United States county jail treatment and care of pregnant incarcerated persons with opioid use disorder.

Standards of care for pregnant persons with opioid use disorder (OUD) have been published across multiple institutions specializing in obstetrics and addiction medicine. Yet, this population faces serious barriers in accessing medications for OUD (MOUD) while incarcerated. Therefore, we examined the availability of MOUD in jails. A Cross-sectional survey of jail administrators (n=371 across 42 states; 2018-2019) was conducted. Key indicators for this analysis include pregnancy testing at intake, number of county jails offering methadone or buprenorphine to pregnant incarcerated persons for detoxification on admission, continuation of pre-incarceration treatment, or linkage to post-incarceration treatment. Analyses were performed using SAS. Pregnant incarcerated persons had greater access to MOUD than non-pregnant persons (χ2=142.10, p<0.0001). Larger jurisdiction size and urban jails were significantly more likely to offer MOUD (χ2=30.12, p<0.0001; χ2=26.46, p<0.0001). Methadone was the most common MOUD offered for continued care for all incarcerated persons. Of the 144 jails within a county with at least one public methadone clinic, 33% did not offer methadone treatment to pregnant persons, and over 80% did not provide linkage after release from jail. MOUD access was greater for pregnant incarcerated persons compared to non-pregnant persons. Compared to urban jails, rural jails were significantly less likely to offer MOUD, even as the number of opioid deaths in rural counties continues to surpass those in urban counties. The lack of post-incarceration linkage in counties with at least one public methadone clinic could be indicative of broader issues surrounding connections to MOUD resources.

Benck KN ，Seide K ，Jones AK ，Omori M ，Rubinstein LB ，Beckwith C ，Nowotny KM ... -  《-》

Opioid use disorder incidence and treatment among incarcerated pregnant women in the United States: results from a national surveillance study.

The established standard care in pregnancy is medication for opioid use disorder (MOUD); however, many institutions of incarceration do not have MOUD available. We aimed to describe the number of incarcerated pregnant women with opioid use disorder (OUD) in the United States and jails' and prisons' MOUD in pregnancy policies. Epidemiological surveillance study of 6 months of outcomes of pregnant, incarcerated women with OUD and cross-sectional survey of institutional policies. United States. Twenty-two state prison systems and six county jails. The number of pregnant women with OUD admitted and treated with methadone, buprenorphine or withdrawal; policies on provision of MOUD and withdrawal in pregnancy. Twenty-six per cent of pregnant women admitted to prisons and 14% to jails had OUD. One-third were managed through withdrawal. The majority who were prescribed MOUD were on methadone (78%, prisons; 81%, jails), not buprenorphine. While most sites (n = 18 prisons, n = four jails) continued pre-incarceration MOUD in pregnancy, very few initiated in custody (n = four prisons; n = two jails). Two-thirds of prisons and three-quarters of jails providing MOUD in pregnancy discontinued it postpartum. In this sample of US prisons and jails, one-third required pregnant women with opioid use disorder to go through withdrawal, contrary to medical guidelines. More women were prescribed methadone than buprenorphine, despite the fewer regulatory barriers on prescribing buprenorphine. Most sites stopped medication for opioid use disorder postpartum, signaling prioritization of the fetus, not the mother. Pregnant incarcerated women with opioid use disorder in the United States frequently appear to be denied essential medications and receive substandard medical care.

Sufrin C ，Sutherland L ，Beal L ，Terplan M ，Latkin C ，Clarke JG ... -  《-》

Availability of Medications for the Treatment of Opioid Use Disorder Among Pregnant and Postpartum Individuals in US Jails.

Sufrin C ，Kramer CT ，Terplan M ，Fiscella K ，Olson S ，Voegtline K ，Latkin C ... -  《JAMA Network Open》

Factors Associated With the Availability of Medications for Opioid Use Disorder in US Jails.

Flanagan Balawajder E ，Ducharme L ，Taylor BG ，Lamuda PA ，Kolak M ，Friedmann PD ，Pollack HA ，Schneider JA ... -  《JAMA Network Open》

Expanding access to Medication for Opioid Use Disorder (MOUD) in jails: A comprehensive program evaluation.

Pourtaher E ，Gelberg KH ，Fallico M ，Ellendon N ，Li S ... -  《-》