British Columbia Centre on Substance Use, Vancouver, Canada.
Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
Int J Prison Health. 2020 Aug 24;16(4):337-342. doi: 10.1108/IJPH-02-2020-0012.
The prevalence of substance use disorders among incarcerated individuals in Canada is substantially higher than in the general population. Many incarcerated individuals with opioid use disorder remain untreated due to inadequate access to opioid agonist therapy (OAT). A considerable proportion of overdose-related deaths in the province of Ontario are individuals who have recently been released from prison. The purpose of this paper is to highlight that discontinuation of OAT as a disciplinary measure remains an active concern within prisons in Canada and places individuals with opioid use disorder at increased risk of relapse and resultant overdose death.
DESIGN/METHODOLOGY/APPROACH: This case report describes an incarcerated client with opioid use disorder who was initially stable on OAT, but was forcibly tapered off OAT as a disciplinary measure and subsequently relapsed to illicit opioid use while in custody.
This case calls attention to concerns regarding treatment of opioid use disorder during incarceration, as forcible detoxification from OAT as a disciplinary measure is a highly dangerous practice. The authors discuss concerns regarding diversion and ways in which prison-based OAT programs can be improved to increase their safety and acceptability among correctional staff. Ongoing advocacy is required on the part of health-care workers and policymakers to ensure that individuals are able to appropriately access this life-saving therapy while incarcerated.
ORIGINALITY/VALUE: To the best of the authors' knowledge, this is the first case report to describe forcible tapering of OAT as a disciplinary measure during incarceration. Despite existing evidence emphasizing the significant risk of overdose associated with detoxification from opioids, this case highlights the need for further research into the causes and prevalence of this practice.
加拿大被监禁者中物质使用障碍的患病率明显高于一般人群。由于获得阿片类药物激动剂治疗（OAT）的机会不足，许多患有阿片类药物使用障碍的被监禁者仍未得到治疗。安大略省因过量用药而死亡的人数中，相当一部分是最近刚从监狱获释的人。本文旨在强调，将 OAT 停药作为一种纪律处分措施在加拿大监狱中仍然是一个活跃的关注点，这使患有阿片类药物使用障碍的人面临更高的复发和由此导致的过量死亡风险。
设计/方法/方法：本案例报告描述了一名患有阿片类药物使用障碍的被监禁者，他最初在 OAT 治疗下稳定，但因纪律处分而被迫逐渐减少 OAT，随后在监禁期间复发并重新使用非法阿片类药物。
该案例引起了对监禁期间治疗阿片类药物使用障碍的关注，因为作为纪律处分的 OAT 强制脱毒是一种非常危险的做法。作者讨论了对药物滥用的担忧以及如何改进基于监狱的 OAT 计划，以提高其在狱警中的安全性和可接受性。卫生保健工作者和政策制定者需要持续倡导，以确保在监禁期间，个人能够适当获得这种救命治疗。
原创性/价值：据作者所知，这是第一个描述在监禁期间因纪律处分而强制减少 OAT 的案例报告。尽管现有证据强调了从阿片类药物戒断相关的严重过量风险，但该案例强调了需要进一步研究这种做法的原因和普遍性。
