Do Pregnant Inmates have a Constitutional Right to Opioid Replacement Therapy?

An Interpretive Description of Drug Withdrawal Among Pregnant Women in Jail

OBJECTIVE

To explore the experience of drug withdrawal among pregnant women in jail.

DESIGN

A qualitative interpretive descriptive approach.

SETTING/PROBLEM

The care of incarcerated pregnant women constitutes a complex and significant public health problem. Many have substance use disorder (SUD) and cycle in and out of jails in their community, resulting in repeated experiences of drug withdrawal. Most jails do not provide medication-assisted therapy for management of withdrawal, a situation that violates standards of care set by leading health organizations. The experience of drug withdrawal among pregnant women in jail has not been qualitatively explored in the literature.

PARTICIPANTS

Five women completed interviews for the study.

INTERVENTION

In-depth, qualitative interviews.

RESULTS

Five themes with subthemes emerged from the interviews: Framing the Story Through Life History: I Need You to Know Where I Come From, Patterns of Thinking About Substance Use, The Manifestations of Withdrawal: Body and Mind, Perceived Punishment for Drug Use During Pregnancy, and Mixed Perceptions of Withdrawal Treatment.

CONCLUSION

Participants told a story beyond that of the physical withdrawal symptoms, revealing new insights into their maternal distress and the need for compassionate, nonstigmatized care to address physical and mental symptoms, as well as advocacy for the provision of an evidence-based standard of care. Nurses who care for pregnant women with SUD in the jail setting could benefit from collaborative relationships with other health care professionals in the community to reduce disparate health outcomes for this vulnerable population.

Opioid dependence among pregnant and post-partum incarcerated individuals: A review of the literature

BACKGROUND

Pregnant and post-partum women with opioid dependence are an extremely vulnerable population within correctional facilities. A significant number of maternal inmates, however, still lack adequate provision of medications for opioid use disorder (OUD) and are subsequently forced into withdrawal. Currently, there exist no comprehensive reviews on the scope of literature regarding the management of this population. We aimed to provide a review on the research surrounding these women.

DESIGN

A systematic search of PubMed Central was conducted to identify studies evaluating OUD among pregnant and post-partum incarcerated women. Citations from only the last 20 years were included to ensure both relevance and scope of information.

RESULTS

The topics that emerged from this review included medications for OUD (MOUD) administration vs detoxification practices, treatment upon incarceration and upon release, and maternal and fetal outcomes. Across all articles, current care management of this population appeared inadequate. We further compiled all author recommendations and perspectives into a framework that can inform potential improvements in care coordination.

CONCLUSIONS

This review identifies significant gaps in current management-particularly regarding administration of MOUDs-and emphasizes the need for standardization of addiction-related and perinatal healthcare. We also highlight gaps in the literature and potential areas for future research.

State Laws on Substance Use Treatment for Incarcerated Pregnant and Postpartum People

Background

Incarcerated perinatal populations report high rates of substance use in the United States (US). Despite this, substance use disorder (SUD) treatment is not routinely available in carceral settings and state policies related to the provision of substance use screening and treatment are unknown.

Methods

We conducted a systematic search in WestLaw through the end of the 2020 legislative session combining the terms "pregnant" and "postpartum" with terms for incarceration and related terms. The search returned 453 statutes from 43 states. A deductive codebook of various maternal health topics was developed. Legislative texts related to SUD screening and treatment were extracted for textual analysis.

Results

Of the 43 states identified as having at least 1 state statute pertaining to pregnant or postpartum incarcerated people, 7 states had statutes relevant to SUD screening and treatment. Statutes related to substance use screening, education, treatment and diversion programs, program eligibility, aftercare and release planning, and funding appropriations.

Conclusions

The majority of states across the U.S. lack legislation that address SUD screening and treatment among incarcerated perinatal populations. Given the known limited access to SUD treatment for perinatal populations in custody, increasing legislative statutes could increase access to essential care.

An integrative literature review of substance use treatment service need and provision to pregnant and postpartum populations in carceral settings

Pregnancy is a critical time to provide access to substance use treatment; this is especially true among incarcerated populations, who are known to be at particularly high risk of poor health outcomes. In this integrated literature review, we (1) report what is known about the prevalence of substance use among incarcerated pregnant and postpartum populations; (2) describe substance use treatment programs and current care practices of pregnant and postpartum populations in carceral settings; and (3) explore recommendations and strategies for increasing access to substance use treatment for incarcerated pregnant and postpartum populations. A comprehensive search of seven electronic databases yielded in the retrieval of 139 articles that were assessed for inclusion. Of the retrieved articles, 33 articles met criteria for inclusion in this review. A review of the literature revealed that the understanding of substance use prevalence among pregnant incarcerated women is limited. We also found that treatment of substance use disorders among pregnant and postpartum populations is not routinely available, enhanced perinatal services are sorely needed, and substance use treatment programs are feasible with the help of community partnerships. More research is required to understand current substance use treatment initiatives and outcomes for pregnant women in prison. In addition, strategies for integrating evidence-based, substance use treatment in carceral settings is also needed. Future directions are discussed.

Care for Incarcerated Pregnant People With Opioid Use Disorder: Equity and Justice Implications

With the simultaneous rise in maternal opioid use disorder (OUD) and the incarceration of pregnant people in the United States, we must ensure that prisons and jails adequately address the health and well-being of incarcerated pregnant people with OUD. Despite long-established, clear, and evidence-based recommendations regarding the treatment of OUD during pregnancy, incarcerated pregnant people with OUD do not consistently receive medication treatment and are instead forced into opioid withdrawal. This inadequate care raises multiple concerns, including issues of justice and equity, considerations regarding the legal and ethical obligations of the provision of health care, and violations of the medical and legal rights of incarcerated people. We offer recommendations for improving care for this often-ignored group.