Individuals leaving correctional facilities experience rates of drug overdose an estimated 10 times higher than the general population. To mitigate this risk, jails and prisons are increasingly providing medication for addiction treatment (MAT), an evidence-based approach for treating addiction, particularly opioid use disorder. Notably, MAT is included in the Center for Medicare & Medicaid Services’ reentry 1115 demonstration waiver opportunity, which enables states to reimburse for key pre-release services through Medicaid. However, providing MAT in jail settings presents unique challenges compared to prisons, as lengths of stay can be short and unpredictable.
The Camden County Correctional Facility (CCCF), a jail in Camden County, New Jersey, operates an MAT program that serves around 225 people daily (out of an average daily jail population of around 900) and has reduced the risk of overdose among participants following release. In addition to offering MAT for individuals with substance use disorders (SUD) in the jail, they also provide other wraparound supports during the reentry period. Critical to CCCF’s success is the partnership with Cooper University Health Care, which provides technical assistance, staff training, and serves as a trusted community-based provider for people leaving CCCF.
The Better Care Playbook spoke with Sharon Bean, Jail Population Manager and Justice Systems Reform & Innovations Unit Supervisor at CCCF and Ernest Egu, MD, Medical Director, Correctional Addiction Medicine, Cooper University Health Care, to learn more about the program and how this correctional-health care partnership has improved outcomes for their population.
Q. What led to the creation of CCCF’s MAT program?
S. Bean: A large portion of our population are either already receiving MAT in the community or self-report SUDs. Prior to starting our MAT program in 2018, we were not continuing any of this medication, except for methadone provided to pregnant patients. Instead, we solely used detox and withdrawal protocols. Many would leave jail and return to previous levels of drug use, consistent with research showing high overdose rates post-release.
By offering MAT, we're providing basic lifesaving medication just as we would for anybody coming in with diabetes or a heart condition.
It was clear that our approach was causing more harm than good. Given our unique position to save lives, it felt obvious that we needed to change our strategy. It sometimes even feels weird referring to this as a program, because by offering MAT we're providing basic lifesaving medication just as we would for anybody coming in with diabetes or a heart condition.
Today, we not only offer substance use education and counseling, but also initiate individuals on Vivitrol and Suboxone, and continue medications like methadone, Sublocade, or Brixadi for those already receiving them in the community. The program is primarily funded through grants from the New Jersey Department of Health and Human Services. Our approach focuses on both medication and the additional supports needed to meet reentry needs and help people continue treatment following their release.
Q. Could you share more about the technical assistance partnership between Cooper and CCCF?
E. Egu: Our technical assistance focuses on supporting correctional staff in adhering to best practices and providing quality care. This includes detailed instructions on the induction of specific medications and broader education on the biological model of addiction. We help staff understand the brain pathways involved in SUD and the time required for the brain to heal once treatment begins. We also work to shift perceptions by labeling SUD as a chronic, relapsing disease rather than a personal choice, emphasizing the neurobiological model of addiction.
We also work to shift perceptions by labeling SUD as a chronic, relapsing disease rather than a personal choice, emphasizing the neurobiological model of addiction.
Additionally, we provide consultation on emerging issues. For example, with the increasing prevalence of xylazine in the drug supply, we assist staff in addressing related challenges, including withdrawal management and wound care.
As part of our work with the Southern New Jersey MAT Centers of Excellence, we also host monthly case conferences for all correctional facilities in the state. During these sessions, we discuss challenging cases and present the latest literature on addiction treatment. We ensure these sessions are as accessible as possible — questions are encouraged, and we invite all correctional staff, not just medical providers.
S. Bean: Cooper’s expertise has been vital for the program. We recognized right away that we needed comprehensive education for all staff — correctional, civilian, and medical — since there can be a lot of stigma surrounding SUD. Securing buy-in from staff who may have previously been focused on screening mail to prevent these medications from entering the facility can be challenging. Addressing these concerns and personal biases through education about MAT and the science of addiction has made program implementation far less disruptive and complicated. Now, this education is embedded in our annual trainings and new officer orientation.
Q. What does reentry look like for people in the program as they are released from jail?
S. Bean: Our MAT navigators enhance our usual reentry supports for program participants. They often assist with checking insurance status and, if needed, help with the Medicaid presumptive eligibility application process. We've had diverse individuals fill this role, including nurses from Cooper, social work students, and long-time jail employees familiar with the population. We ensure that a navigator is available to meet with participants whenever they start the program, including evenings and weekends.
Each participant leaves our facility with any necessary bridge medications. We also provide a photo ID, a backpack with essential items and fentanyl test strips, and an information sheet with the MAT navigators' contact information, our prescription access hotline, and any appointment details we've arranged.
Lastly, we support participants who self-report as homeless with a reentry transitional home and are exploring setting up a P.O. Box to help facilitate Medicaid enrollment for this population.
E. Egu: We have implemented several strategies to serve as a helpful landing spot in support of individuals continuing their treatment after release. CCCF notifies us through a Health Information Exchange (HIE) when an individual is released, allowing our navigators to schedule appointments quickly.
For those without an appointment, we offer a walk-in clinic Monday through Friday, providing a low-barrier access point that is particularly helpful for this population. Our emergency department (ED) is also available to individuals leaving jail. Most of our ED providers are experienced in buprenorphine treatment and work closely to refer patients to our clinic following initial treatment. In cases where an individual's insurance is temporarily inactive following release, we provide temporary coverage through New Jersey's federal Opioid Response grant, ensuring they can access their medications. Even a few days of coverage can be critical during this period.
I also tell Sharon or anyone from CCCF that if you need an appointment for a patient, you can just call my cell phone. I'm always available. This free-flowing communication allows us to ensure patients are connected.
Q. What role do peer support specialists play within the program?
S. Bean: We couldn’t do this work without our peers. Individuals with lived recovery and criminal justice experience play a crucial role in our reentry team, including leading a peer-centered reentry program specifically for those with SUD.
We couldn’t do this work without our peers. Individuals with lived recovery and criminal justice experience play a crucial role in our reentry team, including leading a peer-centered reentry program specifically for those with SUD.
E. Egu: We also facilitate a weekly peer-led reentry support group for individuals with SUDs who were previously incarcerated. This group provides a sense of community and support while also connecting participants with resources to address other health-related social needs. Engaging peers in our work has proven to be tremendously valuable, aligning with research showing that their involvement leads to increased program retention and engagement in treatment. One thing to be mindful of is that peers, particularly in this context, may have criminal records. I would encourage correctional facilities and community-based providers to keep in mind that it’s okay to let them into your facility, as their involvement will strengthen your program.
Q. What are some of the main challenges your facility has experienced in implementing this program?
S. Bean: Our MAT navigators have really helped us build trust among our population, but this is an ongoing challenge. Many people coming into our facility have been in and out of correctional settings several times without anyone ever asking them if they need help, or what kind of help they need.
The variability in how long people are in our facility also poses challenges. 97 percent of our population are here pre-disposition, meaning their length of stay is driven by a potentially unpredictable court case duration. For the approximately half of our population released within five days or less, we have to act quickly to prevent lapses in medication and connect them to a provider upon release. The HIE is crucial in this respect, allowing us to share real-time information with Cooper and quickly schedule appointments.
However, individuals can fall through the cracks, especially during short stays that begin on weekends, when it can be difficult to ensure they receive a methadone dose due to the need to coordinate with a community-based provider. While buprenorphine can often be continued more easily, methadone presents more challenges. Having our MAT navigators available is crucial, as they work quickly to gather pharmacy information and coordinate care. Of course, some individuals are simply focused on leaving as soon as possible and not interested in receiving treatment, so we make every effort to assist them in accessing treatment post-release if they reach out.
Lastly, we have individuals who stay in our facility for extended periods, more than a year in some cases, which makes financing their services challenging. For example, we had to limit the availability of Sublocade due to funding constraints, despite it being preferred by some patients. However, we also know that these medications are life-saving and so are committed to finding solutions to continue providing them.
Q. Do you have any advice for other correctional facilities or health care providers looking to implement similar programs in their community?
S. Bean: It’s so important to have strong internal buy-in and communication among jail staff. On top of all the staff training, we meet as a team every two weeks to gel and make sure that we’re addressing any concerns or challenges quickly. Through those meetings, it feels like we’re constantly learning something new.
E. Egu: It’s also important for jails to have relationships with community providers. Individuals who are incarcerated are going to go back out into the community, so we are all treating the same patients. I would recommend that any facility looking to implement an MAT program start by reaching out to your community providers. Invite them in, get their buy-in, because it's going to make the process flow so much more smoothly.