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Docusign Envelope lD: 97E7029C-8CD5-4FBF-9DC4-1 837DD2691 89 2.2.9.3.lf withdrawal is not clinically indicated and the only reason for considering discontinuation of buprenorphine is the lack of an available buprenorphine provider in the community to which the individual will be released, the decisions when or if buprenorphine should be discontinued prior to release should be made based on the following: a. A plan mutually agreed-upon between the individual and the prescriber; b. The length of time the individual is expected to remain in the jail; c. The risks of opioid misuse or overdose during the incarceration; and d. The individual's willingness to receive a dose of an extended-release injectable buprenorphine just prior to release which will provide a safe tapered withdrawalfor the individual. 2.2.9.4 Provide naltrexone in oralformulation while the individual is incarcerated. Offer injectable long-acting naltrexone or buprenorphine as an option prior to release. 2.2.9.5 Offer oral buprenorphine without naloxone while the individual is incarcerated but must discharge the individual on a formulation of buprenorphine with naloxone unless there is a clinical reason not to do so. E.g., the individual is discharged on injectable buprenorphine, the individual is allergic to naloxone. 2.2.10 Contractor shall not facilitate forced opioid withdrawal, including withdrawal using a tapering dose of buprenorphine or methadone, unless the individual provides an informed refusal of treatment or the individual elects MOUD treatment with naltrexone, in which case withdrawal is clinically required. 2.2.10.1. ln such case, Contractor may use other medications (e.9., clonidine, anti-emetics, anti-diarrheals, analgesics, etc.) in place of buprenorphine or methadone if the individual chooses or as adjuncts to these medications, but they may not be the only withdrawaltreatment available. 2.2.10.2 lnitiation of buprenorphine or methadone, whether for induction of treatment or for withdrawal, may not be delayed for administrative reasons, e.9., unavailability of a prescriber, beyond when they are clinically indicated to be started. 2.2.11. Provide immediate evaluation to individuals at risk for, or in, opioid or alcohol withdrawalwho refuse treatment by a medical or mental health prescriber or a licensed mental health professional at the masters' level or higher, to determine if they have decision-making capacity. HCA Contract No. K5885-04 Page 6 of 13