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

Area of Science:

• Perinatal Health
• Addiction Medicine
• Public Health Policy

Background:

• Pregnant individuals with opioid use disorder (OUD) face higher incarceration rates, creating barriers to essential treatment.
• Access to and continuity of care for OUD are critical for reducing overdose risk and improving perinatal outcomes.
• The carceral system presents unique challenges for providing consistent and effective substance use disorder treatment.

Purpose of the Study:

• To describe the implementation of an integrated perinatal clinic for pregnant individuals with OUD within a state correctional facility.
• To assess the successes and challenges of providing medications for opioid use disorder (MOUD) and comprehensive care during incarceration.
• To support the initiation and maintenance of MOUD for pregnant and postpartum individuals within the carceral setting.

Main Methods:

• Established an integrated clinic within North Carolina's sole state prison facility for pregnant individuals.
• Provided comprehensive services including prenatal care, MOUD, counseling, case management, and post-release care coordination.
• Focused on integrating physical and behavioral health services for incarcerated pregnant and postpartum individuals with OUD.

Main Results:

• Achieved faster initiation and continuation of MOUD for pregnant individuals.
• Increased staff capacity, enhanced stakeholder collaboration, and reduced costs for perinatal OUD care.
• Identified challenges in consistent screening, withdrawal surveillance, postpartum care, and continuity of treatment post-release.

Conclusions:

• The integrated clinic model successfully supports MOUD initiation and maintenance for incarcerated pregnant and postpartum individuals.
• This novel program demonstrates the feasibility of integrating physical and behavioral health services in a carceral setting.
• Future efforts should focus on patient perspectives and expanded partnerships to further reduce overdose morbidity and mortality.