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This lecture will introduce the topic of perinatal incarceration, including the epidemiology of perinatal incarceration in the US and the direct and indirect harms of incarceration during pregnancies affected by perinatal substance use disorder. It will also outline the availability of MOUD and other SUD treatment during pregnancies affected by incarceration and highlight the work of the presenter in the North Carolina state prison system on access of MOUD. The lecture will conclude with reflections on better ways forward to manage perinatal SUD, including alternatives to incarceration. Rural communities have been highly impacted by the current opioid crisis and growing polysubstance use, yet often lack optimal infrastructure to support needed services for individuals with substance use disorder (SUD), and especially for people who inject drugs (PWID). This course offers a focused educational session on the growth of low threshold harm reduction/syringe service programs in Kentucky's Appalachian region, and presents collaborative research findings from the University of Kentucky College of Medicine and the Knox County KY Health Department.

At the end of the seminar learners will be able to:

• Describe the current state of perinatal incarceration and the overlap with perinatal SUD in the US.
• Explain the ways that perinatal incarceration affects SUD management.
• Analyze the gaps in availability of MOUD and SUD treatment that occur as a result of perinatal incarceration.
• Identify multiple levels of interventions that might improve MOUD and SUD treatment access for pregnant and postpartum people who are involved in the criminal legal system.

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Andrea K. Knittel, MD PhD is Assistant Professor and Medical Director for Incarcerated Women's Health at the University of North Carolina at Chapel Hill School of Medicine. She completed her MD and PhD degrees at the University of Michigan, Ann Arbor, and her OB/GYN residency at the University of California, San Francisco. Dr. Knittel is a clinician and researcher focused on illuminating and mitigating the reproductive health disparities facing people who experience incarceration across the life course. In her clinical work, she provides full spectrum OB/GYN care to women, trans men, and gender expansive people incarcerated in the NC state women's prison system. Her current research work addresses the obstetric and gynecologic impact of incarceration, including on pregnancies affected by opioid use disorder, HIV and STI prevention, and experiences of menopause.

Funding for this initiative was made possible (in part) by grant no. 1H79TI085588 from SAMHSA. The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations imply endorsement by the U.S. Government.

Financial Disclosure & Disclaimer: This program receives no commercial financial support.

The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by the AOA. In no event will the AOA be liable for any decision made or action taken in reliance upon the information provided through this CME.