Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap
Expanding low-threshold buprenorphine to justice-involved individuals through mobile treatment: Addressing a critical care gap
复制标题
DOI：
10.1016/j.jsat.2019.05.002
复制
发表时间：
2019-08-01
影响因子：
3.9
通讯作者：
Agus, Deborah
中科院分区：
文献类型：
--
作者：
Krawczyk, Noa;Buresh, Megan;Agus, Deborah
背景：阿片类药物使用障碍（OUD）在涉及正义的个人中非常普遍。虽然该人群中阿片类药物使用过量和其他不良后果的风险较高，但大多数涉及正义的个人和其他高危群体在参与阿片类激动剂治疗时遇到多重障碍。 方法：本文描述了“重返项目连接”(PCARE) 的开发，这是一项低门槛丁丙诺啡治疗计划，通过一辆停在巴尔的摩市监狱外的移动货车为弱势患者提供护理。病人可以由监狱工作人员转介，也可以从街上步行进来。临床团队包括一名经验丰富的开丁丙诺啡的初级保健医生、一名护士和一名同伴康复教练。该团队开始对 OUD 患者进行治疗，并将有其他需求的患者转介给适当的提供者。一旦病情稳定，患者将过渡到长期治疗计划或初级保健以维持丁丙诺啡。本文描述了该计划的开发过程、该计划第一年的患者特征和初步结果，以及对公共卫生实践的影响。 结果：从 2017 年 11 月 15 日到 2018 年 11 月 30 日，220 人询问了治疗服务并完成了入院访谈，190 人开始接受丁丙诺啡/纳洛酮处方治疗。开始使用丁丙诺啡的人主要是男性 (80.1%)、非裔美国人 (85.1%)，平均年龄为 44.1 (SD = 12.2)，平均使用阿片类药物 24.0 (SD = 13.6) 年。大多数患者（94.4%）有过刑事司法经历、失业（72.9%）和居住不稳定（70.8%）。超过三分之一（32.1%）的患者之前曾服用过过量药物。在开始治疗的患者中，67.9% 的患者进行了第二次或更多次就诊，31.6% 的患者在 30 天后仍在接受治疗。在开始护理的人中，20.5% 已转移到合作地点继续接受丁丙诺啡治疗。结论：PCARE 计划表明，低阈值丁丙诺啡治疗有可能吸引那些参与正义且很大程度上与护理脱节的人群。虽然需要做更多的工作来改善弱势患者的治疗保留率，并在拘留释放后立即让接受护理的人参与进来，但提供按需、灵活和去污名化的治疗可能会成为将高危人群与医疗保健系统和干预措施联系起来的首要点，以降低用药过量和相关伤害的风险。
Background: Opioid use disorder (OUD) is highly prevalent among justice-involved individuals. While risk for overdose and other adverse consequences of opioid use are heightened among this population, most justice involved individuals and other high-risk groups experience multiple barriers to engagement in opioid agonist treatment.Methods: This paper describes the development of Project Connections at Re-Entry (PCARE), a low-threshold buprenorphine treatment program that engages vulnerable patients in care through a mobile van parked directly outside the Baltimore City Jail. Patients are referred by jail staff or can walk in from the street. The clinical team includes an experienced primary care physician who prescribes buprenorphine, a nurse, and a peer recovery coach. The team initiates treatment for those with OUD and refers those with other needs to appropriate providers. Once stabilized, patients are transitioned to longer-term treatment programs or primary care for buprenorphine maintenance. This paper describes the process of developing this program, patient characteristics and initial outcomes for the first year of the program, and implications for public health practice.Results: From November 15, 2017 through November 30, 2018, 220 people inquired about treatment services and completed an intake interview, and 190 began treatment with a buprenorphine/naloxone prescription. Those who initiated buprenorphine were primarily male (80.1%), African American (85.1%), had a mean age of 44.1 (SD = 12.2), and a mean of 24.0 (SD = 13.6) years of opioid use. The majority of patients (94.4%) had previous criminal justice involvement, were unemployed (72.9%) and were unstably housed (70.8%). Over a third (32.1%) of patients had previously overdosed. Of those who began treatment, 67.9% returned for a second visit or more, and 31.6% percent were still involved in treatment after 30 days. Of those who initiated care, 20.5% have been transferred to continue buprenorphine treatment at a partnering site.Conclusions: The PCARE program illustrates the potential for low-threshold buprenorphine treatment to engage populations who are justice-involved and largely disconnected from care. While more work is needed to improve treatment retention among vulnerable patients and engaging persons in care directly after release from detention, offering on-demand, flexible and de-stigmatizing treatment may serve as a first point to connect high-risk populations with the healthcare system and interventions that reduce risk for overdose and related harms.