Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 18, 3012, Bern, Switzerland.
Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.
Harm Reduct J. 2020 Oct 13;17(1):67. doi: 10.1186/s12954-020-00412-0.
In the context of the current US opioid crisis and the compelling fact that a quarter to a third of all those addicted to heroin pass through its prisons and jails each year, the care of incarcerated opioid-using individuals (OUI) needs to be improved.
Little has been published on the effectiveness or outcomes of heroin-assisted treatment (HAT), a treatment option for severely dependent OUI delivered in a prison setting. The aim of this study was therefore to evaluate such treatment since its implementation. The primary objective was to investigate whether heroin-assisted treatment was associated with severe detrimental health outcomes. The secondary objective was to compare the heroin-assisted treatment group with the general prison population in terms of occupational functioning.
Retrospective cohort study SETTING: An open prison with 120 places SUBJECTS: Data on 1885 male prisoners with a total of 2239 imprisonment periods between 2000 and 2015 was available. Ninety-seven inmates in heroin-assisted treatment were compared with 1788 inmates from the general prison population (reference group).
Mortality, medical complications (including overdoses), and work performance (days worked, sick days, and monthly wages earned).
Inmates receiving HAT were on average 1 year younger (33.8 vs. 34.9 years), had longer prison stays (7.3 vs. 3.0 months), were more often of Swiss nationality (68.0% vs. 28.9%), and had committed more drug- and property-related offenses (49.5% vs. 23.2% and 63.9% vs. 38.3%, respectively) compared to the reference group. No serious heroin-related medical complication occurred during the 15-year window of observation among inmates with heroin-assisted treatment. Their work performance was comparable to that of the reference group.
This study shows that heroin-assisted treatment can be a valuable treatment option for severely dependent OUI during imprisonment, can be delivered safely by prison health staff over extended periods of time, and allows OUI in treatment to achieve work performance rates comparable to that of the general prison population.
在美国阿片类药物危机的背景下，每年有四分之一到三分之一的海洛因成瘾者都会进入监狱和看守所，因此，需要改善对被监禁的阿片类药物使用者（OUI）的治疗。
在监狱环境中为严重依赖的 OUI 提供的治疗选择——海洛因辅助治疗（HAT）的效果或结果很少有报道。因此，本研究旨在评估自实施以来的这种治疗方法。主要目的是调查海洛因辅助治疗是否与严重的不良健康结果相关。次要目的是比较海洛因辅助治疗组与普通监狱人口在职业功能方面的情况。
回顾性队列研究
一个拥有 120 个床位的开放式监狱
2000 年至 2015 年期间，共有 1885 名男性囚犯，共进行了 2239 次监禁，其中 97 名囚犯接受了海洛因辅助治疗，与 1788 名普通监狱囚犯（对照组）进行了比较。
死亡率、医疗并发症（包括过量）和工作表现（工作天数、病假天数和每月工资收入）。
接受 HAT 的囚犯平均年龄小 1 岁（33.8 岁比 34.9 岁），监禁时间更长（7.3 个月比 3.0 个月），瑞士国籍的囚犯比例更高（68.0%比 28.9%），与对照组相比，他们的毒品和财产犯罪比例更高（分别为 49.5%比 23.2%和 63.9%比 38.3%）。在接受海洛因辅助治疗的囚犯 15 年的观察期间，没有发生严重的与海洛因相关的医疗并发症。他们的工作表现与对照组相当。
本研究表明，海洛因辅助治疗可以成为严重依赖的 OUI 在监禁期间的一种有价值的治疗选择，可以由监狱卫生工作人员安全地提供，并且可以在较长时间内进行，并且可以使接受治疗的 OUI 达到与普通监狱人口相当的工作表现率。
