Opioid Use Disorder Treatment Decision Making And Care Navigation Upon Release From Prison: A Feasibility Study
Opioid Use Disorder Treatment Decision Making And Care Navigation Upon Release From Prison: A Feasibility Study
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DOI：
10.2147/sar.s192045
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发表时间：
2019-01-01
影响因子：
1.8
通讯作者：
Tsui, Judith, I
中科院分区：
文献类型：
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作者：
Banta-Green, Caleb J.;Floyd, Anthony S.;Tsui, Judith, I
目的：阿片类药物使用障碍（OUD）是一种可用药物有效治疗的医学疾病。打破OUD和相关非法活动循环的一个主要挑战是在个人离开监狱或监狱时无缝引入阿片类药物使用障碍（MOUD）。我们研究了一个试点干预的可行性，参与者正在进行的MOUD和社会心理支持释放后，从customer.Methods：这项研究招募了成人的历史，从华盛顿州监狱释放到惩教署（DOC）社区监督的OUD。参与者被随机分配到研究干预组或对照组。干预措施包括OUD和可用治疗的教育，个性化治疗决策的支持，以及持续6个月的护理导航，以促进与所选治疗的联系。被随机分配到对照组的参与者从社区矫正人员那里获得社区服务。护理导航活动日志记录了干预参与者的干预参与、服务利用和需求。在1个月和6个月进行随访访谈，以评估满意度的干预。结果：15名参与者被招募。所有患者均为男性，大多数为白色（86.6%），平均年龄为36.9岁。大多数（15名参与者中的14名）在监禁前几乎每天都有海洛因使用者，患有严重的OUD。在7名干预参与者中，有2人希望立即开始药物治疗。三名参与者报告在随后的随访期间开始丁丙诺啡或美沙酮，有或没有社会支持和/或门诊咨询，三名参与者报告在没有药物的情况下参加社会支持和/或门诊咨询。接受干预的参与者表示满意度很高。我们讨论的障碍和促进因素，研究implementation.Conclusion：干预措施，参与者正在进行的MOUD和心理社会支持后，从监狱释放的参与者之间有广泛的可接受性，是可行的，以实施那些招募;但是，在此情况下，入组人数远低于预期，研究干预并未显示出促进MOUD使用的预期效果，在这个小样本的参与者中释放。鉴于最近的研究表明，释放前药物启动的好处，这种两部分干预的潜在附加效益应在释放前启动MOUD的系统中进行研究。
Purpose: Opioid use disorder (OUD) is a medical condition that is effectively treated with medications. A major challenge in breaking the cycle of OUD and related illegal activity is seamlessly introducing medications for opioid use disorder (MOUD) as individuals leave jail or prison. We examined the feasibility of a pilot intervention to link participants to ongoing MOUD and psychosocial supports following release from custody.Methods: The study enrolled adults with a history of OUD released from Washington State prisons to Department of Corrections (DOC) community supervision. Participants were randomized to the study intervention or comparison group. The intervention consisted of education on OUD and available treatments, support with individualized treatment decision making, and continued care navigation for 6 months to facilitate linkage to chosen treatments. Participants randomized to the control condition received referral to services in the community from their community corrections officers. A care navigation activity log documented intervention participants' intervention engagement, service utilization, and needs. Follow-up interviews were conducted at 1 and 6 months to assess satisfaction with the intervention.Results: Fifteen participants were enrolled. All were male, most were white (86.6%) and the average age was 36.9 years. The majority (14 of 15 participants) were near-daily heroin users with severe OUD prior to incarceration. Of the seven intervention participants, two wished to start medications immediately. Three participants reported starting buprenorphine or methadone in the subsequent follow-up period, with or without social support and/or outpatient counseling, and three reported enrolling in social support and/or outpatient counseling without medications. Participants who received the intervention reported high satisfaction. We discuss barriers and facilitators to study implementation.Conclusion: An intervention to link participants to ongoing MOUD and psychosocial supports following release from prison had broad acceptability among participants and was feasible to implement among those recruited; however, enrollment was much lower than anticipated and the study intervention did not demonstrate the intended effect to facilitate use of MOUD immediately post-release in this small sample of participants. Given recent research showing benefits of pre-release medication initiation, the potential added benefits of this two-part intervention should be studied in systems that initiate MOUD prior to release.