Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails
Estimating the impact of wide scale uptake of screening and medications for opioid use disorder in US prisons and jails
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DOI：
10.1016/j.drugalcdep.2020.107858
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发表时间：
2020-03-01
影响因子：
4.2
通讯作者：
Marshall, Brandon D. L.
中科院分区：
文献类型：
--
作者：
Macmadu, Alexandria;Goedel, William C.;Marshall, Brandon D. L.
背景：治疗阿片使用障碍(OUD)的药物是治疗OUD的最有效方法，但这些救命药物在美国监狱和监狱环境中的应用极其有限，可用于指导政策决策的数据也有限。这项研究的目的是评估美国监狱和监狱中OUD药物筛查和治疗对释放后阿片类药物相关死亡率的影响。方法：我们使用来自国家生命统计中心、司法部统计局的数据和相关文献构建蒙特卡罗模拟，模拟2016年美国监狱和监狱大规模接受OUD药物筛查和治疗的情景。结果：我们的模型预测，如果所有临床指示的人都在监禁期间接受OUD药物治疗，1840人(95%模拟区间[SI]：-2757-4959)的生命将在全国范围内得到拯救。该模型还预测，如果所有被临床指征的人在被监禁期间接受OUD药物治疗，并在出院后继续接受治疗，全国约有4400人(95%SI：2675-5557)的生命将被挽救。这些估计分别相当于每10,000名囚犯挽救了668人(95%SI：-1008-1812)和1609人(972-2037)的生命。结论：监狱和基于监狱的项目全面筛查并为OUD提供药物治疗，有可能大幅减少高危人群中阿片类药物相关的过量死亡；然而，出院后对治疗的保留是人口水平影响的关键驱动因素。
Background: Medications for opioid use disorder (OUD) are the most effective treatment for OUD, but uptake of these life-saving medications has been extremely limited in US prisons and jail settings, and limited data are available to guide policy decisions. The objective of this study was to estimate the impact of screening and treatment with medications for OUD in US prisons and jails on post-release opioid-related mortality.Methods: We used data from the National Center for Vital Statistics, the Bureau of Justice Statistics, and relevant literature to construct Monte Carlo simulations of a counterfactual scenario in which wide scale uptake of screening and treatment with medications for OUD occurred in US prisons and jails in 2016.Results: Our model predicted that 1840 (95% Simulation Interval [SI]: -2757 - 4959) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated. The model also predicted that approximately 4400 (95% SI: 2675 - 5557) lives would have been saved nationally if all persons who were clinically indicated had received medications for OUD while incarcerated and were retained in treatment post-release. These estimates correspond to 668 (95% SI: -1008 - 1812) and 1609 (95% SI: 972 - 2037) lives saved per 10,000 persons incarcerated, respectively.Conclusions: Prison and jail-based programs that comprehensively screen and provide treatment with medications for OUD have the potential to produce substantial reductions in opioid-related overdose deaths in a high-risk population; however, retention on treatment post-release is a key driver of population level impact.