Indexed on: 12 Mar '20Published on: 07 Mar '20Published in: Addiction
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 people with opioid use disorder (OUD) in the U.S. and jails' and prisons' MOUD in pregnancy policies. Epidemiologic surveillance study of 6 months of outcomes of pregnant, incarcerated people with OUD and cross-sectional survey of institutional policies. USA PARTICIPANTS: Twenty-two state prison systems and six county jails MEASUREMENTS: Number of pregnant people with OUD admitted and treated with methadone, buprenorphine, or withdrawal; policies on provision of MOUD and withdrawal in pregnancy. Twenty-six percent of pregnant people 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=4 jails) continued pre-incarceration MOUD in pregnancy, very few initiated in custody (n=4 prisons; n=2 jails). Two-thirds of prisons and 3/4 of jails providing MOUD in pregnancy discontinued it postpartum. In this sample of US prisons and jails, one-third required pregnant people with opioid use disorder go through withdrawal, contrary to medical guidelines. More people were prescribed methadone than buprenorphine, despite the fewer regulatory barriers on prescribing buprenorphine. Most sites stopped medication for OUD postpartum, signaling prioritization of the fetus, not the mother. Pregnant incarcerated people with OUD in the US frequently appear to be denied essential medications and receive substandard medical care. This article is protected by copyright. All rights reserved.