Department of Health Management & Informatics, University of Central Florida, United States of America.
Department of Health Management & Informatics, University of Central Florida, United States of America.
J Subst Abuse Treat. 2019 Sep;104:72-82. doi: 10.1016/j.jsat.2019.06.011. Epub 2019 Jun 28.
Despite its efficacy, medication-assisted treatment (MAT) is rarely available in the criminal justice system in the United States, including in problem-solving courts or diversionary settings. Previous studies have demonstrated criminal justice administrators' hostility towards MAT, especially in prisons and jails. Yet, few studies have examined attitudes among court personnel or compared beliefs among different types of personnel. Also, few studies have explored the relationship between MAT education/training and attitudes. Finally, few studies have directly compared attitudes towards methadone, oral buprenorphine, and extended-release naltrexone in the criminal justice system.
We modified a survey by Matusow et al. (2013) to explore justice professionals' MAT attitudes, including associations with demographic variables, court role, and previous MAT education/training. After piloting the survey, we distributed it to a convenience sample of justice professionals registered for an educational summit held in Indiana in 2018. Data was analyzed using descriptive and inferential statistical methods.
231 Indiana court employees who had registered for a state MAT educational summit completed the survey prior to the summit, including judges, probation officers, law enforcement personnel, attorneys, probation officers, program directors, counselors, and case managers. Overall, participants had significantly more positive attitudes towards extended-release naltrexone than towards other medications (p value <0.01). Court employee average attitudes towards methadone were significantly more negative than average attitudes towards oral buprenorphine; and average attitudes towards oral buprenorphine were significantly more negative than average attitudes towards extended-release naltrexone (p value <0.01). Employment as a prosecutor or law enforcement officer was associated with more negative attitudes towards oral buprenorphine and methadone (p value <0.05). Exposure to previous MAT training was associated with more positive attitudes for all medications (p value <0.05). Compared to participants with graduate degrees, participants with less education had significantly more negative attitudes towards extended-release naltrexone (p < 0.05). Gender, age, rurality, and personal/family recovery history were not associated with differences in attitudes.
As expected, court employees' attitudes significantly differ by medication, with average attitudes towards agonist medications being more negative than attitudes towards extended-release naltrexone. Despite a larger evidence base for the efficacy of methadone and oral buprenorphine, justice personnel may have more positive attitudes towards extended-release naltrexone due to targeted marketing by the pharmaceutical manufacturer, fears about diversion or misuse of agonist medications, and historic criminal justice hostility towards agonist medications. Importantly, previous education/training regarding MAT is associated with more positive attitudes, suggesting that more awareness-raising or capacity building educational interventions are needed, especially for prosecutors and law enforcement personnel.
尽管药物辅助治疗（MAT）有效，但在美国的刑事司法系统中，包括在解决问题的法院或转移设置中，很少提供药物辅助治疗。先前的研究表明，刑事司法管理人员对 MAT 持敌对态度，尤其是在监狱和拘留所。然而，很少有研究调查法庭人员的态度，或比较不同类型人员的信仰。此外，很少有研究探讨 MAT 教育/培训与态度之间的关系。最后，很少有研究直接比较刑事司法系统中对美沙酮、丁丙诺啡和纳曲酮的态度。
我们修改了 Matusow 等人（2013 年）的一项调查，以探讨司法专业人员对 MAT 的态度，包括与人口统计学变量、法庭角色和以前的 MAT 教育/培训的关联。在对调查进行试点后，我们向参加 2018 年在印第安纳州举行的教育峰会的司法专业人员便利样本分发了该调查。使用描述性和推论性统计方法分析数据。
231 名已注册参加印第安纳州 MAT 教育峰会的州法院雇员在峰会前完成了调查，包括法官、缓刑官、执法人员、律师、缓刑监督官、项目主任、顾问和案件经理。总体而言，参与者对纳曲酮的态度明显比其他药物更积极（p 值<0.01）。法庭雇员对美沙酮的平均态度明显比丁丙诺啡更消极；丁丙诺啡的平均态度明显比纳曲酮更消极（p 值<0.01）。作为检察官或执法人员的雇佣与对丁丙诺啡和美沙酮的态度更消极有关（p 值<0.05）。接触以前的 MAT 培训与所有药物的态度更积极有关（p 值<0.05）。与具有研究生学历的参与者相比，受教育程度较低的参与者对纳曲酮的态度明显更消极（p<0.05）。性别、年龄、农村性和个人/家庭康复史与态度差异无关。
正如预期的那样，法庭人员的态度因药物而异，阿片类激动剂药物的平均态度比纳曲酮更消极。尽管美沙酮和丁丙诺啡的疗效有更大的证据基础，但由于制药公司的针对性营销、对阿片类激动剂药物滥用或滥用的担忧，以及刑事司法系统对阿片类激动剂药物的历史敌对态度，司法人员可能对纳曲酮有更积极的态度。重要的是，以前关于 MAT 的教育/培训与更积极的态度有关，这表明需要进行更多的提高认识或能力建设教育干预，特别是针对检察官和执法人员。
