Social Network Barriers to Extended-Release Naltrexone Within Rural Appalachia: Perspectives from Justice-Involved Clients and Clinicians

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.