Novel Approach for Educating Prison Populations About Medication for Opioid Use Disorder

More than 90,000 people die of a drug overdose each year, with 75 percent of those involving an opioid, according to the Centers for Disease Control and Prevention.

Although medication—buprenorphine, methadone or naltrexone—is an effective component in helping people with opioid use disorders, only a small number receive this care.

This disparity of care, often among people of color, is urgently important in correctional institutions, where 85 percent of the population has an active substance use disorder or were incarcerated for a crime involving drugs or drug use—a population that is at a higher risk for overdose upon release.

Recognizing this disparity, Rutgers University Correctional Health Care, which has a comprehensive program offering all available medications for opioid use disorder, and the New Jersey Department of Corrections developed a short video that educates incarcerated people on medication for opioid use disorder. The campaign is the first in the United States to use an easily accessible video to educate all incarcerated people, including underserved populations, on how medication can help with opioid use disorder.

Anthony Tamburello, UCHC Statewide Associate Director of Psychiatry and Clinical Associate Professor of Psychiatry at Robert Wood Johnson Medical School, discusses how the educational campaign can serve as a model for correctional intuitions nationwide.

What prompted you to produce this video?
Research has shown that Black people are less than a quarter as likely as white people to get buprenorphine, an FDA-approved medication for opioid use disorder. We recently published a study on our practice, in which we observed a degree of racial disparity in our prescription of buprenorphine that was similar to what is seen in the community. This was surprising because of the controlled nature of the prison environment and the easy access our patients have to medical, mental healthnd substance use disorder treatment.

What are the factors driving this disparity in prescription of medication to treat opioid use disorder?
The United States Substance Abuse and Mental Health Services Administration [SAMHSA] published thorough investigative reports on this question in 2020 for both the Black/African-American and the Hispanic/Latinx populations. Barriers to care included negative stereotypes, misperceptions and stigma surrounding substance use problems, fears of legal repercussions, lack of culturally respectful care and limited access to treatment.

Family and community are culturally important influences, but statistics and words like “opioid crisis” may turn people away. We noticed that many of these barriers can be addressed with education and by making connections between our patients and the services that are more available than ever before.

How did UCHC address this need for education to reduce disparities in the facilities it serves?
We first brought the preliminary findings from our study to the attention of Rutgers staff responsible for prescribing medication for opioid use disorder. Next, we formed a diverse workgroup of professionals, including a forensic psychiatry fellow, a psychiatrist and a medical advanced practice nurse, to brainstorm how best to bring good information to those who may benefit. Informed by the SAMHSA documents, we created educational flyers that were posted in treatment areas. The message is simple: Opioid use disorders affect people of all races, genders, ages and walks of life. There is treatment available that is effective. They will not be “trading one drug for another.” The treatment is about helping people stay healthy and live their best lives as members of their community.

That information was sent directly to JPAY players, which are popular small tablet computers that incarcerated persons can purchase. We also worked with the DOC to create a video for distribution to closed-circuit TV and for download on JPAY. 

What is your goal for the video?
The video allows us to reach more people, which increases the opportunity to counteract misinformation, stereotypes and negative attitudes. The people who appear in the video are familiar faces because we work in the prison system. We want to generate buzz. We want people to start having conversations about the problem and the treatments that are out there. We hope that the questions these conversations create will be brought to health care staff who can have one-on-one conversations about how we can help.

What advice do you have for other correctional facilities?
To our knowledge, this type of campaign has not been done before in other prison systems, but it should. In a recent survey of states with high rates of opioid use disorders, only 7 percent of prison facilities even offered a comprehensive program of medications for opioid use disorder like we do.

Our experience suggests that there is much more work to do beyond just making these treatments available. We need to build partnerships among health care staff, correctional staff and government officials. Since nearly all incarcerated people return to the community, good prison health care is good community health care. Partnerships like Rutgers’ Intensive Recovery Treatment Support can help link incarcerated people with services outside the prison walls that we know reduce opioid use, medical problems, re-incarceration, suicide and other causes of death. Equally important is a partnership between incarcerated people and health care providers to share information and to provide the best available treatments. The educational part that we developed could not have been done without the New Jersey Department of Corrections, which supported our research, encouraged our early efforts to produce educational content and directly worked with us to produce the video.