Ferguson Warren J, Johnston Joan, Clarke Jennifer G, Koutoujian Peter J, Maurer Kathleen, Gallagher Colleen, White Julie, Nickl Dyana, Taxman Faye S
Department of Family Medicine and Community Health, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA.
St. Vincent Hospital, Worcester, MA, 01608, USA.
Health Justice. 2019 Dec 12;7(1):19. doi: 10.1186/s40352-019-0100-2.
Opioid use disorder (OUD) is among the most prevalent medical condition experienced by incarcerated persons, yet medication assisted therapy (MAT) is uncommon. Four jail and prison systems partnered with researchers to document their adoption of MAT for incarcerated individuals with opioid use disorders (OUD) using their established treatment protocols. Employing the EPIS (Exploration, Planning, Implementation, and Sustainment) framework, programs report on systematic efforts to expand screening, treatment and provide linkage to community-based care upon release.
All four systems were engaged with implementation of MAT at the outset of the study. Thus, findings focus more on uptake and penetration as part of implementation and sustainment of medication treatment. The prevalence of OUD during any given month ranged from 28 to 65% of the population in the participating facilities. All programs developed consistent approaches to screen individuals at intake and provided care coordination with community treatment providers at the time of release. The proportion of individuals with OUD who received MAT ranged considerably from 9 to 61%. Despite efforts at all four sites to increase utilization of MAT, only one site achieved sustained growth in the proportion of individuals treated over the course of the project. Government leadership, dedicated funding and collaboration with community treatment providers were deemed essential to adoption of MAT during implementation phases. Facilitators for MAT included increases in staffing and staff training; group education on medication assisted therapies; use of data to drive change processes; coordination with other elements of the criminal justice system to expand care; and ongoing contact with individuals post-release to encourage continued treatment. Barriers included lack of funding and space and institutional design; challenges in changing the cultural perception of all approved treatments; excluding or discontinuing treatment based on patient factors, movement or transfer of individuals; and inability to sustain care coordination at the time of release.
Adoption of evidence-based medication assisted therapies for OUD in prisons and jails can be accomplished but requires persistent effort to identify and overcome challenges and dedicated funding to sustain programs.
阿片类药物使用障碍（OUD）是被监禁者中最普遍的医疗状况之一，但药物辅助治疗（MAT）并不常见。四个监狱系统与研究人员合作，记录他们使用既定治疗方案对患有阿片类药物使用障碍（OUD）的被监禁者采用MAT的情况。采用EPIS（探索、规划、实施和维持）框架，各项目报告了为扩大筛查、治疗并在释放后提供与社区护理的联系所做的系统努力。
在研究开始时，所有四个系统都参与了MAT的实施。因此，研究结果更多地关注作为药物治疗实施和维持一部分的接受率和渗透率。在任何给定月份，参与设施中OUD的患病率在人群的28%至65%之间。所有项目都制定了一致的方法，在 intake 时对个人进行筛查，并在释放时与社区治疗提供者进行护理协调。接受MAT的OUD患者比例差异很大，从9%到61%不等。尽管所有四个地点都努力提高MAT的利用率，但只有一个地点在项目过程中实现了接受治疗的人数比例持续增长。政府领导、专项资金以及与社区治疗提供者的合作被认为是在实施阶段采用MAT的关键。MAT的促进因素包括增加人员配备和员工培训；关于药物辅助治疗的团体教育；利用数据推动变革过程；与刑事司法系统的其他要素协调以扩大护理范围；以及在释放后与个人持续联系以鼓励继续治疗。障碍包括缺乏资金和空间以及机构设计；改变对所有批准治疗的文化认知方面的挑战；基于患者因素、个人的转移或调动而排除或停止治疗；以及在释放时无法维持护理协调。
在监狱中采用基于证据的阿片类药物使用障碍药物辅助治疗是可以实现的，但需要持续努力识别和克服挑战，并需要专项资金来维持项目。
