Uncommon and preventable: Perceptions of diversion of medication for opioid use disorder in jail.
Uncommon and preventable: Perceptions of diversion of medication for opioid use disorder in jail.
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DOI：
10.1016/j.jsat.2022.108746
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发表时间：
2022-07
影响因子：
3.9
通讯作者：
Friedmann, Peter D.
中科院分区：
文献类型：
--
作者：
Evans, Elizabeth A.;Pivovarova, Ekaterina;Stopka, Thomas J.;Santelices, Claudia;Ferguson, Warren J.;Friedmann, Peter D.
关键词：
惩教官员经常以转移用于阿片类药物使用障碍 (MOUD) 治疗的药物（例如丁丙诺啡）作为不在监狱和监狱中提供 MOUD 治疗的理由，但人们对这些担忧是否合理尚知之甚少。我们的目的是了解工作人员对监狱 MOUD 计划中药物转移的看法以及导致和阻止转移的因素。我们对 2019-20 年在马萨诸塞州七所监狱实施 MOUD 项目的 61 名行政、安全、行为健康和临床工作人员进行的半结构化深度访谈和焦点小组进行了定性分析。与工作人员的预期相反，丁丙诺啡转移被认为在 MOUD 计划实施期间很少发生。 MOUD 计划改变了工作人员对丁丙诺啡的看法，即将丁丙诺啡视为合法治疗药物，而不是非法违禁品。此外，该计划被认为扰乱了监狱中的非法丁丙诺啡市场，并减少了相关的胁迫。积极主动的策略对于预防和应对丁丙诺啡转移至关重要。预防转移战略的关键组成部分包括： 区分不同转移原因的工作人员；全面、常规但灵活的给药方案；沟通、教育和监测；患者参与评估转移原因；以及裁决转移后果的书面政策。通过适当的方案，旨在提供 MOUD 治疗的惩教项目中丁丙诺啡的转移被认为是不常见且可以预防的。项目设计中的有希望的做法有助于限制药物转移，并在惩教官员和立法者考虑是否以及如何在惩教环境中提供 MOUD 治疗时为他们提供信息。
Correctional officials often cite diversion of medication for opioid use disorder (MOUD) treatment (e.g., buprenorphine) as a reason for not offering MOUD treatment in jails and prisons, but it is poorly understood whether these fears are justified. We aimed to understand staff perceptions of medication diversion from jail-based MOUD programs and the factors that contribute to and prevent diversion. We conducted qualitative analyses of semi-structured in-depth interviews and focus groups performed in 2019–20 with 61 administrative, security, behavioral health, and clinical staff who implement MOUD programming in seven Massachusetts jails. Contrary to staff expectations, buprenorphine diversion was perceived to occur infrequently during MOUD program implementation. The MOUD program changed staff views of buprenorphine, i.e., as legitimate treatment instead of as illicit contraband. Also, the program was perceived to have disrupted the illicit buprenorphine market in jail and reduced related coercion. Proactive strategies were essential to prevent and respond to buprenorphine diversion. Key components of diversion prevention strategies included: staff who distinguished among different reasons for diversion; comprehensive and routinized but flexible dosing protocols; communication, education, and monitoring; patient involvement in assessing reasons for diversion; and written policies to adjudicate diversion consequences. With appropriate protocols, buprenorphine diversion within correctional programs designed to provide MOUD treatment is perceived to be uncommon and preventable. Promising practices in program design help limit medication diversion and inform correctional officials and lawmakers as they consider whether and how to provide MOUD treatment in correctional settings.
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DOI：
10.1521/aeap.2014.26.5.411
发表时间：
2014-10
期刊：
AIDS education and prevention : official publication of the International Society for AIDS Education
影响因子：
--
作者：
Visher CA;Hiller M;Belenko S;Pankow J;Dembo R;Frisman LK;Pearson FS;Swan H;Wiley TR
通讯作者：
Wiley TR
影响因子：
5.5
作者：
Carroll, Jennifer J.;Rich, Josiah D.;Green, Traci C.
通讯作者：
Green, Traci C.
影响因子：
3.9
作者：
Monico, Laura B.;Gryczynski, Jan;Chilcoat, Howard
通讯作者：
Chilcoat, Howard
影响因子：
4.2
作者：
Macmadu, Alexandria;Goedel, William C.;Marshall, Brandon D. L.
通讯作者：
Marshall, Brandon D. L.
影响因子：
1.8
作者：
Belenko, Steven;Visher, Christy;Willett, Jennifer
通讯作者：
Willett, Jennifer