von Bernuth Kira, Seidel Peter, Krebs Julia, Lehmann Marc, Neumann Britta, Konrad Norbert, Opitz-Welke Annette
Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Department of Psychiatry and Psychotherapy, Prison Hospital Berlin, Berlin, Germany.
Front Psychiatry. 2020 Aug 12;11:794. doi: 10.3389/fpsyt.2020.00794. eCollection 2020.
Among people living in detention, substance use is highly prevalent, including opioid dependence. Opioid agonist treatment (OAT) has been established as an evidence-based, first-line treatment for opioid dependence. Despite high prevalence of opioid dependence, conclusive data regarding its prevalence and the OAT practice in German prisons is scarce; rather, the existing data widely diverges concerning the rates of people in detention receiving OAT.
We conducted a cross-sectional survey of all detention facilities in Berlin. On the date of data collection, a full census of the routine records was completed based on the medical documentation system. For each opioid dependent individual, we extracted sociodemographic data (i.e., age, sex, and non-/German nationality, whether people experienced language-related communication barriers), information about OAT, comorbidities (HIV, hepatitis C, schizophrenia), and the detention center, as well as the anticipated imprisonment duration and sentence type. The data was first analyzed descriptively and secondly in an evaluative-analytical manner by analyzing factors that influence the access to OAT of people living in detention.
Among the 4,038 people in detention in the Berlin custodial setting under investigation, we identified a 16% prevalence of opioid dependence. Of the opioid-dependent individuals, 42% received OAT; 31% were treated with methadone, 55% were treated with levomethadone, and 14% were treated with buprenorphine. Access to OAT seemed mainly dependent upon initial receipt of OAT at the time of imprisonment, detention duration, the prisons in which individuals were detained, German nationality, and sex. The overall prevalence of HIV was 4-8%, hepatitis C was 31-42%, and schizophrenia was 5%.
The prevalence of opioid dependence and access to OAT remains a major health issue in the custodial setting. OAT implementation must be especially intensified among male, non-German, opioid-dependent individuals with a short detention period. Treatment itself must be diversified regarding the substances used for OAT, and institutional treatment differences suggest the need for a consistent treatment approach and the standardized implementation of treatment guidelines within local prison's standard operating procedures. Testing for infectious diseases should be intensified among opioid-dependent people living in detention to address scarcely known infection statuses and high infection rates.
在被拘留人群中，药物使用现象极为普遍，其中包括阿片类药物依赖。阿片类激动剂治疗（OAT）已被确立为治疗阿片类药物依赖的循证一线治疗方法。尽管阿片类药物依赖现象普遍，但关于德国监狱中其患病率及阿片类激动剂治疗实践的确切数据却很匮乏；相反，现有数据在接受阿片类激动剂治疗的被拘留者比例方面差异很大。
我们对柏林所有拘留设施进行了横断面调查。在数据收集当日，基于医疗文档系统完成了常规记录的全面普查。对于每一位阿片类药物依赖个体，我们提取了社会人口学数据（即年龄、性别、非德国国籍/德国国籍、是否存在语言交流障碍）、关于阿片类激动剂治疗的信息、合并症（艾滋病毒、丙型肝炎、精神分裂症）以及拘留中心信息，还有预期监禁时长和刑期类型。数据首先进行描述性分析，其次通过分析影响被拘留者获得阿片类激动剂治疗的因素进行评估分析。
在接受调查的柏林拘留场所的4038名被拘留者中，我们确定阿片类药物依赖患病率为16%。在阿片类药物依赖个体中，42%接受了阿片类激动剂治疗；31%接受美沙酮治疗，55%接受左美沙酮治疗，14%接受丁丙诺啡治疗。获得阿片类激动剂治疗似乎主要取决于入狱时首次接受阿片类激动剂治疗的情况、拘留时长、被拘留个体所在的监狱、德国国籍以及性别。艾滋病毒总体患病率为4 - 8%，丙型肝炎为31 - 42%，精神分裂症为5%。
在拘留场所，阿片类药物依赖的患病率及获得阿片类激动剂治疗的情况仍是一个主要的健康问题。对于男性、非德国籍、拘留期短的阿片类药物依赖个体，必须特别加强阿片类激动剂治疗的实施。在用于阿片类激动剂治疗的药物方面，治疗本身必须多样化，而且机构间的治疗差异表明需要一种一致的治疗方法，并在当地监狱的标准操作程序中标准化治疗指南的实施。对于被拘留的阿片类药物依赖者，应加强传染病检测，以了解鲜为人知的感染状况和高感染率。
