"I Kicked the Hard Way. I Got Incarcerated." Withdrawal from Methadone During Incarceration and Subsequent Aversion to Medication Assisted Treatments.
"I Kicked the Hard Way. I Got Incarcerated." Withdrawal from Methadone During Incarceration and Subsequent Aversion to Medication Assisted Treatments.
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DOI：
10.1016/j.jsat.2015.11.004
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发表时间：
2016-03
影响因子：
3.9
通讯作者：
Fox AD
中科院分区：
文献类型：
--
作者：
Maradiaga JA;Nahvi S;Cunningham CO;Sanchez J;Fox AD
监禁是阿片类药物使用障碍患者的常见经历，包括接受药物辅助治疗（MAT）的患者，如丁丙诺啡或美沙酮。在美国，MAT在监禁期间很少可用。我们感兴趣的是，在监禁期间美沙酮维持治疗的挑战是否会影响释放后对MAT的态度。我们对21名在社区药物滥用治疗环境中患有阿片类药物使用障碍的前监禁人员进行了半结构化访谈。访谈录音，转录，并使用扎根理论的方法进行分析。研究小组讨论了反复阅读记录时出现的主题。与美沙酮有关的三个主题是：1）监禁期间迅速减少剂量; 2）监禁期间美沙酮的中断; 3）监禁后对美沙酮的厌恶。在监禁前接受美沙酮维持治疗的参与者报告了监禁期间美沙酮治疗的快速剂量减少或中断导致的严重和长期戒断症状。监禁期间的严重退出导致随后的厌恶美沙酮和不利影响未来的决定，重新参与MAT。虽然MAT是阿片类药物使用障碍最有效的治疗方法，但目前的刑事政策通常要求在监禁期间停止MAT，可能会劝阻阿片类药物使用障碍患者在从监禁中释放后考虑和参与MAT。
Incarceration is a common experience for individuals with opioid use disorder, including those receiving medication assisted treatments (MAT), such as buprenorphine or methadone. In the United States, MAT is rarely available during incarceration. We were interested in whether challenges with methadone maintenance treatment during incarceration affected subsequent attitudes toward MAT following release. We conducted semi-structured interviews with 21 formerly incarcerated individuals with opioid use disorder in community substance abuse treatment settings. Interviews were audio recorded, transcribed, and analyzed using a grounded theory approach. Themes that emerged upon iterative readings of transcripts were discussed by the research team. The three main themes relating to methadone were: 1) rapid dose reduction during incarceration; 2) discontinuity of methadone during incarceration; and 3) post incarceration aversion to methadone. Participants who received methadone maintenance treatment prior to incarceration reported severe and prolonged withdrawal symptoms from rapid dose reductions or disruption of their methadone treatment during incarceration. The severe withdrawal during incarceration contributed to a subsequent aversion to methadone and adversely affected future decisions regarding reengagement in MAT. Though MAT is the most efficacious treatment for opioid use disorder, current penal policy, which typically requires cessation of MAT during incarceration, may dissuade individuals with opioid use disorder from considering and engaging in MAT after release from incarceration.