Strange C Clare, Manchak Sarah M, Hyatt Jordan M, Petrich Damon M, Desai Alisha, Haberman Cory P
Department of Sociology and Criminology, Criminal Justice Research Center Pennsylvania State University University Park Pennsylvania USA.
University of Cincinnati School of Criminal Justice Cincinnati Ohio USA.
Campbell Syst Rev. 2022 Jan 7;18(1):e1215. doi: 10.1002/cl2.1215. eCollection 2022 Mar.
The overlap between justice system involvement and drug use is well-documented. Justice-involved people who misuse opioids are at high risk for relapse and criminal recidivism. Criminal justice policymakers consider opioid-specific medication-assisted therapies (MATs) one approach for improving outcomes for this population. More research is needed that explores the impacts of opioid-specific MATs for justice-involved people.
This study sought to assess the effects of opioid-specific MAT for reducing the frequency and likelihood of criminal justice and overdose outcomes for current or formerly justice-involved individuals.
Records were searched between May 7, 2021 and June 23, 2021. We searched a total of sixteen proprietary and open access databases that included access to gray literature and conference proceedings. The bibliographies of included studies and relevant reviews were also searched.
Studies were eligible for inclusion in the review if they: (a) assessed the effects of opioid-specific MATs on individual-level criminal justice or overdose outcomes; included (b) a current or formerly justice-involved sample; and (c) a randomized or strong quasi-experimental design; and c) were published in English between January 1, 1960 and October 31, 2020.
We used the standard methodological procedures as expected by The Campbell Collaboration.
Twenty studies were included, representing 30,119 participants. The overall risk of bias for the experimental studies ranged from "some" to "high" and for quasi-experimental studies ranged from "moderate" to "serious." As such, findings must be interpreted against the backdrop of less-than-ideal methodological contexts. Of the 20 included studies, 16 included outcomes that were meta-analyzed using mean log odds ratios (which were reported as mean odds ratios). Mean effects were nonsignificant for reincarceration (odds ratio [OR] = 0.93 [0.68, 1.26], SE = .16), rearrest (OR = 1.47 [0.70, 3.07], SE = 0.38), and fatal overdose (OR = 0.82 [0.56, 1.21], SE = 0.20). For nonfatal overdose, the average effect was significant (OR = 0.41 [0.18, 0.91], SE = 0.41, < 0.05), suggesting that those receiving MAT had nearly 60% reduced odds of a nonfatal overdose.
The current review supports some utility for adopting MAT for the treatment of justice-involved people with opioid addiction, however, more studies that employ rigorous methodologies are needed. Researchers should work with agencies to improve adherence to medication regimens, study design, and collect more detailed information on participants, their criminal and substance use histories, onset, and severity. This would help clarify whether treatment and control groups are indeed comparable and provide better insight into the potential reasons for participant dropout, treatment failure, and the occurrence of recidivism or overdose. Outcomes should be assessed in multiple ways, if possible (e.g., self-report and official record), as reliance on official data alone may undercount participants' degree of criminal involvement.
司法系统介入与药物使用之间的重叠现象已有充分记录。滥用阿片类药物的司法涉入者复发和再次犯罪的风险很高。刑事司法政策制定者认为，针对阿片类药物的药物辅助治疗（MATs）是改善这一人群治疗效果的一种方法。需要更多研究来探索针对阿片类药物的MATs对司法涉入者的影响。
本研究旨在评估针对阿片类药物的MATs对降低当前或曾经司法涉入个体的刑事司法和过量用药后果的频率和可能性的效果。
于2021年5月7日至2021年6月23日进行记录检索。我们总共检索了16个专有和开放获取数据库，包括获取灰色文献和会议记录。还检索了纳入研究和相关综述的参考文献。
如果研究符合以下条件，则有资格纳入综述：（a）评估针对阿片类药物的MATs对个体层面刑事司法或过量用药后果的影响；（b）纳入当前或曾经司法涉入的样本；（c）采用随机或强准实验设计；（d）于1960年1月1日至2020年10月31日期间以英文发表。
我们采用了坎贝尔合作组织所期望的标准方法程序。
纳入了20项研究，代表30119名参与者。实验性研究的总体偏倚风险范围为“中等”至“高”，准实验性研究的总体偏倚风险范围为“中等”至“严重”。因此，研究结果必须在方法学背景不太理想的情况下进行解读。在纳入的20项研究中，16项研究纳入了使用平均对数比值比（报告为平均比值比）进行荟萃分析的结果。重新监禁（比值比[OR]=0.93[0.68,1.26]，标准误=0.16）、再次逮捕（OR=1.47[0.70,3.07]，标准误=0.38）和致命过量用药（OR=0.82[0.56,1.21]，标准误=0.20）的平均效应不显著。对于非致命过量用药，平均效应显著（OR=0.41[0.18,0.91]，标准误=0.41，P<0.05），这表明接受MAT治疗的人非致命过量用药的几率降低了近60%。
当前综述支持采用MAT治疗阿片类药物成瘾的司法涉入者具有一定效用，然而，需要更多采用严格方法的研究。研究人员应与机构合作，提高对药物治疗方案的依从性、研究设计，并收集关于参与者、他们的犯罪和药物使用历史、发病情况及严重程度的更详细信息。这将有助于阐明治疗组和对照组是否确实具有可比性，并更好地洞察参与者退出、治疗失败以及再次犯罪或过量用药发生的潜在原因。如果可能，应以多种方式评估结果（例如，自我报告和官方记录），因为仅依赖官方数据可能会低估参与者的犯罪参与程度。
