Systematic Analysis of the Service Process and the Legislative and Regulatory Environment for a Pharmacist-Provided Naltrexone Injection Service in Wisconsin

Abstract

Community pharmacists are viewed by the public as convenient and trustworthy sources of healthcare and pharmacists likely can play a larger role in addressing the major public health issue of the opioid epidemic affecting Wisconsin residents. Approved medications, including long-acting injectable naltrexone, can transform the treatment of individuals with opioid use disorder (OUD). Due to shortages of behavioral health providers in the U.S., and pharmacists’ knowledge about the safe use of medications, pharmacists can be a significant access point for treating OUD with naltrexone. Wisconsin’s pharmacy practice laws authorize pharmacists to administer medications via injection, and a small number of pharmacists currently are using this authority to provide a naltrexone injection service. This exploratory study had two objectives: (1) describe the pharmacist injection service process and identify barriers and facilitators to that service and (2) analyze the legislative/regulatory environment to ascertain support for expanding naltrexone injection service. Semi-structured pharmacist interviews (n = 4), and an analysis of Wisconsin statutes/regulations governing public health and social services, were undertaken to explore the objectives. Findings suggest that the service process requires considerable coordination and communication with practitioners, patients, and pharmacy staff, but many opportunities exist to broaden and sustain the service throughout Wisconsin.