Nunn Amy, Zaller Nickolas, Dickman Samuel, Trimbur Catherine, Nijhawan Ank, Rich Josiah D
Alpert Medical School of Brown University, Division of Infectious Diseases, 164 Summit Avenue, Providence, RI 02906, USA.
Drug Alcohol Depend. 2009 Nov 1;105(1-2):83-8. doi: 10.1016/j.drugalcdep.2009.06.015. Epub 2009 Jul 21.
More than 50% of incarcerated individuals have a history of substance use, and over 200,000 individuals with heroin addiction pass through American correctional facilities annually. Opiate replacement therapy (ORT) with methadone or buprenorphine is an effective treatment for opiate dependence and can reduce drug-related disease and recidivism for inmates. Provision of ORT is nevertheless a frequently neglected intervention in the correctional setting.
We surveyed the 50 state; Washington, District of Columbia (DC); and Federal Department of Corrections' medical directors or their equivalents about their facilities' ORT prescribing policies and referral programs for inmates leaving prison.
We received responses from 51 of 52 prison systems nationwide. Twenty-eight prison systems (55%) offer methadone to inmates in some situations. Methadone use varies widely across states: over 50% of correctional facilities that offer methadone do so exclusively for pregnant women or for chronic pain management. Seven states' prison systems (14%) offer buprenorphine to some inmates. The most common reason cited for not offering ORT was that facilities "prefer drug-free detoxification over providing methadone or buprenorphine." Twenty-three states' prison systems (45%) provide referrals for some inmates to methadone maintenance programs after release, which increased from 8% in 2003; 15 states' prison systems (29%) provide some referrals to community buprenorphine providers.
Despite demonstrated social, medical, and economic benefits of providing ORT to inmates during incarceration and linkage to ORT upon release, many prison systems nationwide still do not offer pharmacological treatment for opiate addiction or referrals for ORT upon release.
超过50%的被监禁者有药物使用史，每年有超过20万海洛因成瘾者进入美国惩教机构。美沙酮或丁丙诺啡的阿片类药物替代疗法（ORT）是治疗阿片类药物依赖的有效方法，可减少囚犯与毒品相关的疾病和再犯罪率。然而，在惩教环境中，ORT的提供仍是一种经常被忽视的干预措施。
我们调查了50个州、华盛顿特区和联邦惩教部的医疗主任或其同等人员，了解他们所在机构针对出狱囚犯的ORT处方政策和转诊计划。
我们收到了全国52个监狱系统中51个的回复。28个监狱系统（55%）在某些情况下为囚犯提供美沙酮。美沙酮的使用在各州差异很大：超过50%提供美沙酮的惩教机构仅将其用于孕妇或慢性疼痛管理。7个州的监狱系统（14%）为一些囚犯提供丁丙诺啡。不提供ORT最常见的原因是机构“更喜欢无毒品戒毒而非提供美沙酮或丁丙诺啡”。23个州的监狱系统（45%）为一些囚犯提供出狱后转介到美沙酮维持治疗项目的服务，这一比例从2003年的8%有所增加；15个州的监狱系统（29%）为社区丁丙诺啡提供者提供一些转介服务。
尽管在监禁期间为囚犯提供ORT以及在出狱后与ORT建立联系已显示出社会、医疗和经济效益，但全国许多监狱系统仍未提供阿片类药物成瘾的药物治疗或出狱后ORT的转介服务。
