评估在美国监狱中广泛采用阿片类药物使用障碍筛查和药物治疗的影响。
Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails.
作者信息
Macmadu Alexandria, Goedel William C, Adams Joëlla W, Brinkley-Rubinstein Lauren, Green Traci C, Clarke Jennifer G, Martin Rosemarie A, Rich Josiah D, Marshall Brandon D L
机构信息
Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA; The Center for Prisoner Health and Human Rights, The Miriam Hospital, 8 Third Street, Providence, RI, USA.
Department of Epidemiology, Brown University School of Public Health, 121 South Main Street, Providence, RI, USA.
出版信息
Drug Alcohol Depend. 2020 Mar 1;208:107858. doi: 10.1016/j.drugalcdep.2020.107858. Epub 2020 Jan 18.
BACKGROUND
Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality.
METHODS
We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016.
RESULTS
Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 - 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 - 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 - 1812) and 1609 (95% SI: 972 - 2037) lives saved per 10,000 persons incarcerated, respectively.
CONCLUSIONS
Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.
背景
用于治疗阿片类物质使用障碍（OUD）的药物是治疗OUD最有效的方法，但在美国监狱环境中，这些救命药物的使用极为有限，且缺乏指导政策决策的相关数据。本研究的目的是评估美国监狱中对OUD进行筛查和药物治疗对释放后阿片类物质相关死亡率的影响。
方法
我们使用了国家生命统计中心、司法统计局的数据以及相关文献，构建了一个反事实情景的蒙特卡洛模拟，即2016年美国监狱中广泛开展对OUD的筛查和药物治疗。
结果
我们的模型预测，如果所有临床指征明确的人在监禁期间都接受了OUD药物治疗，全国范围内将挽救1840例（95%模拟区间[SI]：-2757至4959）生命。该模型还预测，如果所有临床指征明确的人在监禁期间都接受了OUD药物治疗，并在释放后继续接受治疗，全国范围内将挽救约4400例（95% SI：2675至5557）生命。这些估计分别相当于每10000名被监禁者中挽救668例（95% SI：-1008至1812）和1609例（95% SI：972至2037）生命。
结论
全面筛查并提供OUD药物治疗的监狱项目有可能大幅降低高危人群中与阿片类物质相关的过量死亡；然而，释放后继续接受治疗是对人群水平影响的关键驱动因素。
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