholders.

Conclusions: The results can be used to inform an intervention that improves the connection between formerly incarcerated individuals and community pharmacists and increases access to Vivitrol. Increased access to Vivitrol has several implications for this patient population, including decreased rates of overdose, rearrest, and reincarceration, improved mental health outcomes, and improved family and community health and safety. Improving MOUD access for formerly incarcerated individuals can help combat racial and ethnic health disparities, as Black, Hispanic, and Latine individuals are disproportionately impacted by this problem. Finally, this study can help improve the reentry process and advance the practice of community pharmacists.