Year of Publication



Public Health

Date Available


Degree Name

Master of Public Health (M.P.H.)

Committee Chair

Dr. April Young

Committee Member

Dr. Patricia Rippetoe Freeman

Committee Member

Dr. Terry Bunn


Aim: To identify demographic, socio-economic, and other factors associated with likelihood of obtaining extended-release injectable naltrexone (EIN) if provided in a private space at a local pharmacy among people who use opioids (PWUO) in rural Appalachian Kentucky.

Methods: People who used opioids in the past 6 months in rural Appalachian Kentucky (n=170) completed interviewer-administered questionnaires eliciting demographic, socio-economic, and other characteristics. Participants were also asked about whether they will be more likely to obtain EIN if provided in a private space at a local pharmacy. Factors associated with increased likelihood to obtain pharmacy-provided EIN were assessed using unadjusted univariate and multivariate log-binomial regression.

Results: Less than one-third (31.8%) of participants reported receiving any help or treatment for opioid use disorder in the past 6 months, with 1.8% (n=3) having received EIN compared to 18.8% (n=32) who reported receiving methadone or buprenorphine. Fifty percent (n=85) reported being more likely to receive pharmacy-provided EIN. In univariate analysis, we found that age was negatively associated with increased likelihood to receive pharmacy-provided EIN (Prevalence ratio (PR): 0.98; 95% CI [0.96, 0.99]). Those who reported no use of opioids in past 30 days (PR: 1.38; 95% CI [1.01, 1.89]), experienced more shame related to their drug use (PR: 2.29; 95% CI [1.18, 4.43]), and had been involved in the criminal legal system (CLS) in the past 6 months (PR: 1.52; 95% CI [1.14, 2.02]) were more likely to obtain pharmacy-provided EIN.

Conclusions: Few rural PWUO in this cohort had recently received EIN. Provision of EIN at local pharmacies has the potential to increase uptake and treatment retention in rural settings, especially among PWUO who are younger, on probation, parole, supervised release or community supervision, and who experience shame around their OUD.

Available for download on Thursday, June 05, 2025