Assessment of Correctional Center Educational Needs to Promote Treatment with Medications for Opioid Use Disorder (Project ACCEPT-MOUD)

Project Lead: Annabelle Belcher, PhD

A publication describing this study is in the Journal of Correctional Health Care:

"Correlates of Staff Acceptability of a Novel Telemedicine-Delivered Medications for Opioid Use Disorder Program in a Rural Detention Center"

Background

The opioid use disorder (OUD) public health crisis poses a particularly acute problem for incarcerated individuals, an estimated 15% of whom have OUD¹. Medications for opioid use disorder (MOUD) initiation in correctional settings have been associated not only with decreased post-release overdose deaths² ³ but with vastly improved social functioning and recidivism outcomes⁴ ⁵. Jails and detention centers offer a controlled, monitored setting, conducive to initiating such treatments; yet MOUD is rarely offered to justice-involved individuals as standard-of-care⁶. Several factors have been cited to explain the underutilization of MOUD in carceral settings, including lack of understanding of the effectiveness of MOUD, limited knowledge of the benefits of MOUD, and negative or stigmatizing attitudes regarding MOUD⁷. These perceptions hamper MOUD appeal and staff buy-in, particularly for new MOUD implementation efforts such as our team’s program of telemedicine MOUD clinical program for incarcerated populations (tele-MOUD)⁸. The aim of the current study was to assess detention center staff acceptability of the tele-MOUD program and to assess staff perceptions of MOUD effectiveness, as well as stigmatizing notions towards MOUD. We hypothesized that staff ratings of tele-MOUD acceptability would correlate positively with perceptions of MOUD effectiveness and would correlate negatively with MOUD stigma.

Methods

We collected data from rural county detention center staff and contracted medical providers at a single site where tele-MOUD buprenorphine treatment services are provided by our team. Detention center staff were invited through an email that was disseminated by the jail leadership to participate in a one-time, web-based, anonymous survey to better understand acceptability and perceptions of the tele-MOUD program. Survey measures included basic demographic information, indicators of tele-MOUD acceptability (Acceptability of Intervention Measure, AIM⁹), perceptions of the effectiveness of MOUD¹⁰ ¹³, stigma as it relates to MOUD¹⁰ ¹³, and an open-ended comment section. Nonparametric correlations between scores on the AIM and MOUD Effectiveness, and between scores on the AIM and MOUD Stigma were assessed with Spearman’s rank correlation. Significant correlations are reported at p < 0.05. Statistical analyses were conducted using SPSS v.27.

Results

Respondents were majority male (57%), and all 28 (100%) identified as White with no Hispanic or Latinx ethnicity (N=28). We found a positive correlation between AIM and MOUD Effectiveness, r(26) = .78, p <.001, and a negative correlation between AIM and MOUD Stigma, r(26) = -.821, p <.001, suggesting that staff acceptability scaled positively with staff perceptions of the effectiveness of MOUD, but scaled negatively with stigmatizing notions of MOUD.

Discussion

To the best of our knowledge, this brief report is the first to assess jail staff acceptance and perceptions of a telemedicine buprenorphine program. We found a significant positive correlation between tele-MOUD acceptability and perceptions of MOUD effectiveness and a significant negative correlation between acceptability and MOUD stigma. These findings support our hypothesis that staff are more likely to have a positive view of the tele-MOUD program if they perceive MOUD as an effective treatment, while they are more likely to have a negative view of the program if they hold stigmatizing or negative views of MOUD. These findings illustrate the challenges that are likely to be faced with future efforts to expand our team’s existing telemedicine clinical platform and highlight the importance of staff education. Further, as states continue to take action to expand MOUD access within correctional facilities, these data suggest the need for educational interventions to increase awareness of the evidence base demonstrating the effectiveness and potency of tele-MOUD treatment, as well as to help staff understand the goals of MOUD treatment.

Figure 1. Scatterplots depicting mean individual scores on the Acceptability of the Intervention Measure (AIM) against MOUD Effectiveness score (Figure 1A) and Stigma score (Figure 1B).

References

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