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1. Purpose. To provide medication for opioid use disorder (MOUD) in jails to incarcerated individuals who present <br />with an opioid use disorder (OUD). To support a full MOUD program which includes the following: an OUD <br />assessment, discussion of MOUD options between the incarcerated individual and provider, initiation prior to <br />the onset of withdrawal or continuation of MOUD, release and reentry planning to include connection with <br />continued treatment, same day release appointment when possible or MOUD to bridge patient until next <br />appointment and naloxone upon release. Reentry planning may also include assisting the incarcerated individual <br />with sign-up of Medicaid, reestablishing Medicaid and connection with the Managed Care Organizations <br />(MCOs). <br />Health Equity - This project also intends to address inequities in OUD treatment and recovery services by <br />providing medically necessary treatment for opioid use disorder to incarcerated individuals. MOUD in jails <br />programs should understand cultural barriers and provide culturally appropriate services and recognize the need <br />for inclusion of people with lived experiences in the development of the MOUD in jails programs. Additionally, <br />this project intends to identify stigma and educate staff to ensure ongoing collaboration and openness to <br />change. <br />2. Performance Work Statement. The Contractor shall ensure funds are responsibly used towards the MOUD <br />program in the jail/jails and provide the core components or a progressive plan to achieve the core components <br />which include; <br />a. FDA approved medication for opioid use disorder (MOUD) must be available and offered to all <br />incarcerated individuals who present with OUD at intake. Individuals with OUD may decline MOUD at <br />any time, but ongoing discussions on MOUD may be offered. <br />b. Methadone, buprenorphine, naltrexone should all be offered unless: (a) an opioid treatment program <br />(OTP) is not within reasonable driving distance from the jail, in which case the jail is not required to offer <br />methadone as an option; or (b) there is no available buprenorphine provider in the community to which <br />the patient will likely release, in which case the jail is not required to offer buprenorphine as an option. <br />Naltrexone may be provided in oral formulation while the patient is incarcerated, but injectable long- <br />acting naltrexone must be offered as an option prior to release. <br />c. MOUD must be continued for those who are already taking MOUD upon entering the facility. MOUD is <br />continued using the same medication, at the same dose unless ordered otherwise by the prescriber <br />based on clinical need (documented in the patient's medical record) with the exception of injectable <br />long-acting naltrexone which may be converted to an equivalent oral dose until just prior to release and <br />the injectable form is restarted. Methadone may be transitioned to buprenorphine if the jail is not a <br />licensed opioid treatment program (OTP) and the nearest OTP is not within reasonable driving distance <br />from the jail. The presence of other illicit or controlled substances should not result in discontinuation of <br />MOUD (consistent with the 2020 ASAM National Practice Guideline for the Treatment of Opioid <br />Use Disorder). <br />d. Assessing for risk of acute withdrawal must be done upon intake. Assessing for opioid use disorder <br />(OUD) absent a risk of acute withdrawal must also be done, but it may be done after intake, as long as <br />the delay does not impair the ability to begin treatment prior to release. The incarcerated individual <br />must be educated on treatment choices and the process for continuation of access to MOUD, during <br />incarceration, and upon release. (See resources for validated tool suggestions.) <br />e. Individuals entering the facility who are physically dependent on opioids, must be offered MOUD <br />treatment; withdrawal (including withdrawal using buprenorphine or methadone) is not acceptable <br />unless the patient provides an informed refusal of treatment or the patient elects MOUD treatment with <br />naltrexone, in which case withdrawal is clinically required. Use of other medications (clonidine, anti- <br />emetics, anti-diarrheals, analgesics) may be used as adjuncts or may be used in place of opioid agonist <br />or partial agonist if the individual so chooses, but they may not be the only withdrawal treatment <br />available. <br />f. Methadone and buprenorphine must be administered daily or more frequently. Alternate -day <br />("Balloon") dosing of buprenorphine may be used in rare cases based on a clinical need, the decision for <br />