监禁是否会影响患者治疗阿片类药物使用障碍的目标？对监狱中丁丙诺啡治疗的定性研究。
Does incarceration influence patients' goals for opioid use disorder treatment? A qualitative study of buprenorphine treatment in jail.
机构信息
Department of Medicine, Montefiore Medical Center-Albert Einstein College of Medicine, United States; Correctional Health Services, NYC Health + Hospitals, United States.
Department of Pediatrics, Montefiore Medical Center-Albert Einstein College of Medicine, United States.
出版信息
Drug Alcohol Depend. 2021 May 1;222:108529. doi: 10.1016/j.drugalcdep.2021.108529. Epub 2021 Mar 18.
BACKGROUND
Correctional facilities increasingly offer medications for opioid use disorder (OUD), including buprenorphine. Nevertheless, retention in treatment post-incarceration is suboptimal and overdose mortality remains high. Our objectives were to understand how incarcerated patients viewed buprenorphine treatment and identify modifiable factors that influenced treatment continuation post-release.
METHODS
We conducted semi-structured interviews with 22 men receiving buprenorphine treatment in an urban jail. Interviews were audio recorded, professionally transcribed, and analyzed using a grounded-theory approach. Team members constructed preliminary case memos from transcripts, and then interactively discussed themes within respective memos. We established participant 'typologies' by consensus.
RESULTS
Distinct typologies emerged based on participants' post-release treatment goals: (1) those who viewed buprenorphine treatment as a cure for OUD; (2) those who thought buprenorphine would help manage opioid-related problems; and (3) those who did not desire OUD treatment. Participants also described common social structural barriers to treatment continuation and community re-integration. Participants reported that post-release housing instability, unemployment, and negative interactions with parole contributed to opioid use relapse and re-incarceration.
CONCLUSION
Participants had different goals for post-release buprenorphine treatment continuation, but their prior experiences suggested that social structural issues would complicate these plans. Incarceration can intensify marginalization, which when combined with heightened legal supervision, reinforced cycles of release, relapse, and re-incarceration. Participants valued buprenorphine treatment, but other structural and policy changes will be necessary to reduce incarceration-related inequities in opioid overdose mortality.
背景
惩教机构越来越多地提供阿片类药物使用障碍（OUD）药物治疗，包括丁丙诺啡。然而，监禁后的治疗保留率并不理想，过量死亡率仍然很高。我们的目的是了解监禁中的患者如何看待丁丙诺啡治疗，并确定影响释放后治疗延续的可改变因素。
方法
我们对 22 名在城市监狱接受丁丙诺啡治疗的男性进行了半结构化访谈。访谈进行了录音，专业转录，并使用扎根理论方法进行了分析。小组成员从记录中构建了初步的案例备忘录，然后在各自的备忘录中互动讨论主题。我们通过共识建立了参与者的“典型类型”。
结果
根据参与者释放后的治疗目标，出现了不同的典型类型：（1）那些认为丁丙诺啡治疗是 OUD 的治愈方法的人；（2）那些认为丁丙诺啡将有助于管理与阿片类药物相关问题的人；（3）那些不希望接受 OUD 治疗的人。参与者还描述了治疗延续和社区重新融入的常见社会结构障碍。参与者报告说，释放后的住房不稳定、失业和与假释官的负面互动导致阿片类药物使用复发和重新监禁。
结论
参与者对释放后丁丙诺啡治疗延续有不同的目标，但他们的先前经历表明，社会结构问题将使这些计划复杂化。监禁会加剧边缘化，再加上更高的法律监督，强化了释放、复发和重新监禁的循环。参与者重视丁丙诺啡治疗，但需要进行其他结构和政策变革，以减少与监禁相关的阿片类药物过量死亡率的不平等。
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