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. Docusign Envelope lD: 700826AD-3CE3-815C-8194-013EF364AA04 Though MOUD/MAUD must not be discontinued on a policy or administrative basis because of the presence of othlr illicit or controlled substances, administration of the community-based MOUD or MAUD may be adjusted if clinically necessary due to pharmacologic risks of drug-drug interaction. tr Contractor shall screen for OUD and AUD without physical dependence (i.e., without a risk of acute withdrawal) and history of opioid overdose, soon after intake. n Educate individuals on treatment choices and the process for continuation of access to MOUD/MAUD during incarceration and upon release. I Make available and offer treatment using some formulation of methadone, buprenorphine, or naltrexone based on a mutually agreed-upon plan between the prescriber and the individual. The.plan must take into consideration, among other clinically relevant factors, the availability of specific medications at their residence of release. . Contractor may provide naltrexone or buprenorphine in oral formulation,'with or without naloxone while the individual is incarcerated but must offer an oralformulation of buprenorphine WITH naloxone unless there is a clinical reason not to do so, e.9., the individual is allergic to naloxone at release. n Contractor shall not allow an individual to undergo opioid'withdrawal, including withdrawal using a tapering dose of buprenorphine or methadone, unless the individual provides an lnformed Refusal of continuing maintenance MOUD treatment after withdrawing or the individual elects MOUD treatment with naltrexone. . ln either case, Contractor will offer the individualtapering doses of buprenorphine or methadone supplemented, as necessary, with alpha-2 adrenergic agonists (e.9., lofexidine), anti-emetics, anti- diarrheals, analgesics, fluid and electrolyte replacement (e 9., Gatorade@)). . lnitiation of buprenorphine or methadone, whether for maintenance or for withdrawal, must not be delayed for administrative reasons, e.g., unavailability of a prescriber, beyond when they are clinically indicated to be started. 2, DURING INCARCERATION tr Offer initiation of maintenance MOUD/MAUD to individuals who did not start MOUD/MAUD for acute opioid or alcohol withdrawal.as identified at intake, e.g., individuals with OUD but without physical dependence, or'individuals with AUD who underwent withdrawal. . For all individuals initiation should begin soon enough to attempt stabilization of dosing prior to release. . For.individuals with a history of opioid overdose, initiation should begin as soon as possible after identified. tr Educate individuals on treatment choices and the process for continuation of access to MOUD/MAUD during incarceration and.upon release. tr Contractor shall not use alternate-day or "balloon" dosing of buprenorphine (i.e., administering a dose of medlcation on one (1) day which is intended to last for two (2) or more days). tr Administer methadone and buprenorphine more often than one dose daily if clinically necessary, e'9., in some pregnant or post-partum individuals, those who metabolize the medication faster, and individuals who have side effects from large single doses. HCA Contract No. K5885-05 Page 11 of 13