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HCA Contract No. K5885-05 Page 5 of 13 <br />(7) days a week. The individual must be started back on methadone prior to <br />release if they plan to resume methadone in the community. <br />b. There is no OTP within reasonable distance of the individual’s release residence. <br />3.2.5.5. Though MOUD/MAUD must not be discontinued on a policy or administrative basis <br />because of the presence of other illicit or controlled substances, administration of the <br />community-based MOUD or MAUD may be adjusted if clinically necessary due to <br />pharmacologic risks of drug-drug interaction. <br />3.2.6. Contractor shall screen for OUD and AUD without physical dependence (i.e., without a risk of <br />acute withdrawal) and history of opioid overdose, soon after intake. <br />3.2.7. Educate individuals on treatment choices and the process for continuation of access to <br />MOUD/MAUD during incarceration and upon release. <br />3.2.8. Make available and offer treatment using some formulation of methadone, buprenorphine, or <br />naltrexone based on a mutually agreed-upon plan between the prescriber and the individual. <br />The plan must take into consideration, among other clinically relevant factors, the availability of <br />specific medications at their residence of release. <br />3.2.8.1. Contractor may provide naltrexone or buprenorphine in oral formulation, with or without <br />naloxone while the individual is incarcerated but must offer an oral formulation of <br />buprenorphine WITH naloxone unless there is a clinical reason not to do so, e.g., the <br />individual is allergic to naloxone at release. <br />3.2.9. Contractor shall not allow an individual to undergo opioid withdrawal, including withdrawal using <br />a tapering dose of buprenorphine or methadone, unless the individual provides an Informed <br />Refusal of continuing maintenance MOUD treatment after withdrawing or the individual elects <br />MOUD treatment with naltrexone. <br />3.2.9.1. In either case, Contractor will offer the individual tapering doses of buprenorphine or <br />methadone supplemented, as necessary, with alpha-2 adrenergic agonists (e.g., <br />lofexidine), anti-emetics, anti-diarrheals, analgesics, fluid and electrolyte replacement <br />(e.g., Gatorade®). <br />3.2.9.2. Initiation of buprenorphine or methadone, whether for maintenance or for withdrawal, <br />must not be delayed for administrative reasons, e.g., unavailability of a prescriber, <br />beyond when they are clinically indicated to be started. <br />3.3. During Incarceration <br />3.3.1. Offer initiation of maintenance MOUD/MAUD to individuals who did not start MOUD/MAUD for <br />acute opioid or alcohol withdrawal as identified at intake, e.g., individuals with OUD but without <br />physical dependence, or individuals with AUD who underwent withdrawal. <br />3.3.1.1. For all individuals initiation should begin soon enough to attempt stabilization of dosing <br />prior to release. <br />3.3.1.2. For individuals with a history of opioid overdose, initiation should begin as soon as <br />possible after identified. <br />Docusign Envelope ID: 700826AD-3CE3-815C-8194-013EF364AA04