Social Network Barriers to Extended-Release Naltrexone Within Rural Appalachia

Perspectives from Justice-Involved Clients and Clinicians

Bibliographic Data

ID21645453
AuthorsAmanda M Bunting (0000-0002-2103-9655, Department of Population Health, New York University Grossman School of Medicine, corresponding author), Carrie B Oser (0000-0001-8658-9335, University of Kentucky), Marisa Booty (0000-0003-3991-8196, University of Kentucky), Hannah K Knudsen (0000-0002-0137-9337, Center on Drug & Alcohol Research, University of Kentucky), Evan J Batty (0000-0003-0683-7162, University of Kentucky), Michele Staton (0000-0002-5093-8131, Center on Drug & Alcohol Research, University of Kentucky)
Year2025
Volume60
Issue5
Pages758-765
Publication date2025-04-16
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueSubstance Use & Misuse (JOURNAL)
Journal identifiersISSN: 1082-6084 • E-ISSN: 1532-2491
PublisherInforma UK Limited (PUBLISHER • GB)
DOI10.1080/10826084.2024.2447430
PMID39810404
OpenAlexW4406406468
LanguageEN
Citations received1
References cited38

Background Extended-release naltrexone (XR-NTX, Vivitrol®) is an effective, but underutilized, evidence-based treatment for people with opioid use disorder (POUD) who are incarcerated. Networks of family, friends, and clinicians serve as social influencers of health behaviors, including XR-NTX initiation, and are especially salient in Appalachia.Objectives Using a triangulation of perspectives, this study examined concordance between the social network themes that emerged from qualitative interviews with clinicians and POUD social network findings.Methods Audio-recorded qualitative interviews were conducted with all clinicians (n = 15) providing assessments and community-based treatment linkages to justice-involved POUDs in Kentucky’s Appalachian counties. Two independent coders coded the transcribed interviews. Social network data were collected from POUDs who completed prison-based treatment programs and were recently released from prison (n = 52).Results Three themes related to POUDs’ social network barriers of XR-NTX emerged from the clinician interviews: (1) networks with limited knowledge of XR-NTX, (2) homophily in networks, and (3) limited support networks. From the perspective of the POUD, knowledge of XR-NTX was nonexistent within their networks, aligning with the clinician theme. Homophily was prevalent in some attributes (e.g., employment), but only 31.8% of POUD networks had used drugs, providing mixed support for this theme. In concordance with clinicians, POUDs received high levels of emotional support, but lacked instrumental, financial, and treatment support from networks.Conclusions The network characteristics of Appalachian POUDs recently released from prison create challenges associated with recovery, which may be addressed through network and educational interventions

Appalachia · Appalachian Region · Criminology · Economic Justice · Geography · Naltrexone · Opioid · Political science · Psychiatry · Social justice · HIV, Drug Use, Sexual Risk · Medicine · Opioid Use Disorder Treatment · Psychology · Social Psychology · Substance Abuse Treatment and Outcomes

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