Curtis Bone, M.D., M.H.S., is an addiction medicine research fellow at the Yale University School of Medicine and West Haven VA. Lindsay Eysenbach, B.A., is currently a medical student at the Yale University School of Medicine and co-founder of the Yale Addiction Medicine Collaborative. Kristen Bell, J.D., Ph.D., is currently a Lecturer in Law, Associate Research Scholar in Law, and Senior Liman Fellow in Residence at Yale Law School. Declan T. Barry, Ph.D., is a psychologist and an associate professor of psychiatry at the Yale University School of Medicine. He is also the director of research at the APT foundation, a non-profit substance abuse treatment facility in Connecticut.
J Law Med Ethics. 2018 Jun;46(2):268-271. doi: 10.1177/1073110518782933.
The opioid epidemic has claimed the lives of more than 183,000 individuals since 1999 and is now the leading cause of accidental death in the United States. Meanwhile, rates of incarceration have quadrupled in recent decades, and drug use is the leading cause of incarceration. Medication-assisted treatment or MAT (i.e. methadone, buprenorphine) is the gold standard for treatment of opioid use disorder. Incarcerated individuals with opioid use disorder treated with methadone or buprenorphine have a lower risk of overdose, lower rates of hepatitis C transmission, and lower rates of re-incarceration. Despite evidence of improved outcomes, many jails and prisons do not offer MAT to individuals with opioid use disorder. This seems partly due to a scientifically unjustified preference for an abstinence-only treatment approach. The absence of MAT in prisons and jails results in poor outcomes for individuals and poses a public health threat to communities. Furthermore, it disproportionately harms poor communities and communities of color. Health care providers in prisons and jails have an ethical obligation to offer MAT to individuals with opioid use disorder to mitigate risk of infectious diseases, opioid overdose and health disparities associated with incarceration.
自 1999 年以来，阿片类药物泛滥已导致超过 18.3 万人死亡，目前已成为美国导致意外死亡的主要原因。与此同时，近年来监禁率增长了三倍，而药物滥用是监禁的主要原因。药物辅助治疗或 MAT（即美沙酮、丁丙诺啡）是治疗阿片类药物使用障碍的金标准。接受美沙酮或丁丙诺啡治疗的患有阿片类药物使用障碍的监禁者，其过量用药的风险较低，丙型肝炎传播率较低，再次入狱率也较低。尽管有改善结果的证据，但许多监狱和看守所不为患有阿片类药物使用障碍的个人提供 MAT。这似乎部分归因于对完全戒断治疗方法的一种缺乏科学依据的偏好。监狱和看守所缺乏 MAT 会导致个人的不良后果，并对社区构成公共卫生威胁。此外，它不成比例地伤害贫困社区和有色人种社区。监狱和看守所的医疗保健提供者有提供 MAT 的道德义务，以减轻与监禁相关的传染病、阿片类药物过量和健康差异的风险。
