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DocuSign Envelope ID: 666BF09F-322B-4BB9-BGBO-40579A7ED52G <br />3.2.7.2. If there is no available buprenorphine provider in the community to which the <br />individual will release, the Jail must still offer buprenorphine (tapered over several <br />days) if opioid withdrawal is clinically indicated. <br />3.2.7.3. If withdrawal is not clinically indicated and the only reason for considering <br />discontinuation of buprenorphine is the lack of an available buprenorphine provider <br />in the community to which the individual will release, a decision whether or not — or <br />when — to discontinue buprenorphine prior to release should be made based on a <br />plan mutually agreed -upon between the individual and the prescriber based on the <br />length of time the individual is expected to remain in the jail, the risks of opioid <br />misuse or overdose during the incarceration, and the individual's willingness to <br />receive a dose of an extended release injectable buprenorphine just prior to release <br />that will provide the individual a safe tapered withdrawal in the community if no <br />provider is available. <br />3.2.7.4. Provide naltrexone in oral formulation while the individual is incarcerated. Offer <br />injectable long -acting naltrexone or buprenorphine as an option prior to release. <br />3.2.7.5. Offer oral buprenorphine without naloxone while the individual is incarcerated but <br />must discharge the individual on a formulation of buprenorphine with naloxone <br />unless there is a clinical reason not to do so (e.g., the individual is discharged on <br />injectable buprenorphine, the individual is allergic to naloxone). <br />3.2.8. Contractor shall not facilitate forced opioid withdrawal (including withdrawal using a tapering <br />dose of buprenorphine or methadone) unless the individual provides an informed refusal of <br />treatment or the individual elects MOUD treatment with naltrexone, in which case withdrawal <br />is clinically required. <br />3.2.8.1. In such case, Contractor may use other medications (clonidine, anti -emetics, anti- <br />diarrheals, analgesics) in place of buprenorphine or methadone if the individual so <br />chooses or as adjuncts to these medications, but they may not be the only <br />withdrawal treatment available. <br />3.2.8.2. Initiation of buprenorphine or methadone, whether for induction of treatment or for <br />withdrawal, may not be delayed for administrative reasons, e.g., unavailability of a <br />prescriber, beyond when they are clinically indicated to be started. <br />3.2.9. Offer treatment for withdrawal with benzodiazepines to individuals entering the facility who are <br />physically dependent on alcohol, if clinically appropriate. <br />3.2.10. Provide immediate evaluation to individuals at risk for, or in, opioid or alcohol withdrawal who <br />refuse treatment by a medical or mental health prescriber or a licensed mental health <br />professional at the masters' level or higher, to determine if they have decision -making <br />capacity. If they do not, they must be transported to a community hospital and may not return <br />to the jail until they are clinically safe to return to the jails AND have regained decision -making <br />capacity. <br />Washington State Page 5 of 10 MOUD in Jails Services <br />Health Care Authority FICA Contract No. K5885-3 <br />Schedule A-3 <br />