刑事司法系统对阿片类物质使用障碍药物使用的影响：一项定性研究
Influences of the criminal justice system on use of medications for opioid use disorder: a qualitative study.
作者信息
Taylor Emmeline, Gray Caroline, Stimmel Matthew, Binswanger Ingrid A, Morse Erica, Timko Christine, Harris Alex H S, Smelson David, Finlay Andrea K
机构信息
Center for Innovation to Implementation (Ci2i), VA Palo Alto Healthcare System, 795 Willow Road (MPD-152), Menlo Park, CA, 94025, USA.
Department of Clinical Psychology, University of Colorado, Colorado Springs, CO, USA.
出版信息
BMC Glob Public Health. 2024 Sep 19;2(1):64. doi: 10.1186/s44263-024-00093-y.
BACKGROUND
Legal-involved veterans with opioid use disorder (OUD) have lower receipt of medications for opioid use disorder (MOUD) than other veterans served at the Veterans Health Administration (VHA). This qualitative study examined the influence of the criminal justice system on access to MOUD for legal-involved veterans in the U.S.
METHODS
VHA facilities (n = 14) that varied in their provision of MOUD to legal-involved veterans were selected for qualitative interviews. Interviewees included legal-involved veterans (n = 18), VHA Veterans Justice Programs Specialists (n = 15), substance use disorder treatment providers (n = 5), and criminal justice staff (n = 12). Team members applied codes to meaningful units of analysis (quotations) in the transcribed interviews. Using a matrix approach, team members created a spreadsheet matrix with codes, facility rate of MOUD, and relevant quotations summarized for each participant. Themes and connections between individual participants and cross-interview concepts were explored. Participants were not asked to provide feedback on the findings.
RESULTS
Themes identified were as follows: (1) Veterans Treatment Court policies both enhanced and limited MOUD treatment access and utilization among participants; (2) cross-system collaboration strengths and challenges existed; and (3) criminal justice system treatment preferences and policies both enhanced and limited MOUD in jails and prisons.
CONCLUSIONS
The influence of the criminal justice system on MOUD has led to variable access to MOUD for legal-involved veterans. Our findings can help inform recommendations to enhance access to MOUD for veterans within the criminal justice system, including the development of a national database of MOUD education materials for Veterans Treatment Courts, strengthening community-court relationships, allowing individuals to use their own healthcare coverage within jails and prisons and extend Medicaid coverage into criminal justice settings, and applying national quality measures for MOUD to criminal justice settings and develop a national system for tracking these quality measures.
背景
患有阿片类药物使用障碍（OUD）且涉及法律问题的退伍军人，比起在退伍军人健康管理局（VHA）接受服务的其他退伍军人，获得阿片类药物使用障碍药物治疗（MOUD）的比例更低。这项定性研究考察了刑事司法系统对美国涉及法律问题的退伍军人获得MOUD的影响。
方法
选取了14个向涉及法律问题的退伍军人提供不同MOUD服务的VHA机构进行定性访谈。受访者包括涉及法律问题的退伍军人（18人）、VHA退伍军人司法项目专家（15人）、物质使用障碍治疗提供者（5人）以及刑事司法工作人员（12人）。团队成员对转录访谈中有意义的分析单元（引文）进行编码。通过矩阵方法，团队成员创建了一个电子表格矩阵，其中包含编码、MOUD的机构提供率以及为每个参与者总结的相关引文。探索了个体参与者之间的主题和联系以及跨访谈概念。未要求参与者对研究结果提供反馈。
结果
确定的主题如下：（1）退伍军人治疗法庭政策既增加了参与者获得MOUD治疗的机会和利用率，同时也有所限制；（2）存在跨系统协作的优势和挑战；（3）刑事司法系统的治疗偏好和政策既增加了监狱中MOUD的可及性，同时也有所限制。
结论
刑事司法系统对MOUD的影响导致涉及法律问题的退伍军人获得MOUD的机会各不相同。我们的研究结果有助于为改善刑事司法系统内退伍军人获得MOUD的建议提供信息，包括为退伍军人治疗法庭开发MOUD教育材料的全国数据库、加强社区与法庭的关系、允许个人在监狱中使用自己的医疗保险并将医疗补助覆盖范围扩展到刑事司法环境，以及将MOUD的国家质量措施应用于刑事司法环境并建立一个跟踪这些质量措施的国家系统。
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