Probation clients' barriers to access and use of opioid use disorder medications
Probation clients' barriers to access and use of opioid use disorder medications
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DOI：
10.1186/s40352-019-0089-6
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发表时间：
2019-05-28
期刊：
影响因子：
3.5
通讯作者：
Gleicher, Lily
中科院分区：
文献类型：
--
作者：
Reichert, Jessica;Gleicher, Lily
背景阿片类药物使用障碍（OUDs）的循证治疗与目前监督OUDs患者的缓刑部门的做法之间存在差距。尽管有强有力的证据表明这些药物有效，但许多患有oud的见习者无法获得fda批准的药物来治疗他们的疾病。在缓刑监督下的患者使用药物的障碍包括从业人员对药物的消极态度、费用、污名化和转移风险。缓刑官有道德义务帮助他们的客户减少获得所需护理的障碍，这反过来可以改善他们的结果并增加公共安全。结果本研究通过对伊利诺伊州26名缓刑部门主管/行政人员（以下简称缓刑部门领导）的调查，探讨了缓刑部门如何应对患有OUD的缓刑人员，重点关注获得OUD药物的障碍。大多数缓刑部门的领导报告说，他们认为工作人员阻碍他们的客户获得药物。原因包括缺乏医务人员经验、费用、需要药物指导以及其组织或辖区制定的禁止病人使用药物的法规。与丁丙诺啡和纳曲酮相比，缓刑部门的领导报告说，他们对美沙酮的使用以及如何使用美沙酮知之甚少。此外，与美沙酮相比，缓刑部门领导通常更愿意推荐客户接受包括丁丙诺啡或纳曲酮在内的治疗。尽管对美沙酮的培训或熟悉程度略低于其他药物，但知道三种fda批准的药物在哪里推荐的缓刑部门领导的数量是相似的。目前的研究发现，缓刑部门的领导认为他们的员工在联系或推荐客户使用OUD药物方面存在一些障碍。研究结果表明，需要进行行政和工作人员层面的培训、机构间合作和政策改革，以增加缓刑客户获得、教育和使用药物的机会。这样的努力将最终帮助缓刑中患有oud的客户稳定并坚持其他缓刑要求，并参与行为治疗，这可能会产生积极的结果，如减少再犯，提高生活质量，降低死亡率。
Background There is a gap between evidence-based treatment with medications for opioid use disorders (OUDs) and current practices of probation departments who supervise individuals with OUDs. Many probationers with OUDs cannot access FDA-approved medications to treat their disorders despite the strong evidence of their effectiveness. The barriers to medications for those under probation supervision include practitioners' negative attitudes toward medications, costs, stigma, and diversion risk. Probation officers have an ethical obligation to help their clients reduce barriers to access the care they need which in turn can improve their outcomes and increase public safety. Results The current study explores how probation departments respond to probationers with OUDs, focusing on the barriers to accessing OUD medications based on a survey of probation department directors/administrators (hereafter referred to as probation department leaders) in Illinois (N = 26). A majority of probation department leaders reported perceived staff barriers to their clients accessing medications. Reasons included lack of medical personnel experience, cost, need for guidance on medications, and regulations set by their organization or jurisdiction that prohibit client use of medications. Probation department leaders reported knowing less about the use of methadone and how it is administered, compared to buprenorphine and naltrexone. In addition, probation department leaders were generally more open to referring clients for treatment that include buprenorphine or naltrexone compared to methadone. Despite slightly less training or familiarity with methadone than the other medications, the number of probation department leaders who knew where to refer someone for each of the three FDA-approved medications was similar. Conclusions The current study found probation department leaders perceive some barriers to their staff linking or referring their clients to OUD medications. Study findings indicate a need for administration- and staff-level training, interagency collaboration, and policy changes to increase access to, education on, and use of, medications for probation clients. Such efforts will ultimately help probation clients with OUDs stabilize and adhere to other probation requirements and engage in behavioral therapy, which may result in positive outcomes such as reduced recidivism, increased quality of life, and reduced mortality.