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

Publisher: American Medical Association Country of Publication: United States NLM ID: 101729235 Publication Model: Electronic Cited Medium: Internet ISSN: 2574-3805 (Electronic) Linking ISSN: 25743805 NLM ISO Abbreviation: JAMA Netw Open Subsets: MEDLINE

Original Publication: Chicago, IL : American Medical Association, [2018]-

Jails* ; Postpartum Period*; Opiate Substitution Treatment/*statistics & numerical data ; Opioid-Related Disorders/*drug therapy ; Pregnancy Complications/*drug therapy ; Prisoners/*statistics & numerical data; Analgesics, Opioid/therapeutic use ; Buprenorphine/therapeutic use ; Cross-Sectional Studies ; Female ; Humans ; Pregnancy ; Young Adult

Importance: Thousands of pregnant people with opioid use disorder (OUD) enter US jails annually, yet their access to medications for OUD (MOUD) that meet the standard of care (methadone and/or buprenorphine) is unknown.
Objective: To assess the availability of MOUD for the treatment of pregnant individuals with OUD in US jails.
Design, Setting, and Participants: In this cross-sectional study, electronic and paper surveys were sent to all 2885 identifiable US jails verified in the National Jails Compendium between August 19 and November 7, 2019. Respondents were medical and custody leaders within the jails.
Main Outcomes and Measures: The primary outcome was the availability of MOUD (methadone and/or buprenorphine) for the treatment of pregnant people with OUD in US jails. Availability of MOUD was assessed based on (1) continuation of MOUD for pregnant incarcerated individuals (if the individual was receiving MOUD before incarceration), with or without initiation of MOUD; (2) both initiation and continuation of MOUD for pregnant individuals; (3) only continuation of MOUD for pregnant individuals; and (4) management of opioid withdrawal for pregnant individuals. Secondary outcomes included MOUD availability during the postpartum period and logistical factors associated with the provision of MOUD. Multivariate logistic regression analysis was used to assess factors associated with MOUD availability during pregnancy.
Results: Among 2885 total surveys sent, 1139 (39.5%) were returned; of those, 836 surveys (73.4%; 29.0% of all surveys sent) could be analyzed, with similar proportions from metropolitan (399 jails [47.7%]) and rural (381 jails [45.6%]) settings. Overall, 504 jails (60.3%) reported that MOUD was available for medication continuation, with or without medication initiation, during pregnancy. Of those, 267 jails (53.0%; 31.9% of surveys included in the analysis) both initiated and continued MOUD, and 237 jails (47.0%; 28.3% of surveys included in the analysis) only continued MOUD; 190 of 577 jails (32.9%; 22.7% of surveys included in the analysis) reported opioid withdrawal as the only management for pregnant people with OUD. Among the 504 medication-providing jails, only 120 (23.8%) continued to provide MOUD during the postpartum period. Methadone was more commonly available at jails that only continued MOUD (84 of 123 jails [68.3%]), whereas buprenorphine was more commonly available at jails that both initiated and continued MOUD (73 of 119 jails [61.3%]). In an adjusted model, jails with higher odds of MOUD availability were located in the Northeast (odds ratio [OR], 10.72; 95% CI, 2.43-47.36) or metropolitan areas (OR, 1.92; 95% CI, 1.31-2.83), had private health care contracts (OR, 1.49; 95% CI, 1.03-2.14) and a higher number of women (≥70) reported in the female census (OR, 1.69; 95% CI, 1.02-2.80), and provided pregnancy testing within 2 weeks of arrival at the jail (OR, 2.66; 95% CI, 1.69-4.17).
Conclusions and Relevance: In this cross-sectional study, a substantial proportion of US jails did not provide access to MOUD to pregnant people with OUD. Although most jails reported continuing to provide MOUD to individuals who were receiving medication before incarceration, few jails initiated MOUD, and most medication-providing jails discontinued MOUD during the postpartum period. These results suggest that many pregnant and postpartum people with OUD in US jails do not receive medication that is the standard of care and are required to endure opioid withdrawal, signaling an opportunity for intervention to improve care for pregnant people who are incarcerated.

J Biomed Inform. 2009 Apr;42(2):377-81. (PMID: 18929686)
MMWR Morb Mortal Wkly Rep. 2018 Aug 10;67(31):845-849. (PMID: 30091969)
PLoS Med. 2019 Dec 31;16(12):e1003002. (PMID: 31891578)
Ann Emerg Med. 2020 Jan;75(1):1-12. (PMID: 31515181)
Mayo Clin Proc. 2020 Oct;95(10):2155-2171. (PMID: 33012347)
Am J Public Health. 2020 Dec;110(12):1728-1729. (PMID: 33180588)
Obstet Gynecol. 2016 Dec;128(6):1233-1240. (PMID: 27824771)
Int J Drug Policy. 2020 Jul;81:102768. (PMID: 32446130)
Fertil Steril. 2017 Aug;108(2):195-199. (PMID: 28697909)
Lancet. 2015 Jul 25;386(9991):350-9. (PMID: 26028120)
JAMA Psychiatry. 2014 Feb;71(2):190-6. (PMID: 24369387)
J Addict Med. 2018 Mar/Apr;12(2):156-162. (PMID: 29341974)
Obstet Gynecol. 2020 May;135(5):1177-1183. (PMID: 32282606)
Addiction. 2020 Feb;115(2):291-301. (PMID: 31692133)
J Am Acad Psychiatry Law. 2021 Dec;49(4):545-552. (PMID: 34341145)
Drug Alcohol Depend. 2009 Nov 1;105(1-2):83-8. (PMID: 19625142)
Lancet. 2015 Jul 25;386(9991):316-8. (PMID: 26028122)
JAMA. 2021 Aug 3;326(5):411-419. (PMID: 34342618)
JAMA Psychiatry. 2018 Apr 1;75(4):405-407. (PMID: 29450443)
Health Justice. 2021 May 19;9(1):12. (PMID: 34009510)
J Addict Med. 2017 May/Jun;11(3):178-190. (PMID: 28406856)
Ann Intern Med. 2007 Oct 16;147(8):573-7. (PMID: 17938396)
Drug Alcohol Depend. 2020 Sep 1;214:108159. (PMID: 32683223)
J Urban Health. 2004 Dec;81(4):645-54. (PMID: 15466845)
Subst Abus. 2019;40(3):356-362. (PMID: 29949454)
JAMA Intern Med. 2018 Sep 1;178(9):1153-1154. (PMID: 30073242)
Obstet Gynecol. 2018 May;131(5):803-814. (PMID: 29630016)
Health Justice. 2021 Jul 24;9(1):17. (PMID: 34304335)
Drug Alcohol Depend. 2018 Mar 1;184:57-63. (PMID: 29402680)
Am J Obstet Gynecol. 2019 Jan;220(1):115-116. (PMID: 30273587)
Addiction. 2010 Sep;105(9):1545-54. (PMID: 20579009)
J Subst Abuse Treat. 2021 Sep;128:108245. (PMID: 33461829)
Matern Child Health J. 2017 Jun;21(6):1260-1266. (PMID: 28236159)
Addiction. 2020 Nov;115(11):2057-2065. (PMID: 32141128)
Obstet Gynecol. 2018 Aug;132(2):466-474. (PMID: 29995730)
JAMA Health Forum. 2020 Jul 1;1(7):e200885. (PMID: 36218700)
Addiction. 2021 Dec;116(12):3504-3514. (PMID: 34033170)
J Rural Health. 2022 Jan;38(1):87-92. (PMID: 33733547)
Ann Intern Med. 2013 Nov 5;159(9):592-600. (PMID: 24189594)

K23 DA045934 United States DA NIDA NIH HHS

0 (Analgesics, Opioid)
40D3SCR4GZ (Buprenorphine)

Date Created: 20220120 Date Completed: 20220224 Latest Revision: 20231105

20240105

PMC8777564

10.1001/jamanetworkopen.2021.44369

35050354