Public Health Institute, Liverpool John Moores University, Liverpool, United Kingdom.
Faculty of Medicine, University of Southampton, Southampton, United Kingdom.
Int J Drug Policy. 2023 Feb;112:103957. doi: 10.1016/j.drugpo.2023.103957. Epub 2023 Jan 22.
Criminalisation of drug use and compulsory detention has largely characterised the Southeast Asia region's response to people who use drugs. Whilst access to and provision of healthcare for people living in prison are mandated by international human rights standards, many opioid dependent people living in prison continue to lack access to opioid substitution treatment (OST) during incarceration, and face uncertainties of continuity of care beyond the prison gate.
A scoping review using Arksey and O'Malley's framework mapped what is currently known about the continuity of OST post-release in Southeast Asia, with a focus on the three countries (Indonesia, Malaysia, Vietnam) that provide OST in at least one prison. A multi-lingual systematic search (English, Malay, Indonesian, Vietnamese) on Medline, CINAHL, Scopus, Web of Science, PsycINFO and the Cochrane Library collected and reviewed extant relevant published empirical and grey literature including government reports between 2011 and 2021. Of the 365 records found, 18 were eligible for inclusion following removal of duplicates and application of exclusion criteria. These records were charted and thematically analysed.
Three main themes were generated: Facilitators of post release continuity of care, Barriers to post release continuity of care and Therapeutic considerations supporting post release continuity of care. When individual and structural gaps exist, disruptions to continuity of OST care post release are observed. Adequate methadone dosage of >80mg/day appears significantly associated with retention in post-release OST.
The review highlights the facilitators, barriers and therapeutic considerations of continuity of care of OST between prison and community for people living in prisons from Indonesia, Malaysia and Vietnam. Improving community services with family support are key to supporting continued OST adherence post release along with reducing societal stigma towards people who use drugs and those entering or leaving prison. Further efforts are warranted to ensure parity, quality and continuity of OST care post release.
在东南亚地区，对吸毒者的处理主要是将其定罪和强制拘留。虽然国际人权标准规定了囚犯获得医疗保健和提供医疗保健的义务，但许多在押的阿片类药物依赖者在监禁期间仍然无法获得阿片类药物替代治疗（OST），并且在出狱后面临着护理连续性的不确定性。
采用 Arksey 和 O'Malley 的框架进行范围审查，以了解东南亚地区 OST 释放后连续性的现状，重点关注在至少一个监狱提供 OST 的三个国家（印度尼西亚、马来西亚、越南）。使用多语言系统搜索（英语、马来语、印度尼西亚语、越南语）在 Medline、CINAHL、Scopus、Web of Science、PsycINFO 和 Cochrane Library 上收集并审查了现有的相关实证和灰色文献，包括 2011 年至 2021 年期间的政府报告。在 365 条记录中，删除重复项并应用排除标准后，有 18 条符合纳入标准。这些记录被图表化并进行了主题分析。
产生了三个主要主题：促进释放后护理连续性的因素、阻碍释放后护理连续性的因素和支持释放后护理连续性的治疗考虑因素。当个人和结构差距存在时，释放后 OST 护理的连续性会受到干扰。每天 >80mg 的足够美沙酮剂量与释放后 OST 的保留明显相关。
该审查强调了印度尼西亚、马来西亚和越南监狱中囚犯的 OST 从监狱到社区的连续性护理的促进因素、障碍和治疗考虑因素。改善具有家庭支持的社区服务是支持释放后继续坚持 OST 的关键，同时减少社会对吸毒者和进出监狱者的污名化。需要进一步努力，以确保释放后 OST 护理的平等、质量和连续性。
