Bringing MOUD "In House": Implementing an Internal MOUD Program During Pregnancy in a State Prison

Pregnant individuals with opioid use disorder (OUD) are incarcerated at higher rates than the general pregnant population and are overrepresented within the carceral system. Although OUD treatment reduces overdose risk and improves perinatal outcomes, incarceration can be a barrier to timely access and continuity of care. We describe the implementation of an integrated perinatal medications for opioid use disorder (MOUD) clinic ("the clinic") within the single state prison facility housing pregnant individuals in North Carolina. The clinic provides prenatal care, screening for substance use disorders, MOUD, recovery-focused counseling and case management, referral to mental and behavioral health services, and coordination of care after release with community clinicians. Implementation successes included faster initiation and continuation of MOUD, increased staff capacity, improved collaboration among key stakeholders, and reduced costs associated with perinatal OUD care. Challenges involved consistent intake screening, adherence to withdrawal surveillance protocols, postpartum maintenance of treatment, and continuity of therapy upon release. This novel program integrates physical and behavioral health services to support initiation and maintenance of MOUD for pregnant and postpartum individuals during incarceration. Future steps include incorporating patient perspectives and expanding partnerships to further decrease overdose morbidity and mortality.