Opioid Use Disorder Medicine Lacking for Pregnant Women in US Jails

Most pregnant and postpartum women with opioid use disorder (OUD) in US jails do not receive medication that is standard of care, a JAMA Network Open study found.

The cross-sectional study surveyed 836 US jails verified in the National Jails Compendium between August 19 and November 7, 2019. The study’s primary outcome was the availability of medications to treat pregnant women with OUD.

Overall, 39.7 percent of jails did not allow continuation of OUD medication during pregnancy, and only 31.9 percent permitted initiation of OUD medication during pregnancy.

Additionally, 60.3 percent of jails reported OUD medication availability for continuation, with or without medication initiation during pregnancy. Of those jails, 53 percent both initiated and continued OUD medication and 47 percent only continued medication.

Nearly 190 of 557 jails reported opioid withdrawal as the only management for pregnant women with OUD. And among 504 medication-providing jails, 23.8 percent continued to provide OUD medication during the postpartum period.

Methadone was most commonly available at jails that only continued medication (68.3 percent), while buprenorphine was most commonly available at jails that both initiated and continued OUD medications.

Jails in the Northeast had higher OUD medication availability and private healthcare contracts.

Notably, allowing pregnant women to experience opioid withdrawal during pregnancy increases the need for staff to respond to medical issues resulting from withdrawal.

The most common dispensing arrangement among 386 jails providing methadone was picking up or sending medication to the jail for administration by jail staff (53.1 percent), followed by transporting the pregnant person offsite to receive medication (51.6 percent).

And of 386 jails providing buprenorphine, most (67.9 percent) dispensed medication on site. Conversely, fewer jails (24.9 percent) transported the pregnant woman offsite to receive medication.

Overall, the study results suggest that many pregnant and postpartum women with OUD in US jails do not receive medication that meets the standard of care often required to endure opioid withdrawal.

Therefore, there is a great need for intervention to improve care for incarcerated pregnant women.

“These findings suggests that thousands of pregnant people entering jails are likely required to endure opioid withdrawal each year. Withdrawal is not only a difficult experience, especially when in custody, but it is also accompanied by short- and long-term risks for both pregnant,” researchers explained in the study.

“People and their fetuses, including increased risk of overdose combined with higher risk of overdose at jail release and greater risk of suicide,” they concluded.