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<br />HCA Contract No. K5885-04 Page 6 of 13 <br />2.2.9.3. If withdrawal is not clinically indicated and the only reason for <br />considering discontinuation of buprenorphine is the lack of an available <br />buprenorphine provider in the community to which the individual will be <br />released, the decisions when or if buprenorphine should be <br />discontinued prior to release should be made based on the following: <br />a. A plan mutually agreed-upon between the individual and the <br />prescriber; <br />b. The length of time the individual is expected to remain in the jail; <br />c. The risks of opioid misuse or overdose during the incarceration; and <br />d. The individual’s willingness to receive a dose of an extended-release <br />injectable buprenorphine just prior to release which will provide a <br />safe tapered withdrawal for the individual. <br />2.2.9.4. Provide naltrexone in oral formulation while the individual is <br />incarcerated. Offer injectable long-acting naltrexone or buprenorphine <br />as an option prior to release. <br />2.2.9.5. Offer oral buprenorphine without naloxone while the individual is <br />incarcerated but must discharge the individual on a formulation of <br />buprenorphine with naloxone unless there is a clinical reason not to do <br />so. E.g., the individual is discharged on injectable buprenorphine, the <br />individual is allergic to naloxone. <br />2.2.10. Contractor shall not facilitate forced opioid withdrawal, including withdrawal using a <br />tapering dose of buprenorphine or methadone, unless the individual provides an <br />informed refusal of treatment or the individual elects MOUD treatment with <br />naltrexone, in which case withdrawal is clinically required. <br />2.2.10.1. In such case, Contractor may use other medications (e.g., clonidine, <br />anti-emetics, anti-diarrheals, analgesics, etc.) in place of buprenorphine <br />or methadone if the individual chooses or as adjuncts to these <br />medications, but they may not be the only withdrawal treatment <br />available. <br />2.2.10.2. Initiation of buprenorphine or methadone, whether for induction of <br />treatment or for withdrawal, may not be delayed for administrative <br />reasons, e.g., unavailability of a prescriber, beyond when they are <br />clinically indicated to be started. <br />2.2.11. Provide immediate evaluation to individuals at risk for, or in, opioid or alcohol <br />withdrawal who refuse treatment by a medical or mental health prescriber or a <br />licensed mental health professional at the masters’ level or higher, to determine if <br />they have decision-making capacity.