Opioid dependence among pregnant and post-partum incarcerated individuals: A review of the literature





opioid, incarceration, pregnant, post-partum, medications for opioid use disorder, medication-assisted treatment


Background: Pregnant and post-partum women with opioid dependence are an extremely vulnerable population within correctional facilities. A significant number of maternal inmates, however, still lack adequate provision of medications for opioid use disorder (OUD) and are subsequently forced into withdrawal. Currently, there exist no comprehensive reviews on the scope of literature regarding the management of this population. We aimed to provide a review on the research surrounding these women.

Design: A systematic search of PubMed Central was conducted to identify studies evaluating OUD among pregnant and post-partum incarcerated women. Citations from only the last 20 years were included to ensure both relevance and scope of information.

Results: The topics that emerged from this review included medications for OUD (MOUD) administration vs detoxification practices, treatment upon incarceration and upon release, and maternal and fetal outcomes. Across all articles, current care management of this population appeared inadequate. We further compiled all author recommendations and perspectives into a framework that can inform potential improvements in care coordination.

Conclusions: This review identifies significant gaps in current management—particularly regarding administration of MOUDs—and emphasizes the need for standardization of addiction-related and perinatal healthcare. We also highlight gaps in the literature and potential areas for future research.

Author Biographies

Serra Sozen

Department of Medicine, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, Vermont

David Krag, MD

Department of Surgery, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, Vermont

Carly Milliren

Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts


Staton M, Leukefeld C, Webster JM: Substance use, health, and mental health: Problems and service utilization among incarcerated women. Int J Offender Ther Comp Criminol. 2003; 47(2): 224-239. DOI: 10.1177/0306624X03251120. DOI: https://doi.org/10.1177/0306624X03251120

Fazel S, Yoon IA, Hayes AJ: Substance use disorders in prisoners: An updated systematic review and meta-regression analysis in recently incarcerated men and women. Addiction. 2017; 112(10): 1725-1739. DOI: 10.1111/add.13877. DOI: https://doi.org/10.1111/add.13877

Mumola CJ, Karberg JC: Drug Use and Dependence, State and Federal Prisoners, 2004. Washington, DC: Bureau of Justice Statistics, 2015.

Zeng Z: Jail Inmates in 2017. Washington, DC: US Department of Justice, 2017.

Bronson J, Carson A: Prisoners in 2017. Washington, DC: Bureau of Justice Statistics, 2019.

Sufrin C, Sutherland L, Beal L, et al.: Opioid use disorder incidence and treatment among incarcerated pregnant women in the United States: Results from a national surveillance study. Addiction. 2020; 115(11): 2057-2065. DOI: 10.1111/add.15030. DOI: https://doi.org/10.1111/add.15030

Committee opinion no. 711: Opioid use and opioid use disorder in pregnancy. Obstet Gynecol. 2017; 130(2): e81-e94. DOI: 10.1097/AOG.0000000000002235. DOI: https://doi.org/10.1097/AOG.0000000000002235

Terplan M, Laird HJ, Hand DJ, et al.: Opioid detoxification during pregnancy: A systematic review. Obstet Gynecol. 2018; 131(5): 803-814. DOI: 10.1097/AOG.0000000000002562. DOI: https://doi.org/10.1097/AOG.0000000000002562

Drago MJ, Shabanova V, Hochreiter D, et al.: Does maternal incarceration impact infants with neonatal abstinence syndrome? Matern Child Health J. 2022; 26(5): 1095-1103. DOI: 10.1007/s10995-021-03356-4. DOI: https://doi.org/10.1007/s10995-021-03356-4

Friedmann PD, Hoskinson R, Gordon M, et al.: Medication-assisted treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): Availability, barriers, and intentions. Subst Abus. 2012; 33(1): 9-18. DOI: 10.1080/08897077.2011.611460. DOI: https://doi.org/10.1080/08897077.2011.611460

Kelsey CM, Medel N, Mullins C, et al.: An examination of care practices of pregnant women incarcerated in jail facilities in the United States. Matern Child Health J. 2017; 21(6): 1260-1266. DOI: 10.1007/s10995-016-2224-5. DOI: https://doi.org/10.1007/s10995-016-2224-5

King Z, Kramer C, Latkin C, et al.: Access to treatment for pregnant incarcerated people with opioid use disorder: Perspectives from community opioid treatment providers. J Subst Abuse Treat. 2021; 126: 108338. DOI: 10.1016/j.jsat.2021.108338. DOI: https://doi.org/10.1016/j.jsat.2021.108338

Knittel AK, Zarnick S, Thorp JM, Jr, et al.: Medications for opioid use disorder in pregnancy in a state women's prison facility. Drug Alcohol Depend. 2020; 214: 108159. DOI: 10.1016/j.drugalcdep.2020.108159. DOI: https://doi.org/10.1016/j.drugalcdep.2020.108159

Knittel AK, Swartzwelder RA, Zarnick S, et al.: Medications for opioid use disorder during pregnancy: Access and continuity in a state women's prison facility, 2016-2019. Drug Alcohol Depend. 2022; 232: 109308. DOI: 10.1016/j.drugalcdep.2022.109308. DOI: https://doi.org/10.1016/j.drugalcdep.2022.109308

Nunn A, Zaller N, Dickman S, et al.: Methadone and buprenorphine prescribing and referral practices in US prison systems: Results from a nationwide survey [published correction appears in Drug Alcohol Depend. 2011; 113(2-3): 252. Drug Alcohol Depend. 2009; 105(1-2): 83-88. DOI: 10.1016/j.drugalcdep.2009.06.015. DOI: https://doi.org/10.1016/j.drugalcdep.2010.07.002

Rich JD, Boutwell AE, Shield DC, et al.: Attitudes and practices regarding the use of methadone in US state and federal prisons. J Urban Health. 2005; 82(3): 411-419. DOI: 10.1093/jurban/jti072. DOI: https://doi.org/10.1093/jurban/jti072

Scott CK, Dennis ML, Grella CE, et al.: The impact of the opioid crisis on U.S. state prison systems. Health Justice. 2021; 9(1): 17. DOI: 10.1186/s40352-021-00143-9. DOI: https://doi.org/10.1186/s40352-021-00143-9

Sufrin CB, Knittel A: Health care and social justice implications of incarceration for pregnant people who use drugs. Int Rev Psychiatry. 2021; 33(6): 557-571. DOI: 10.1080/09540261.2021.1887097. DOI: https://doi.org/10.1080/09540261.2021.1887097

Sufrin C, Kramer CT, Terplan M, et al.: Availability of medications for the treatment of opioid use disorder among pregnant and postpartum individuals in US jails. JAMA Netw Open. 2022; 5(1): e2144369. DOI: 10.1001/jamanetworkopen.2021.44369. DOI: https://doi.org/10.1001/jamanetworkopen.2021.44369

Winkelman TNA, Ford BR, Shlafer RJ, et al.: Medications for opioid use disorder among pregnant women referred by criminal justice agencies before and after Medicaid expansion: A retrospective study of admissions to treatment centers in the United States. PLoS Med. 2020; 17(5): e1003119. DOI: 10.1371/journal.pmed.1003119. DOI: https://doi.org/10.1371/journal.pmed.1003119

Bell J, Towers CV, Hennessy MD, et al.: Detoxification from opiate drugs during pregnancy. Am J Obstet Gynecol. 2016; 215(3): 374.e1-374.e3746. DOI: 10.1016/j.ajog.2016.03.015. DOI: https://doi.org/10.1016/j.ajog.2016.03.015

Serino MD, Peterson MB, Rosen MT: Psychological functioning of women taking illicit drugs during pregnancy and the growth and development of their offspring in early childhood. J Dual Diagn. 2018; 14(3): 158-170. DOI: 10.1080/15504263.2018.1468946. DOI: https://doi.org/10.1080/15504263.2018.1468946

Patrick SW, Schiff DM: Committee on Substance Use and Prevention. A public health response to opioid use in pregnancy. Pediatrics. 2017; 139(3): e20164070. DOI: 10.1542/peds.2016-4070. DOI: https://doi.org/10.1542/peds.2016-4070

Ahlbach C, Sufrin C, Shlafer R: Care for incarcerated pregnant people with opioid use disorder: Equity and justice implications. Obstet Gynecol. 2020; 136(3): 576-581. DOI: 10.1097/AOG.0000000000004002. DOI: https://doi.org/10.1097/AOG.0000000000004002

O'Connor A, Bowling N: Initial management of incarcerated pregnant women with opioid use disorder. J Correct Health Care. 2020; 26(1): 17-26. DOI: 10.1177/1078345819897063. DOI: https://doi.org/10.1177/1078345819897063

Nair S, McGreevy JE, Hutchinson-Colas J, et al.: Pregnancy in incarcerated women: Need for national legislation to standardize care. J Perinat Med. 2021; 494(7): 830-836. DOI: 10.1515/jpm-2021-0145. DOI: https://doi.org/10.1515/jpm-2021-0145

Sutter MB, Gopman S, Leeman L: Patient-centered care to address barriers for pregnant women with opioid dependence. Obstet Gynecol Clin North Am. 2017; 44(1): 95-107. DOI: 10.1016/j.ogc.2016.11.004. DOI: https://doi.org/10.1016/j.ogc.2016.11.004

Dematteis M, Auriacombe M, D'Agnone O, et al.: Recommendations for buprenorphine and methadone therapy in opioid use disorder: A European consensus. Expert Opin Pharmacother. 2017; 18(18): 1987-1999. DOI: 10.1080/14656566.2017.1409722. DOI: https://doi.org/10.1080/14656566.2017.1409722

Peeler M, Fiscella K, Terplan M, et al.: Best practices for pregnant incarcerated women with opioid use disorder. J Correct Health Care. 2019; 25(1): 4-14. DOI: 10.1177/1078345818819855. DOI: https://doi.org/10.1177/1078345818819855

Williams JB: Do pregnant inmates have a constitutional right to opioid replacement therapy? Am J Obstet Gynecol. 2018; 219(5): 455.e1-455.e4. DOI: 10.1016/j.ajog.2018.07.004. DOI: https://doi.org/10.1016/j.ajog.2018.07.004



How to Cite

Sozen, S., D. Krag, and C. Milliren. “Opioid Dependence Among Pregnant and Post-Partum Incarcerated Individuals: A Review of the Literature”. Journal of Opioid Management, vol. 19, no. 7, Oct. 2023, pp. 123-3, doi:10.5055/jom.2023.0806.