Medications for opioid use disorder in pregnancy in a state women’s prison facility

Knittel, Andrea K.; Zarnick, Samantha; Thorp, John M.; Amos, Elton; Jones, Hendrée E.

doi:10.1016/j.drugalcdep.2020.108159

Cited by 10 publications

(22 citation statements)

References 23 publications

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“…In addition, among 179 pregnant people with OUD in the North Carolina prison system, which includes pretrial detention, almost one-half of individuals endured opioid withdrawal. 45 The lack of required health care standards and oversight in carceral facilities, despite a constitutional requirement to provide health care, has produced substantial variability in available health care services, 46,47 which is consistent with our findings of variable access to MOUD during pregnancy. Furthermore, with more than 3000 jails in the US, most of which are under local jurisdiction, some jail leaders may not have the resources to obtain information or enact standards of care.…”

Section: Discussionsupporting

confidence: 83%

“…The high proportion of jails that did not provide MOUD during pregnancy in our study was similar to the proportion found in a survey study of 53 jails, in which at least 46% of jails reported opioid withdrawal, not access to MOUD, as their means of managing OUD among pregnant individuals. In addition, among 179 pregnant people with OUD in the North Carolina prison system, which includes pretrial detention, almost one-half of individuals endured opioid withdrawal …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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IMPORTANCEThousands 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. RESULTSAmong 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 (Ն70) 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).

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

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

et al. 2022

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“…Among the 37 studies, 17 were cohort studies, 15 were cross-sectional studies, and 5 were qualitative studies. Twenty-four studies were conducted in the US, 4 in Canada, 3 in Australia, 2 in England, 2 in Ireland, and 1 in Italy, whereas 1 study derived data from Austria, Canada, and the US . Details on study design, setting, sample characteristics, inclusion and exclusion criteria, and study quality are presented in eTable 6 in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

“…Fourteen studies included participants with an opioid use disorder (OUD) diagnosis, 9 examined heroin and other opioid use, and 7 examined any opioid use . In addition, 2 studies examined primary opioid use, 1 evaluated nonmedical prescription opioid use, and 1 reviewed any injection drug use .…”

Section: Resultsmentioning

confidence: 99%

“…In addition, 2 studies examined primary opioid use, 1 evaluated nonmedical prescription opioid use, and 1 reviewed any injection drug use . Sixteen studies included any opioid use during the study period, 9 examined current opioid use, 3 examined past 30-day opioid use, 2 examined past year opioid use, and 1 examined past 6-month opioid use . The remaining studies included opioid use in the 3 months before and 1 month after an opioid-related overdose, upon imprisonment, and in the 3 days and 8 or more years before treatment admission …”

Section: Resultsmentioning

confidence: 99%

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Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults

2022

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IMPORTANCEThe ongoing overdose crisis continues to adversely affect adolescents and young adults (AYAs) and has led to numerous preventable deaths. Medications for opioid use disorder (MOUD), such as methadone, buprenorphine, and naltrexone, have the potential to reduce opioid use and associated harms; however, there are concerns that AYAs lack access to these potentially life-saving medications.OBJECTIVE To systematically review peer-reviewed literature on MOUD access and associated factors to synthesize strategies that can improve MOUD access for AYAs who use opioids. EVIDENCE REVIEWThe MEDLINE, Embase, PsycINFO, CINAHL, Sociological Abstracts, Web of Science, and Global Dissertations & Theses databases were searched from database inception until May 3, 2021. English, French, Russian, or Spanish peer-reviewed studies that evaluated the availability, prescription receipt, or initiation of MOUD were eligible for inclusion.FINDINGS This systematic review identified 37 cohort (n = 17), cross-sectional (n = 15), and qualitative (n = 5) studies that accounted for 179 785 AYAs (mean [SD] age, 24.4 [3.9] years; 148 779 [85%] were female; 67 771 [84%] were White) and examined access to methadone (30 studies), buprenorphine (26 studies), and naltrexone (10 studies). Findings reinforce concerns that AYAs were less likely to access MOUD and suggest that adolescents were more likely to receive naltrexone or buprenorphine-naloxone, which have a lower potential for abuse, in comparison with young adults. This review also identified other factors that were associated with MOUD access, including criminal justice involvement, residing in the US South, living in a limited-income area, Black race, and Hispanic or Latino ethnicity, suggesting ways in which treatment services may be improved to increase MOUD access and meet the treatment goals of AYAs.CONCLUSION AND RELEVANCE This systematic review found gaps in MOUD access between AYAs and non-AYA populations in addition to differences in MOUD access between adolescents and young adults. Considering that existing clinical guidelines recommend the use of MOUD among AYAs, and in light of the increasing number of opioid toxicity deaths, there is a need to improve MOUD access among AYAs by reducing barriers to MOUD and providing AYAs with a continuum of health and social supports alongside MOUD. Future research into ways to encourage MOUD uptake among AYAs may improve the treatment and health outcomes for this population.

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Medications for opioid use disorder during pregnancy: Access and continuity in a state women’s prison facility, 2016–2019

Knittel

Swartzwelder

Zarnick

et al. 2022

Drug and Alcohol Dependence

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Medications for opioid use disorder in pregnancy in a state women’s prison facility

Cited by 10 publications

References 23 publications

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

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

Access to Medications for Opioid Use Disorder and Associated Factors Among Adolescents and Young Adults

Medications for opioid use disorder during pregnancy: Access and continuity in a state women’s prison facility, 2016–2019

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