Providers Overcome Language Barriers, Bring Treatment to Inmates

Efforts to overcome barriers to working with the 23 distinct tribal nations of New Mexico and a program to prevent overdoses among inmates recently released from Philadelphia’s city jails were among the topics covered during breakout sessions on Wednesday at the Rx Drug Abuse and Heroin Summit in Atlanta.

Addressing opioid crisis in Native America

Working with the 23 distinct tribal nations in New Mexico presents unique challenges to the state’s Human Services Department in its fight against the opioid epidemic, but Jay E. Quintana, CPS, and Antonette M. Silva-Jose, prevention program managers for the Behavioral Health Services Division, are among those navigating the complexities.

Language barriers are among the largest hurdles to clear for providers in the region, Quintana told Rx Summit attendees on Tuesday. For many elder members of tribes, English is not the primary language, and tribes also have unique language variances. This can play a role in patients not fully understanding the dangers of their prescribed medications. Building relationships with tribal leaders, establishing points of contact within communities, and providing consistent follow-up all will help to build trust, he said.

Silva-Jose then discussed efforts to launch indigenous PAX, an adaptation of the Good Behavior Game that helps self-regulation through competence, comprehension and cultural memes. The program has been a critical resource in school systems for youth populations, she said.

“It is going to help students be able to have lasting effects later in life that are so very important not only to tribal communities, but all communities and students everywhere,” Silva-Jose said.

Reducing overdoses among released inmates

With about 70% of the inmate population in the Philadelphia Department of Prisons (PDP) jail system and a high mortality rate for those recently released, officials at PDP and the city’s Department of Public Health collaborated on an initiative to address overdose mortality. Representatives from PDP and the health department presented early returns from the project on Wednesday at the Rx Drug Abuse & Heroin Summit on Wednesday in Atlanta.

Of the 82,780 inmates released from 2010 to 2016, 2,522 died, with 837 by overdose, said Lia N. Pizzicato, MPH, substance use epidemiologist for the health department. Released individuals were found to be at more than five times the risk of a fatal overdose compared the non-incarcerated population in Philadelphia, with the first two weeks post-incarceration being the most dangerous period, Pizzacato said.

To address overdose mortality among inmates and those recently released, a pilot buprenorphine program at the city’s all-women’s jail was launched in 2018. (PDP operates five jails, four for men and one for women. The women’s facility was chosen for the pilot because inmates are not transferred to other facilities, making it easier to observe early participants). During the pilot period, February 2018 through July 2018:

• 454 women were evaluated
• 297 were treated with buprenorphine for the duration of their incarceration
• 56 women declined treatment, were deemed not suitable for treatment, or stopped treatment after starting
• 10 women were caught attempting to divert or misuse their medication

PDP has worked with all buprenorphine patients to identify a community MAT provider to continue treatment post-release.