Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S.
Availability of best practices for opioid use disorder in jails and related training and resource needs: findings from a national interview study of jails in heavily impacted counties in the U.S.
复制标题
DOI：
10.1186/s40352-022-00197-3
复制
发表时间：
2022-12-20
期刊：
影响因子：
3.5
通讯作者：
中科院分区：
文献类型：
--
作者：
监狱是筛选阿片类药物使用障碍（OUD）个体并提供所需服务，特别是OUD药物治疗的最佳场所。本研究旨在评估在美国受阿片类药物过量严重影响的县的监狱中OUD“最佳做法”的可用性及其相关的培训和资源需求。使用OUD严重程度的两个指标（阿片类药物过量死亡的绝对数量和人口比率）选择县纳入研究。对目标县185/244（76%）和目标县185/250（74%）监狱的代表进行了结构化访谈。根据目前的治疗和实践指南确定了10个OUD最佳做法。这些措施包括：OUD筛查；临床评估;医疗管理戒断；MOUD管理;孕妇服；咨询和综合服务；与社区提供者合作；医疗补助/保险援助；返回服务;预防用药过量。描述性分析审查了所有服务的提供情况和在最佳做法类别内认可的服务的平均百分比，最佳做法与社区和监狱特点的联系，以及对培训和资源的相关需求。超过70%的监狱答复者表示，在他们的监狱内可获得十项OUD最佳做法的某些方面，从71%使用临床评估到96%提供过量预防。然而，在每个最佳做法类别内核准的项目的平均百分比有很大差异，从涉及重返社会服务的项目的38%到涉及医疗管理戒断的项目的88%不等。监狱中OUD最佳做法的可用性也因社区和监狱的特点而异。据报告，监狱对药品和临床工作人员的资金需求最大。需要制定政策，以解决在监狱内获得OUD最佳做法方面存在的差距。需要培训、技术援助和资金，以提高监狱管理阿片类药物的临床能力，并确保从监狱到社区的护理的连续性，这对于减少释放后阿片类药物过量的风险至关重要。在线版本包含补充材料，可在10.1186/s40352-022-00197-3获得。
Jails are optimal settings in which to screen individuals for opioid use disorders (OUD) and provide needed services, especially medications for OUD (MOUD). This study sought to assess the availability of OUD “best practices” in jails located in counties heavily impacted by opioid overdose in the U.S. and their related training and resource needs. Counties were selected for study inclusion using two indicators of OUD severity: the absolute number and population rate of opioid overdose deaths. Structured interviews were completed with representatives from 185/244 (76%) of targeted counties and 185/250 (74%) of targeted jails in these counties. Ten OUD best practices were identified based on current treatment and practice guidelines. These include: screening for OUD; clinical assessment; medically managed withdrawal; MOUD administration; MOUD for pregnant people; counseling and wrap-around services; collaboration with community providers; assistance with Medicaid/insurance; re-entry services; and overdose prevention. Descriptive analyses examined the provision of any services and average percentage of services endorsed within best-practice categories, association of best-practice availability with community and jail characteristics, and related needs for training and resources. Over 70% of jail respondents indicated that some aspects of each of the ten OUD best practices were available within their jails, ranging from 71% using clinical assessment to 96% providing overdose prevention. However, there was considerable variability in the average percentage of items endorsed within each best-practice category, ranging from 38% of items regarding re-entry services to 88% of items regarding medically managed withdrawal. Availability of OUD best practices in jails also varied by community and jail characteristics. Jails reported the highest needs for funding for medication and clinical staff. Policies are needed to address the identified gaps in availability of OUD best practices within jails. Training, technical assistance, and funding are needed to improve clinical capacity of jails to administer MOUD and to ensure continuity of care from jail to community, which are essential to reducing the risk of opioid-related overdose following release. The online version contains supplementary material available at 10.1186/s40352-022-00197-3.