Buadze Anna, Baggio Stephanie, Schleifer Roman, Aeberhard Eveline, Wolff Hans, Schneeberger Andres, Liebrenz Michael
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Bern, Switzerland.
Front Psychiatry. 2020 May 14;11:395. doi: 10.3389/fpsyt.2020.00395. eCollection 2020.
Opioid agonist treatment (OAT) is an important pillar in the treatment of individuals using opioids and its continuation during imprisonment is recommended. Despite this knowledge access to and continuation of OAT is still limited in many countries. The forced discontinuation during pre-trial detention can cause severe withdrawal symptoms, which in turn may significantly impair the defendant's ability to exercise granted procedural participation rights. Furthermore, it can be argued that forced discontinuation of a desired treatment represents a form of a compulsory intervention.
The present study was developed against the backdrop of a recent ruling by the European Court of Human Rights (Wenner vs. Germany). It intended to examine how defense lawyers dealing with detained persons using opioids view and assess the accessibility of OAT in pre-trial detention as well as during imprisonment in different parts of Switzerland.
Using a qualitative approach, we interviewed 11 defense lawyers from three different cantons of Switzerland with multiple years of experience in providing legal representation to more than 220 defendants using heroin. The interviews were analyzed with QSR NVIVO 11 for Windows. A qualitative content analysis approach was used to evaluate findings.
Defenders who had been exposed to the opioid crisis during the course of their legal career had adopted a positive attitude towards OAT and associated it with a stabilizing influence on their clients, an improvement in criminal prognosis, and a reduction in recidivism. They were generally of the opinion that access to OAT had improved, however identified a considerable variance in different penitentiaries, which were mediated by attitudes of staff and authorities. Based on the assessments of the defense lawyers, it can be estimated that the initiation of OAT especially during pre-trial detention is challenging. The predominant aim of OAT in a variety of Swiss prisons still seems to focus on a discontinuation, mediated by a forced reduction of medication. Some of the interventions reported are not in line with the principle of equivalence and strongly contrast the recommendations of the Council of Europe.
阿片类激动剂治疗（OAT）是治疗阿片类药物使用者的重要支柱，建议在监禁期间继续进行该治疗。尽管有此认识，但在许多国家，获得OAT治疗并持续进行该治疗的机会仍然有限。审前拘留期间被迫停药会导致严重的戒断症状，这反过来可能会严重损害被告行使所赋予的程序参与权的能力。此外，可以认为被迫中断期望的治疗是一种强制干预形式。
本研究是在欧洲人权法院最近一项裁决（温纳诉德国）的背景下开展的。其旨在研究处理使用阿片类药物的被拘留者的辩护律师如何看待和评估瑞士不同地区审前拘留期间以及监禁期间OAT治疗的可及性。
我们采用定性研究方法，采访了来自瑞士三个不同州的11名辩护律师，他们在为220多名使用海洛因的被告提供法律代理方面拥有多年经验。使用适用于Windows的QSR NVIVO 11对访谈进行分析。采用定性内容分析方法评估研究结果。
在其法律职业生涯中经历过阿片类药物危机的辩护律师对OAT持积极态度，并将其与对客户的稳定影响、刑事预后的改善以及累犯率的降低联系起来。他们普遍认为获得OAT治疗的机会有所改善，但发现不同监狱存在相当大的差异，这些差异由工作人员和当局的态度所介导。根据辩护律师的评估，可以估计启动OAT治疗，尤其是在审前拘留期间具有挑战性。瑞士各类监狱中OAT治疗的主要目标似乎仍然侧重于通过强制减少药物来停药。报告的一些干预措施不符合等效原则，与欧洲委员会的建议形成强烈反差。
