The impact of drug court participation on mortality: 15-year outcomes from a randomized controlled trial
The impact of drug court participation on mortality: 15-year outcomes from a randomized controlled trial
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DOI：
10.1016/j.jsat.2019.07.004
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发表时间：
2019-10-01
影响因子：
3.9
通讯作者：
Gottfredson, Denise C.
中科院分区：
文献类型：
--
作者：
Kearley, Brook W.;Cosgrove, John A.;Gottfredson, Denise C.
目的：测试参与毒品法庭对长期死亡风险的影响。方法：1997-98 年期间，235 名被控非暴力犯罪的个人被随机分配到巴尔的摩市毒品治疗法庭 (BCDTC) 或传统裁决机构。海洛因是样本中选择的主要物质。随机分组后，对参与者死亡率进行了为期 15 年的观察。结果：超过 20% 的参与者在研究期间死亡，平均年龄为 46.6 岁，其中 64.4% 的死亡与物质使用有关。生存分析估计，BCDTC 与传统裁决之间，全因死亡率和物质使用相关原因死亡均没有显着差异。结论：样本中频繁和过早死亡表明，这是需要有效物质使用治疗的高危人群。据估计，目前大约有一半的药物治疗法庭提供药物辅助治疗（MAT），这是目前治疗阿片类药物使用障碍最有效的方法。在这项 15 年前实施的 BCDTC 研究中，只有 7% 的参与者接受了 MAT，这可能解释了该计划对死亡率缺乏影响的原因。在毒品法庭环境中提供 MAT 的历史障碍包括准入、对转移的担忧、消极态度、全面禁止和耻辱。戒毒法庭应实施药物滥用治疗和过量预防的最佳实践标准，包括增加获得 MAT 和纳洛酮的机会，以及减少污名化语言和做法的培训。
Aim: To test the effects of drug court participation on long-term mortality risk.Methods: During 1997-98, 235 individuals charged with a non-violent offense were randomly assigned to Baltimore City Drug Treatment Court (BCDTC) or traditional adjudication. Heroin was the predominant substance of choice among the sample. Participant mortality was observed for 15 years following randomization.Results: Over 20% of participants died during the study, at an average age of 46.6 years, and 64.4% of deaths were substance-use related. Survival analyses estimated that neither mortality from any cause nor from substance use-related causes significantly differed between BCDTC and traditional adjudication.Conclusions: Frequent and premature death among the sample indicates that this is a high-risk population in need of effective substance use treatment. Roughly half of drug treatment courts are now estimated to offer medication assisted treatment (MAT), which is currently the most effective treatment for opioid use disorders. In this study of BCDTC implemented over 15 years ago, only 7% of participants received MAT, which may explain the lack of program impact on mortality. Historical barriers to providing MAT in drug court settings include access, concerns about diversion, negative attitudes, blanket prohibitions, and stigma. Drug treatment courts should implement best practice standards for substance use treatment and overdose prevention, including increased access to MAT and naloxone, and training to reduce stigmatizing language and practice.