出狱后治疗阿片类药物使用障碍的药物治疗连续性：一项基于社区的治疗提供者的定性研究。
Medication for opioid use disorder treatment continuity post-release from jail: A qualitative study with community-based treatment providers.
机构信息
Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States.
Department of Public Health and Community Medicine, Tufts University School of Medicine, 200 Harrison Avenue, Boston, MA, 02111, United States.
出版信息
Int J Drug Policy. 2022 Dec;110:103803. doi: 10.1016/j.drugpo.2022.103803. Epub 2022 Aug 11.
BACKGROUND
People released from jail are at elevated opioid overdose risk. Medications for opioid use disorder (MOUD) are effective in reducing overdoses. MOUD treatment was recently mandated in seven Massachusetts jails, but little is known about barriers and facilitators to treatment continuity post-release. We aimed to assess MOUD provider perspectives on treatment continuity among people released from jail.
METHODS
We conducted qualitative interviews with 36 medical, supervisory, and administrative staff at MOUD programs that serve jail-referred patients. We used the Exploration, Preparation, Implementation, and Sustainment (EPIS) implementation science framework to guide development of instruments, codes, and analyses. We employed deductive and inductive coding, and a grounded theory analytical approach to identify salient themes.
RESULTS
Inner context findings highlighted necessary adjustments among jail staff to approve MOUD treatment, especially with agonist medications that were previously considered contraband. Participants perceived that some staff within jails favored abstinence-based recovery, viewing agonists as a crutch. Bridging results highlighted the importance of inter-agency communication and coordination to ensure information transfer for seamless treatment continuity in the community post-release. Pre-release planning, release on pre-scheduled dates, medication provision to cover gaps between jail release and intake at community MOUD sites, and exchange of treatment information across agencies were viewed as paramount to success. Unexpected early releases and releases from court were viewed as barriers to treatment coordination. Outer context domains were largely tied to social determinants of health. Substantial barriers to treatment continuity included shelter, food security, employment, transportation, and insurance reactivation.
CONCLUSION
Through qualitative interviews with community-based MOUD staff, we identified salient barriers and facilitators to treatment continuity post-release from jails. Findings point to needed investments in care coordination, staffing, and funding to strengthen jail-to-community-based MOUD treatment, removing barriers to continuity, and decreasing opioid overdose deaths during this high-risk transition.
背景
从监狱获释的人存在阿片类药物过量的风险。治疗阿片类药物使用障碍（MOUD）的药物在减少过量方面非常有效。最近，马萨诸塞州的七个监狱强制要求进行 MOUD 治疗，但对于出狱后的治疗连续性的障碍和促进因素知之甚少。我们旨在评估 MOUD 提供者对从监狱获释人员治疗连续性的看法。
方法
我们对为监狱转介患者提供服务的 MOUD 项目的 36 名医疗、监督和行政人员进行了定性访谈。我们使用探索、准备、实施和维持（EPIS）实施科学框架来指导仪器、代码和分析的开发。我们采用演绎和归纳编码以及扎根理论分析方法来确定突出的主题。
结果
内部环境结果突出了监狱工作人员在批准 MOUD 治疗方面的必要调整，特别是对于先前被视为违禁品的阿片类激动剂药物。参与者认为，监狱内的一些工作人员赞成基于禁欲的康复，将激动剂视为拐杖。桥梁结果强调了机构间沟通和协调的重要性，以确保在社区出狱后无缝的治疗连续性。提前规划、按预定日期释放、提供药物以填补监狱释放和社区 MOUD 场所入院之间的空白，以及跨机构交换治疗信息被视为成功的关键。意外的提前释放和因法庭原因释放被视为治疗协调的障碍。外部环境领域主要与健康的社会决定因素有关。治疗连续性的重大障碍包括住房、食品安全、就业、交通和保险重新激活。
结论
通过对社区 MOUD 工作人员进行定性访谈，我们确定了出狱后治疗连续性的显著障碍和促进因素。研究结果表明，需要在护理协调、人员配备和资金方面进行投资，以加强从监狱到社区的 MOUD 治疗，消除连续性障碍，并在这一高风险的过渡期间减少阿片类药物过量死亡。
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