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HCA Contract No. K5885-05 Page 4 of 13 <br />a. If sent to a community hospital, Contractor shall not accept the individual back at <br />the jail until it is clinically safe to do so, and they have regained decision-making <br />capacity. <br />3.1.2.3. Decision-making capacity shall only be determined by a medical or mental health <br />prescriber (e.g., physician, nurse practitioner, physician assistant) or a licensed mental <br />health professional at the master’s level or higher. Informed Refusal shall only be <br />executed by a prescriber. <br />3.2. Intake <br />3.2.1. Screen all newly admitted individuals for risk of acute withdrawal from opioids and alcohol upon <br />intake. <br />3.2.2. MOUD1, MAUD 2, and other medications which support the relief of withdrawal symptoms, such <br />as alpha-2 adrenergic agonists (e.g., lofexidine), anti-emetics, anti-diarrheals, analgesics, and <br />fluid and electrolyte replacement (e.g., Gatorade®) must be offered to individuals at no charge <br />to the individual. <br />3.2.3. Offer initiation of MOUD treatment to individuals who are physically dependent on opioids, may <br />have withdrawal symptoms, or have disclosed recent use and anticipate withdrawal. Facilities <br />shall not require tapering from the illicit opioid unless clinically indicated. <br />3.2.4. Offer treatment for withdrawal with benzodiazepines to individuals entering the facility who are <br />physically dependent on alcohol, if clinically appropriate. <br />3.2.5. Continue MOUD and MAUD for individuals who are already taking these medications upon <br />entering the facility. Continue the individual on the same medication at the same dose unless <br />ordered otherwise by the prescriber based on clinical need, unless one of the following <br />exceptions is applicable: <br />3.2.5.1. Injectable long-acting naltrexone may be converted to an equivalent oral dose until just <br />prior to release at which time the injectable form shall be restarted. <br />3.2.5.2. Injectable long-acting buprenorphine may be converted to an equivalent oral dose until <br />just prior to release at which time the injectable form shall be restarted. <br />3.2.5.3. Oral buprenorphine may be converted to any of the three formulations available: film, <br />tablet with naloxone, or tablet without naloxone. <br />3.2.5.4. If the individual is not pregnant, methadone may be transitioned to buprenorphine if <br />one of the following is applicable: <br />a. Contractor is not a licensed Opioid Treatment Program (OTP) and the nearest OTP <br />willing to collaborate with the jail to provide methadone is not within reasonable <br />driving distance from the jail, and the jail does not have nursing staff on site seven <br /> <br />1 Methadone, buprenorphine, naltrexone <br />2 Naltrexone, acamprosate <br />Docusign Envelope ID: 700826AD-3CE3-815C-8194-013EF364AA04