Westra Michel, de Haan Hein A, Arends Marleen T, van Everdingen Jannes J E, Klazinga Niek S
Dienst Justitiële Inrichtingen, afd. Gezondheidszorg, Den Haag, The Netherlands.
Ned Tijdschr Geneeskd. 2009;153:A726.
In the Netherlands, the policy on care for prisoners who are addicted to opiates is still heterogeneous. The recent guidelines entitled 'Medicinal care for drug addicts in penal institutions' should contribute towards unambiguous and more evidence-based treatment for this group. In addition, it should improve and bring the care pathways within judicial institutions and mainstream healthcare more into line with one another. Each rational course of medicinal treatment will initially be continued in the penal institution. In penal institutions the help on offer is mainly focused on abstinence from illegal drugs while at the same time limiting the damage caused to the health of the individual user. Methadone is regarded at the first choice for maintenance therapy. For patient safety, this is best given in liquid form in sealed cups of 5 mg/ml once daily in the morning. Recently a combination preparation containing buprenorphine and naloxone - a complete opiate antagonist - has become available. On discontinuation of opiate maintenance treatment intensive follow-up care is necessary. During this period there is considerable risk of a potentially lethal overdose. Detoxification should be coupled with psychosocial or medicinal intervention aimed at preventing relapse. Naltrexone is currently the only available opiate antagonist for preventing relapse. In those addicted to opiates, who also take benzodiazepines without any indication, it is strongly recommended that these be reduced and discontinued. This can be achieved by converting the regular dosage into the equivalent in diazepam and then reducing this dosage by a maximum of 25% a week.
在荷兰，针对阿片类药物成瘾囚犯的护理政策仍然参差不齐。最近出台的题为《惩教机构中吸毒成瘾者的药物治疗》的指南应有助于为该群体提供明确且更具循证依据的治疗。此外，它应改进司法机构和主流医疗保健机构的护理途径，使其更加协调一致。每种合理的药物治疗疗程最初都将在惩教机构中持续进行。在惩教机构中，所提供的帮助主要集中在戒除非法药物，同时限制对个体使用者健康造成的损害。美沙酮被视为维持治疗的首选药物。为了患者安全，最好以5毫克/毫升的液体形式，每天早晨装在密封杯中服用一次。最近，一种含有丁丙诺啡和纳洛酮（一种完全的阿片类拮抗剂）的复方制剂已可供使用。在停止阿片类药物维持治疗后，强化随访护理是必要的。在此期间，存在潜在致命过量用药的重大风险。戒毒应与旨在预防复发的心理社会或药物干预相结合。纳曲酮是目前唯一可用于预防复发的阿片类拮抗剂。对于那些阿片类药物成瘾且无任何指征就服用苯二氮䓬类药物的人，强烈建议减少并停用这些药物。这可以通过将常规剂量换算成地西泮的等效剂量，然后每周最多减少25%的剂量来实现。
