Reiners Sven, Opitz-Welke Annette, Konrad Norbert, Voulgaris Alexander
Krankenhaus des Maßregelvollzuges Berlin, Forensic Psychiatric Hospital Berlin, Berlin, Germany.
Institute of Forensic Psychiatry, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
Front Psychiatry. 2022 Sep 7;13:961549. doi: 10.3389/fpsyt.2022.961549. eCollection 2022.
Prevalence of substance use disorders, especially opioid use disorders, is high in patients admitted into forensic psychiatric settings. Opioid agonist treatment is a safe, well-established, and effective treatment option for patients that suffer from opioid dependence. Surprisingly, data on the availability and practice of opioid agonist treatment (OAT) options in German Forensic Clinics for Dependency Diseases is rare. Furthermore, essential data on the prevalence of critical incidents such as violent behavior, relapse, or escape from the clinic are missing for this particular treatment setting.
We conducted an observational study on all forensic addiction treatment units in Germany (Sect. 64 of the German Criminal Code). A questionnaire on the availability and practice of OAT was sent to all Forensic Clinics for Dependency Diseases in Germany. Following items were assessed: availability and the total number of patients that received an OAT in 2018, available medication options, specific reasons for start and end of OAT, number of treatments terminated without success, number of successful treatments, and critical incidents such as violent behavior, relapse, escape and reoffending. We compared the forensic clinics that offered OAT with those that did not offer this treatment option. The data were analyzed descriptively. Mean and standard deviation was calculated for metric scaled variables. For categorical variables, absolute and relative frequencies were calculated. The two groups (OAT vs. Non-OAT institutions) were compared concerning the given variables by either using Fishers exact test (categorical variables), -test (normally distributed metric variables), or Wilcoxon-test (metric variables not normally distributed).
In total, 15 of 46 Forensic Clinics for Dependency Diseases participated in the study (33%). In total, 2,483 patients were treated in the participating clinics, 18% were relocated into prison due to treatment termination, and 15% were discharged successfully in 2018. 275 critical incidents were reported: violence against a patient (4%), violence against staff (1.6%), escape (4.7%) and reoffending in (0.5%). In seven clinics treating 1,153 patients, an OAT was available. OAT options in forensic clinics were buprenorphine/naloxone, buprenorphine, methadone, and levomethadone. Regarding critical incidents and successful discharge, no differences were detected in the clinics with or without an OAT. In the clinics that offered an OAT, we found a significantly higher rate of treatment termination without success ( < 0.007) in comparison to clinics without an OAT program. Ninety-nine patients received an OAT, and this treatment was ended due to illegal drug abuse (57%), refusal to give a urine drug sample (71%), and cases where the OAT was given away to other patients (85%).
In Forensic Clinics for Dependency Diseases in Germany, OAT is not available in every institution, and thus, access is limited. Critical incidents such as violent behavior against staff or patients and escape are not uncommon in these forensic treatment settings. Further studies are needed to enhance the understanding of OAT practice and the risks for patients and staff.
在被收治到法医精神病学机构的患者中，物质使用障碍，尤其是阿片类物质使用障碍的患病率很高。阿片类激动剂治疗对于患有阿片类物质依赖的患者来说是一种安全、成熟且有效的治疗选择。令人惊讶的是，关于德国成瘾性疾病法医诊所中阿片类激动剂治疗（OAT）选项的可及性和实践的数据很少。此外，对于这种特殊的治疗环境，诸如暴力行为、复发或逃离诊所等关键事件的患病率的重要数据也缺失。
我们对德国所有法医成瘾治疗单位（《德国刑法典》第64条）进行了一项观察性研究。一份关于OAT可及性和实践的问卷被发送给德国所有成瘾性疾病法医诊所。评估了以下项目：2018年OAT的可及性和接受OAT治疗的患者总数、可用的药物选项、开始和结束OAT的具体原因、治疗未成功终止的次数、成功治疗的次数以及诸如暴力行为、复发、逃离和再次犯罪等关键事件。我们将提供OAT的法医诊所与未提供该治疗选项的诊所进行了比较。对数据进行了描述性分析。计算了计量尺度变量的均值和标准差。对于分类变量，计算了绝对频率和相对频率。通过使用Fisher精确检验（分类变量）、t检验（正态分布的计量变量）或Wilcoxon检验（非正态分布的计量变量），对两组（提供OAT的诊所与未提供OAT的机构）的给定变量进行了比较。
在46家成瘾性疾病法医诊所中，共有15家（33%）参与了研究。参与研究的诊所共治疗了2483名患者，2018年有18%的患者因治疗终止而被转至监狱，15%的患者成功出院。共报告了275起关键事件：针对患者的暴力行为（4%）、针对工作人员的暴力行为（1.6%）、逃离（4.7%）以及再次犯罪（0.5%）。在7家诊所中，有1153名患者可以接受OAT。法医诊所的OAT选项有丁丙诺啡/纳洛酮、丁丙诺啡、美沙酮和左美沙酮。在是否提供OAT的诊所中，未检测到关键事件和成功出院方面的差异。在提供OAT的诊所中，与没有OAT项目的诊所相比，我们发现治疗未成功终止的比率显著更高（P<0.007）。99名患者接受了OAT治疗，该治疗因非法药物滥用（57%）、拒绝提供尿样毒品检测（71%）以及OAT被转赠给其他患者的情况（85%）而结束。
在德国成瘾性疾病法医诊所中，并非每个机构都能提供OAT，因此可及性有限。在这些法医治疗环境中，诸如针对工作人员或患者的暴力行为以及逃离等关键事件并不罕见。需要进一步研究以增进对OAT实践以及患者和工作人员风险的理解。
