Opioid Use Disorder Cascade of Care Among People Who Experienced Perinatal Incarceration: A Qualitative Study

To use the opioid use disorder (OUD) cascade of care to explore the OUD treatment experiences and preferences of pregnant and postpartum people with OUD who experienced incarceration during pregnancy.

We conducted 12 semi-structured interviews with pregnant and postpartum people with OUD who were either currently incarcerated or in a residential treatment program with experience of perinatal incarceration. The interview guide was developed using a trauma-informed approach and Reproductive Justice framework. Interview transcripts were analyzed using the rigorous and accelerated data reduction technique and a generalized inductive approach with the codebook developed a priori with topical codes from the interview guide and then expanded with interpretive codes.

We identified themes along the OUD cascade of care. Treatment engagement was shaped by individual readiness and the availability of treatment, both in the community and during incarceration. Medications for opioid use disorder (MOUD) initiation was limited in some instances by the availability of the medication and, in many instances, stigma limited the desire for and ease of MOUD initiation. Participants described potential facilitators (navigation, gender-responsive services) and barriers (lack of mental health care, unmet preferences in terms of treatment format/structure) to retention in care in the community after incarceration. Participants had limited experience with sustained remission and did not identify incarceration as an effective strategy for sustained remission.

Incarceration is not an effective strategy for sustained remission. Individual, organizational, and structural supports are required to support attempts at recovery that are initiated during incarceration.