Availability of Medications for Opioid Use Disorder in U.S. Jails.
Availability of Medications for Opioid Use Disorder in U.S. Jails.
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美国监狱中阿片类药物使用障碍药物的可用性。
DOI：
10.1007/s11606-022-07812-x
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发表时间：
2023
影响因子：
5.7
通讯作者：
Latkin,Carl
中科院分区：
文献类型：
--
作者：
Sufrin,Carolyn;Kramer,Camille;Terplan,Mishka;Fiscella,Kevin;Olson,Sarah;Voegtline,Kristin;Latkin,Carl
从2019年9月到2020年3月，我们对美国所有可识别的监狱进行了一项横断面调查，以电子或纸质方式完成，这是迄今为止美国监狱最大的调查。4我们评估了非怀孕个体的MOUD可用性，包括监禁前MOUD的开始和持续，药物类型，给药安排，MOUD的障碍，以及受访者和监狱特征。这项分析是一项关于监狱怀孕期间MOUD访问的家长研究的一部分。[5]我们对回复进行了描述性统计分析，并应用Pearson χ 2或Wilcoxon秩和检验。在发送的2986份调查中，1139份（38%）回复，其中836份（28%）可分析。大多数非受访者来自农村县（60%），没有电子邮件地址（66%）。作出答复的监狱分布广泛，在大城市和农村地区的分布情况相似（表1）。32%的监狱报告了MOUD的可用性，29%的监狱报告了MOUD可用性的详细信息（表2）。在所有监狱中，13%的人开始并继续使用至少一种药物，11%的人只继续使用MOUD，17%的人提供更多药物。在238所确认MOUD的监狱中，47%的监狱既开始又继续。59%的MOUD监狱提供一种以上的药物。五十六所监狱继续（占所有答复者的6.7%），13所监狱开始并继续（占所有答复者的1.6%）所有三种药物。当只有1种药物可用时，最常见的是纳洛酮（21%），最少的是美沙酮（8%）。丁丙诺啡最常见的药物管理安排是由豁免的监狱提供者（55%）和美沙酮，药物被发送或挑选（34%）。提供MOUD的监狱不成比例地位于大都市（60%，p< 0.01），位于西部（30%）或中西部（31%）（p= 0.01），并利用非私人医疗保健服务（64%，p< 0.01）。在监狱中提供MOUD的最常见障碍包括对药物转移（40%），MOUD成本（36%）和药物执法管理局（DEA）处方法规（28%）的担忧;报告成本作为障碍的受访者更有可能发挥决策作用（p= 0.05）。
METHODSFrom September 2019 to March 2020, we conducted a cross-sectional survey, completed electronically or paper, of all identifiable jails in the US, the largest survey to date of US jails. 4 We assessed MOUD availability for non-pregnant individuals, including initiation in custody and continuation of pre-incarceration MOUD, medication type, dosing arrangements, barriers to MOUD, and respondent and jail characteristics. This analysis was part of a parent study of MOUD access in pregnancy in jails. 5 We analyzed responses for descriptive statistics and applying Pearson χ 2 or Wilcoxon rank sum tests.RESULTSOf 2986 surveys sent, 1139 (38%) responses were returned with 836 analyzable responses (28%). Most non-respondents were from rural counties (60%) and did not have an email address (66%). Responding jails represented a wide geographic spread, with a similar distribution in metropolitan and rural settings (Table 1). Thirty-two percent of jails reported MOUD availability in some capacity, with 29% reporting details validating MOUD availability (Table 2). Thirteen percent of all jails both initiated and continued at least one medication, 11% only continued MOUD, and 17% provided more than medication. Of the 238 jails with confirmed MOUD, 47% both initiated and continued. Fifty-nine percent of MOUD jails offered more than 1 medication. Fifty-six jails continued (6.7% of all respondents) and 13 jails initiated and continued (1.6% of all respondents) all three medications. When only 1 medication was available, the most common was naltrexone (21%) and the least was methadone (8%). The most common medication administration arrangement for buprenorphine was by a waivered jail provider (55%) and, for methadone, medications being sent or picked (34%). MOUD-providing jails were disproportionately metropolitan (60%, p< 0.01), located in the West (30%) or Midwest (31%)(p= 0.01), and utilized non-private health care service delivery (64%, p< 0.01). The most frequently reported barriers to providing MOUD in jail included concerns regarding medication diversion (40%), cost of MOUD (36%), and Drug Enforcement Administration (DEA) prescribing regulations (28%); respondents reporting cost as a barrier were more likely to have decision-making roles (p= 0.05).