Criminal problem-solving and civil dependency court policies regarding medications for opioid use disorder.
Criminal problem-solving and civil dependency court policies regarding medications for opioid use disorder.
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DOI：
10.1080/08897077.2021.1944958
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发表时间：
2022
期刊：
影响因子：
3.5
通讯作者：
del Pozo, Brandon
中科院分区：
文献类型：
--
作者：
Andraka-Christou, Barbara;Clark, M. H.;Atkins, Danielle N.;del Pozo, Brandon
关键词：
刑事问题解决法院和民事依赖法院经常有物质使用障碍（SUD）的参与者，包括阿片类药物使用障碍（OUD）。这些法院为参与者提供治疗，并为法庭参与者制定与治疗有关的要求，以避免监禁或重新获得儿童监护权。阿片类药物使用障碍（MOUD）是OUD最有效的治疗方法，但未被法院系统参与者充分利用。关于不同MOUD的法院政策变化知之甚少。此外，还需要关于每个MOUD的政策类型的更多信息，包括参与者是否可以开始MOUD，继续先前开始的MOUD，或使用MOUD完成法庭程序。一项在线调查于2019年和2020年分发给佛罗里达的刑事问题解决和民事依赖法官，从58名法官那里获得了数据（回复率为24%）。我们使用非参数统计来检验有序数据的假设。相关样本的弗里德曼检验或科克伦Q被用来进行组内政策和MOUD之间的比较。我们发现了相当大的政策变化，纳洛酮比丁丙诺啡或美沙酮更宽松的政策，继续MOUD比启动MOUD或完成MOUD的法庭程序更宽松的政策。对于每种药物，不到四分之一的法官表示他们的法院总是允许MOUD，大多数法官表示MOUD有时或通常是允许的。由于受访者很少选择“从不”或“总是”的任何MOUD政策，大多数法院似乎是在个案的基础上作出MOUD决定。需要更清楚地了解这一决策过程。一些法庭参与者可能会被要求在完成法庭程序之前停止MOUD，即使他们被允许开始或继续MOUD治疗。在没有医学理由的情况下停止MOUD与OUD患者的护理标准相反，并增加了他们过量的风险。
Criminal problem-solving courts and civil dependency courts often have participants with substance use disorder (SUD), including opioid use disorder (OUD). These courts refer participants to treatment and set treatment-related requirements for court participants to avoid incarceration or to regain custody of children. Medications for opioid use disorder (MOUD) are the most effective treatment for OUD but are underutilized by court system participants. Little is known about variation in court policies for different MOUDs. Also, more information is needed about types of policies for each MOUD, including whether participants may begin MOUD, continue previously begun MOUD, or complete the court program with MOUD. An online survey was distributed to criminal problem-solving and civil dependency judges in Florida in 2019 and 2020, yielding data from 58 judges (a 24% response rate). We used nonparametric statistics to test hypotheses with ordinal data. A Friedman’s test for related samples or Cochran’s Q was used to make within-group comparisons between policies and MOUDs. We found considerable policy variation, with more permissive policies for naltrexone than buprenorphine or methadone, and more permissive policies for continuing MOUD than for initiating MOUD or completing a court program with MOUD. For each medication, less than one quarter of judges indicated their court always permits MOUD, with most indicating that MOUD is permitted sometimes or usually. Because respondents rarely chose “never” or “always” for any MOUD policy, most courts appear to be making MOUD decisions on a case-by-case basis. A clearer understanding of this decision-making process is needed. Some court participants may be required to discontinue MOUD before completing a court program, even if they were permitted to start or continue MOUD treatment. Discontinuation of MOUD without medical justification is contrary to the standard of care for individuals with OUD and increases their risk of overdose.
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3.5
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