Alam Farrukh, Wright Nat, Roberts Paul, Dhadley Sunny, Townley Joanne, Webster Russell
Central and North West London NHS Foundation Trust, London, UK.
Transform Research Alliance, Leeds, UK.
Int J Prison Health. 2019 Dec 5;15(4):293-307. doi: 10.1108/IJPH-12-2017-0061.
The purpose of this paper is to examine the current provision of opioid substitution therapy (OST) during and immediately following release from detention in prisons in England and Wales.
DESIGN/METHODOLOGY/APPROACH: A group of experts was convened to comment on current practices and to make recommendations for improving OST management in prison. Current practices were previously assessed using an online survey and a focus group with experience of OST in prison (Webster, 2017).
Disruption to the management of addiction and reduced treatment choice for OST adversely influences adequate provision of OST in prison. A key concern was the routine diversion of opiate substitutes to other prisoners. The new controlled drug formulations were considered a positive development to ensure streamlined and efficient OST administration. The following patient populations were identified as having concerns beyond their opioid use, and therefore require additional considerations in prison: older people with comorbidities and complex treatment needs; women who have experienced trauma and have childcare issues; and those with existing mental health needs requiring effective understanding and treatment in prison.
ORIGINALITY/VALUE: Integration of clinical and psychosocial services would enable a joint care plan to be tailored for each individual with opioid dependence and include options for detoxification or maintenance treatment. This would better enable those struggling with opioid use to make informed choices concerning their care during incarceration and for the period immediately following their release. Improvements in coordination of OST would facilitate inclusion of strategies to further streamline this process for the benefit of prisoners and prison staff.
本文旨在研究英格兰和威尔士监狱在囚犯被拘留期间及刚获释后阿片类药物替代疗法（OST）的当前提供情况。
设计/方法/途径：召集了一组专家对当前做法发表意见，并就改善监狱中OST管理提出建议。此前通过在线调查和与有监狱OST经验的焦点小组对当前做法进行了评估（韦伯斯特，2017年）。
成瘾管理的中断和OST治疗选择的减少对监狱中OST的充分提供产生了不利影响。一个关键问题是阿片类药物替代品经常被转给其他囚犯。新的管制药物配方被认为是一项积极进展，可确保OST管理简化且高效。以下患者群体除了使用阿片类药物外还存在其他问题，因此在监狱中需要额外考虑：患有合并症且有复杂治疗需求的老年人；经历过创伤且有儿童保育问题的女性；以及那些有现有心理健康需求、需要在监狱中得到有效理解和治疗的人。
原创性/价值：临床和心理社会服务的整合将使为每个阿片类药物依赖者量身定制联合护理计划成为可能，并包括戒毒或维持治疗的选项。这将更好地使那些与阿片类药物使用作斗争的人在监禁期间及刚获释后的时期就其护理做出明智选择。OST协调方面的改进将有助于纳入相关策略，以进一步简化这一过程，造福囚犯和监狱工作人员。
