Legislatively mandated implementation of medications for opioid use disorders in jails: A qualitative study of clinical, correctional, and jail administrator perspectives.
Legislatively mandated implementation of medications for opioid use disorders in jails: A qualitative study of clinical, correctional, and jail administrator perspectives.
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DOI：
10.1016/j.drugalcdep.2022.109394
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发表时间：
2022-05-01
影响因子：
4.2
通讯作者：
Friedmann, Peter D.
中科院分区：
文献类型：
--
作者：
Pivovarova, Ekaterina;Evans, Elizabeth A.;Stopka, Thomas J.;Santelices, Claudia;Ferguson, Warren J.;Friedmann, Peter D.
关键词：
有法律的参与和阿片类药物使用障碍（OUD）的个人过量和过早死亡的风险增加。然而，很少有惩教系统向所有符合条件的被监禁者提供所有FDA批准的OUD（MOUD）药物。我们报告的实施MOUD在七个马萨诸塞州的监狱后，国家立法授权，提供所有FDA批准的MOUD，并连接释放后的治疗。根据探索，准备，实施和维持框架，61名临床，矫正和高级监狱管理人员在2019年12月至2020年1月期间参加了半结构化访谈和焦点小组。定性分析侧重于外部和内部背景以及衔接因素。与会者详细介绍了外部环境（即，立法授权）推动了MOUD的接受，并有助于护理的连续性。显著的内部环境因素包括围绕激动剂药物管理的决策，工作人员的看法和培训，以及基础设施和日常生活的变化。领导力在扁平化标准层级和倡导灵活性方面至关重要。被监禁者，特别是被判刑前的被监禁者，其基于制度的特点给开始治疗带来了挑战。机构间和机构内的衔接因素减少了工作的重复，并促成了快速、创新的解决办法。在监狱中实施MOUD需要与外部机构合作并依赖外部机构。执行的准备工作应包括系统地审查现有资源和联系。执行工作需要体制系统的灵活性，而体制系统本身是僵化的。因此，领导者和政策制定者必须认识到这些计划中固有的文化转变，并允许资源和教育以确保计划成功。
Individuals with legal involvement and opioid use disorders (OUD) are at an increased risk of overdose and premature death. Yet, few correctional systems provide all FDA approved medications for OUD (MOUD) to all qualifying incarcerated individuals. We report on the implementation of MOUD in seven Massachusetts’ jails following a state legislative mandate to provide access to all FDA-approved MOUD and to connect with treatment upon release. Based on the Exploration, Preparation, Implementation, and Sustainment framework, 61 clinical, corrections, and senior jail administrators participated in semi-structured interviews and focus groups between December 2019 and January 2020. Qualitative analyses focused on external and internal contexts and bridging factors. Participants detailed how the outer context (i.e., legislative mandate) drove acceptance of MOUD and assisted with continuity of care. Salient inner context factors included decision-making around administration of agonist medications, staff perceptions and training, and changes to infrastructure and daily routines. Leadership was critical in flattening standard hierarchies and advocating for flexibility. System-based characteristics of incarcerated individuals, specifically those who were pre-sentenced, presented challenges with treatment initiation. Inter- and intra-agency bridging factors reduced duplication of effort and led to quick, innovative solutions. Implementation of MOUD in jails requires collaboration with and reliance on external agencies. Preparation for implementation should involve systematic reviews of available resources and connections. Implementation requires flexibility from institutional systems that are inherently rigid. Accordingly, leaders and policymakers must recognize the cultural shift inherent in such programs and allow for resources and education to assure program success.
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影响因子：
3.5
作者：
Friedmann PD;Hoskinson R;Gordon M;Schwartz R;Kinlock T;Knight K;Flynn PM;Welsh WN;Stein LA;Sacks S;O'Connell DJ;Knudsen HK;Shafer MS;Hall E;Frisman LK;Mat Working Group Of CJ-Dats
通讯作者：
Mat Working Group Of CJ-Dats
影响因子：
3.9
作者：
Aalsma MC;Aarons GA;Adams ZW;Alton MD;Boustani M;Dir AL;Embi PJ;Grannis S;Hulvershorn LA;Huntsinger D;Lewis CC;Monahan P;Saldana L;Schwartz K;Simon KI;Terry N;Wiehe SE;Zapolski TCB
通讯作者：
Zapolski TCB
影响因子：
3.5
作者：
Becan, Jennifer E;Bartkowski, John P;Aarons, Gregory A
通讯作者：
Aarons, Gregory A
影响因子：
4.2
作者：
Brinkley-Rubinstein, Lauren;McKenzie, Michelle;Rich, Josiah
通讯作者：
Rich, Josiah
影响因子：
3.7
作者：
Garner BR;Zehner M;Roosa MR;Martino S;Gotham HJ;Ball EL;Stilen P;Speck K;Vandersloot D;Rieckmann TR;Chaple M;Martin EG;Kaiser D;Ford JH 2nd
通讯作者：
Ford JH 2nd