Impact of Jail-Based Methadone on Overdose, Recidivism, HIV and Health Outcomes, and Costs in New York City, 2011-2017

项目摘要 阿片类药物使用障碍(OID)在社区和刑事司法中日益普遍 系统导致过量死亡率、糟糕的健康状况和高昂的成本不断上升。人 被监禁在当地监狱和监狱中的人特别容易受到无意伤害的风险增加 服药过量，再次监禁，以及不受控制的艾滋病毒。美沙酮维持治疗有效 对OUD的社区治疗。然而，美沙酮维持治疗的影响通常在 大型、高容量、高周转率的市政监狱设置尚未被研究。纽约市，有一个 大型监狱美沙酮项目，监狱电子病历，以及丰富的地区健康信息 监控数据库，提供了一个独特的机会来评估监狱中的美沙酮治疗和 与释放后服药过量、再次监禁、艾滋病毒控制和费用的关系。 这项研究分析了纽约市监狱服刑人员中与阿片类药物相关的重要结果 纽约市在2011-2017年间入狱，并比较了：a)接触监狱美沙酮的个人 维持治疗计划，并因美沙酮维持治疗而获释，或，b) 被诊断出患有阿片类药物使用障碍，但没有接触美沙酮，并从监狱获释- 非治疗(仅限戒毒)。第二，探索性分析将检查c)较小的 丁丙诺啡维持个体样本。我们将测试美沙酮的主要假设 维持性接触降低了致命和非致命过量服药和监狱累犯的风险，改善了 控制艾滋病毒(在艾滋病毒阳性者中)，提高适当的卫生保健利用率和 降低了成本。这项研究建议将纽约市监狱的电子病历与整个纽约市联系起来 服药过量、再次监禁、艾滋病毒/艾滋病以及相关的健康和经济结果数据，以更好地界定 纽约市监狱美沙酮维护对公众健康的影响。

Project Abstract The growing prevalence of opioid use disorders (OUDs) in the community and in Criminal Justice Systems drives increasing rates of overdose mortality, poor health, and high costs. Persons incarcerated in local jails and prisons are particularly susceptible to increased risk of unintentional overdose, re-incarceration, and uncontrolled HIV. Methadone maintenance treatment is effective community treatment for OUD. However, the impact of methadone maintenance offered routinely in a large, high-volume, high-turnover municipal jail setting has not been studied. New York City, with a large jail methadone program, a jail electronic medical record, and a rich collection of regional health surveillance databases, presents a unique opportunity to estimate in-jail methadone treatment and associations with post-release overdose, re-incarceration, HIV control, and costs. This study analyses important opioid-related outcomes among NYC jail inmates admitted to and leaving NYC jails during 2011-2017, and compares individuals who: a) accessed the jail methadone maintenance treatment program and were released from jail on methadone maintenance, or, b) were diagnosed with an opioid use disorder but did not access methadone and were released from jail out- of-treatment (detox-only). Secondary, exploratory analysis will examine outcomes among, c) a smaller sample of buprenorphine maintained individuals. We will test the primary hypotheses that methadone maintenance exposure reduced the risk of fatal and non-fatal overdoses and jail recidivism, improved HIV control (among HIV-positive persons), and improved rates of appropriate health care utilization and lowered costs. This study proposes to link New York City jail electronic medical records with NYC-wide overdose, re-incarceration, HIV/AIDS, and related health and economic outcome data to better define the public health impact of methadone maintenance in NYC jails.