Care for Incarcerated Pregnant People With Opioid Use Disorder

Abstract

With the simultaneous rise in maternal opioid use disorder (OUD) and the incarceration of pregnant people in the United States, we must ensure that prisons and jails adequately address the health and well-being of incarcerated pregnant people with OUD. Despite long-established, clear, and evidence-based recommendations regarding the treatment of OUD during pregnancy, incarcerated pregnant people with OUD do not consistently receive medication treatment and are instead forced into opioid withdrawal. This inadequate care raises multiple concerns, including issues of justice and equity, considerations regarding the legal and ethical obligations of the provision of health care, and violations of the medical and legal rights of incarcerated people. We offer recommendations for improving care for this often-ignored group.

The Use of Once-monthly Injectable Buprenorphine for the Treatment of Opioid Use Disorder in Postpartum Women: A Case Series

“…Medications like BUP are the standard of care for OUD treatment yet are not offered to most incarcerated women. 19 Pregnancy and incarceration are windows of opportunity for OUD treatment engagement, reflected in our case series; all patients who started BUP while incarcerated during pregnancy continued BUP postpartum. Jails and prisons should follow SAMHSA recommendations to evaluate and provide medication to all people with OUD who desire it, including pregnant/postpartum women.…”

“…One-third of the participants presented for BUP induction from jail while pregnant. Medications like BUP are the standard of care for OUD treatment yet are not offered to most incarcerated women 19 . Pregnancy and incarceration are windows of opportunity for OUD treatment engagement, reflected in our case series; all patients who started BUP while incarcerated during pregnancy continued BUP postpartum.…”

An integrative literature review of substance use treatment service need and provision to pregnant and postpartum populations in carceral settings

“…Instead incarcerated pregnant women should be offered medications for OUD. 42 Carceral settings have a moral, ethical, and medical responsibility to provide life-saving medication treatment to incarcerated pregnant and postpartum persons. 42…”

“…For these occurrences, facilities should implement substance use screening procedures with a validated tool to determine the presence of an SUD. 42,55 Early substance use treatment intervention leads to better pregnancy, birth, and postpartum outcomes, as well as the likelihood of treatment continuation upon release. 18,37 Although for most, incarceration can interrupt care, when adequate, evidence-based substance use treatment is initiated during incarceration, and the likelihood of continuity and retention upon release increases.…”

“…It should be noted that this population is marginalized and extremely vulnerable—incarcerated and pregnant; thus, some women have felt coerced into substance use treatment, specifically for OUD. 42,63 Providers should be careful in their recommendations regarding treatment to avoid coercion. 64 Furthermore, while this review includes programming in both prisons and jails, it should be noted that these facilities are characteristically and fundamentally different, which affects the healthcare they are able to provide.…”