Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Johns Hopkins Bayview Hospital, Baltimore, MD, USA.
Addiction. 2020 Nov;115(11):2057-2065. doi: 10.1111/add.15030. Epub 2020 Mar 18.
The established standard care in pregnancy is medication for opioid use disorder (MOUD); however, many institutions of incarceration do not have MOUD available. We aimed to describe the number of incarcerated pregnant women with opioid use disorder (OUD) in the United States and jails' and prisons' MOUD in pregnancy policies.
Epidemiological surveillance study of 6 months of outcomes of pregnant, incarcerated women with OUD and cross-sectional survey of institutional policies.
United States.
Twenty-two state prison systems and six county jails.
The number of pregnant women with OUD admitted and treated with methadone, buprenorphine or withdrawal; policies on provision of MOUD and withdrawal in pregnancy.
Twenty-six per cent of pregnant women admitted to prisons and 14% to jails had OUD. One-third were managed through withdrawal. The majority who were prescribed MOUD were on methadone (78%, prisons; 81%, jails), not buprenorphine. While most sites (n = 18 prisons, n = four jails) continued pre-incarceration MOUD in pregnancy, very few initiated in custody (n = four prisons; n = two jails). Two-thirds of prisons and three-quarters of jails providing MOUD in pregnancy discontinued it postpartum.
In this sample of US prisons and jails, one-third required pregnant women with opioid use disorder to go through withdrawal, contrary to medical guidelines. More women were prescribed methadone than buprenorphine, despite the fewer regulatory barriers on prescribing buprenorphine. Most sites stopped medication for opioid use disorder postpartum, signaling prioritization of the fetus, not the mother. Pregnant incarcerated women with opioid use disorder in the United States frequently appear to be denied essential medications and receive substandard medical care.
目前，妊娠期间的标准治疗方法是使用药物治疗阿片类药物使用障碍（MOUD）；然而，许多监禁机构并不提供 MOUD。我们旨在描述美国被监禁的患有阿片类药物使用障碍（OUD）的孕妇数量，以及监狱在妊娠期间的 MOUD 政策。
对 6 个月患有 OUD 的怀孕被监禁妇女的结果进行的流行病学监测研究，以及对机构政策的横断面调查。
美国。
22 个州监狱系统和 6 个县监狱。
患有 OUD 的怀孕妇女入院人数和接受美沙酮、丁丙诺啡或戒断治疗的人数；提供 MOUD 和妊娠期间戒断的政策。
26%的监狱孕妇和 14%的县监狱孕妇患有 OUD。三分之一的人通过戒断治疗。接受 MOUD 治疗的大多数人（78%的监狱；81%的县监狱）使用的是美沙酮，而不是丁丙诺啡。尽管大多数监狱（n=18）和四个县监狱（n=4）继续在妊娠期间提供入狱前的 MOUD，但在监禁期间很少开始使用（n=4 个监狱；n=2 个县监狱）。三分之二的监狱和四分之三的县监狱在产后停止了孕期的 MOUD。
在这个来自美国监狱的样本中，三分之一需要患有阿片类药物使用障碍的孕妇进行戒断治疗，这与医学指南相违背。尽管丁丙诺啡的处方限制较少，但接受丁丙诺啡治疗的妇女多于美沙酮。大多数监狱在产后停止了阿片类药物使用障碍的治疗，表明胎儿的优先级高于母亲。美国被监禁的患有阿片类药物使用障碍的孕妇经常被剥夺必要的药物治疗，并接受低标准的医疗护理。
