Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: a qualitative study of the perceptions of former inmates with opioid use disorder
Release from incarceration, relapse to opioid use and the potential for buprenorphine maintenance treatment: a qualitative study of the perceptions of former inmates with opioid use disorder
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DOI：
10.1186/s13722-014-0023-0
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发表时间：
2015-01-16
影响因子：
3.7
通讯作者：
Cunningham, Chinazo O.
中科院分区：
文献类型：
--
作者：
Fox, Aaron D.;Maradiaga, Jeronimo;Cunningham, Chinazo O.
背景：美国是世界上监禁率最高的国家（每10万成年人中有937人被监禁）。每年大约有三分之一的海洛因使用者进入矫正设施。在监禁期间，很少有人接受药物辅助治疗（MAT；美沙酮或丁丙诺啡）治疗阿片类药物使用障碍，近四分之三的人在释放后3个月内再次使用海洛因。本定性研究调查了出狱后丁丙诺啡维持治疗（BMT）的障碍和促进因素（“再入”）。方法：我们对从成瘾治疗机构招募的阿片类药物使用障碍的前囚犯进行了21次半结构化访谈。访谈录音，转录，并分析使用接地理论的方法。研究小组讨论了在文本的反复阅读中出现的主题。结果：参与者报告了不利的再入条件，包括持续暴露于药物使用和压力生活事件，这些被认为有助于阿片类药物复发并影响再入期间的成瘾治疗决策。与BMT相关的主题包括：1)对意志力的依赖；2)对药物依赖的恐惧；3)丁丙诺啡的可变暴露；4)复发后BMT的可接受性。意志力被认为比药物对康复更重要。许多参与者在监禁期间经历了痛苦的美沙酮戒断，并担心使用MAT会导致阿片类药物耐受性和未来再次痛苦戒断。参与者报告了服用非法丁丙诺啡的积极和消极经历，这影响了对BMT的兴趣。总的来说，BMT被认为是阿片类药物使用障碍的一个很好的治疗选择，可以降低再次入狱的风险。结论：BMT被认为是可以接受的，但有阿片类药物使用障碍的前囚犯在重返监狱后可能不愿意使用BMT。可以通过政策改变或干预措施来减轻限制BMT利用的因素。刑事司法系统的政策（例如，强制戒毒）可能会阻止前囚犯利用有效的治疗阿片类药物使用障碍的方法。改善阿片类药物使用障碍前囚犯的教育和获得BMT的干预措施可以促进他们接受治疗。迫切需要改变政策和采取干预措施，以减少阿片类药物重新入境后复发的负面后果。
Background: The United States has the highest rate of incarceration in the world (937 per 100,000 adults). Approximately one-third of heroin users pass through correctional facilities annually. Few receive medication assisted treatment (MAT; either methadone or buprenorphine) for opioid use disorder during incarceration, and nearly three-quarters relapse to heroin use within 3 months of release. This qualitative study investigated barriers to and facilitators of buprenorphine maintenance treatment (BMT) following release from incarceration ("re-entry").Methods: We conducted 21 semistructured interviews of former inmates with opioid use disorder recruited from addiction 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.Results: Participants reported adverse re-entry conditions, including persistent exposure to drug use and stressful life events, which were perceived to contribute to opioid relapse and affected addiction treatment decisions during re-entry. Themes that emerged relating to BMT included: 1) reliance on willpower; 2) fear of dependency on medications; 3) variable exposure to buprenorphine; and 4) acceptability of BMT following relapse. Willpower was perceived to be more important for recovery than medications. Many participants experienced painful withdrawal from methadone during incarceration and were fearful that using MAT would lead to opioid tolerance and painful withdrawal again in the future. Participants reported both positive and negative experiences taking illicit buprenorphine, which affected interest in BMT. Overall, BMT was perceived to be a good treatment option for opioid use disorder that could reduce the risk of re-incarceration.Conclusions: BMT was perceived to be acceptable, but former inmates with opioid use disorder may be reluctant to utilize BMT upon re-entry. Factors limiting utilization of BMT could be mitigated though policy change or interventions. Policies of the criminal justice system (e. g., forced detoxification) may be dissuading former inmates from utilizing effective treatments for opioid use disorder. Interventions that improve education and access to BMT for former inmates with opioid use disorder could facilitate entrance into treatment. Both policy changes and interventions are urgently needed to reduce the negative consequences of opioid relapse following re-entry.