From the Center for Health + Justice Transformation, The Miriam Hospital, Providence, RI (EK, AM, HM, JDR, LB-R); Center of Biomedical Research Excellence on Opioids and Overdose, The Rhode Island Hospital, Providence, RI (EK, JDR); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (AT); Rhode Island Department of Corrections, Cranston, RI (AM, JB); Brown University School of Medicine, Providence, RI (JB, JDR); Wesleyan University, Middletown, CT (HM); Smith College, Northampton, MA (CB); Department of Epidemiology, Brown University School of Public Health, Providence, RI (JDR); and Department of Social Medicine, University of North Carolina at Chapel Hill, NC (LB-R).
J Addict Med. 2023;17(1):54-59. doi: 10.1097/ADM.0000000000001029. Epub 2022 Aug 2.
Although the burden of opioid use disorder is disproportionately high among persons who are incarcerated, medications for opioid use disorder are often unavailable in correctional settings. The Rhode Island Department of Corrections provides all 3 classes of medications for opioid use disorder to clinically eligible persons who are incarcerated. Despite a decrease in fatal overdoses among persons with recent criminal legal system involvement since the program's implementation, barriers to continued engagement in treatment after release from incarceration still exist.
We conducted 40 semistructured, qualitative interviews with people who were incarcerated and enrolled in the comprehensive medications for opioid use disorder program at the Rhode Island Department of Corrections. Analysis applied a general, inductive approach using NVivo 12.
Participants discussed barriers to treatment engagement before incarceration, as well as anticipated barriers to medications to treat opioid use disorder continuation after release from incarceration. Structural factors including housing, health insurance, transportation, and the treatment program structure, as well as social factors such as social support networks were perceived to influence retention in medications to treat opioid use disorder post-release.
Our findings suggest that people with opioid use disorder who are incarcerated encounter unique challenges upon community reentry. Addressing structural factors that pose barriers to post-release engagement is essential to sustaining retention. We recommend utilization of peer recovery specialists to alleviate some of the stress of navigating the structural barriers identified by participants.
尽管在被监禁的人中，阿片类药物使用障碍的负担不成比例地高，但在矫正环境中，阿片类药物使用障碍的药物通常无法获得。罗得岛惩教署向符合临床条件的被监禁人员提供所有 3 类阿片类药物使用障碍药物。尽管自该计划实施以来，有近期刑事法律系统涉入的人中的致命过量用药有所减少，但在从监禁中获释后继续参与治疗的障碍仍然存在。
我们对罗得岛惩教署综合阿片类药物使用障碍治疗方案中被监禁和入组的 40 人进行了半结构化、定性访谈。分析采用了 NVivo 12 的通用归纳方法。
参与者讨论了入狱前治疗参与的障碍，以及对出狱后治疗阿片类药物使用障碍继续使用药物的预期障碍。结构因素包括住房、医疗保险、交通和治疗计划结构，以及社会支持网络等社会因素，被认为会影响出狱后治疗阿片类药物使用障碍的保留率。
我们的研究结果表明，患有阿片类药物使用障碍并被监禁的人在重新融入社区时会遇到独特的挑战。解决阻碍出狱后参与的结构性因素至关重要，以维持保留率。我们建议利用同伴康复专家来减轻参与者所确定的结构性障碍带来的一些压力。
