监狱布普伦诺芬实施和释放后阿片类药物使用障碍结果
Benjamin J Bovell-Ammon1,2, Shapei Yan2, Devon Dunn3
1Departments of Medicine and of Healthcare Delivery and Population Sciences, Baystate Health, Springfield, Massachusetts.
JAMA network open
|March 18, 2024
概括
在监狱中实施阿片类药物使用障碍 (OUD) 的布普伦诺芬,增加了释放后的药物接收和降低死亡率. 这项研究表明,监禁期间的布普伦诺芬可用性可以改善治疗机会和治疗结果.
科学领域:
- 公共卫生 公共卫生
- 成 药物 药物 药物 药物
- 刑事司法 卫生 刑事司法 卫生
背景情况:
- 治疗阿片类药物使用障碍 (MOUD) 的药物,如布普伦诺芬和美沙,可以减少从癌症环境中释放后过量服用的风险,但很少提供.
- 马萨诸塞州惩教局 (MADOC) 于2019年4月开始向被监禁的人提供布普伦诺芬,以及现有的注射性纳尔特雷克松.
研究的目的:
- 评估在监禁期间实施布普伦诺啡因对释放后结果的影响.
- 为了评估药物治疗阿片类药物使用障碍的药物变化,阿片类药物过量使用率和布普伦诺芬可用性后的全因死亡率.
主要方法:
- 一项带有中断时间序列分析的队列研究利用了从2014年1月至2020年11月 (男性) 和2015年1月至2019年10月 (女性) 的州范围数据.
- 该研究包括15225名从MADOC设施释放的个人,按性别分层.
- 用细分线性回归来分析2019年4月布普伦诺芬实施前后结果率的变化.
主要成果:
- 在实施后,释放后的布普伦诺芬接收量在男性 (21.2%与10.6%) 和女性 (31.6%与9.5%) 之间显著增加.
- 在男性 (1.0%对6.0%) 和女性 (3.4%对7.2%) 中,纳尔特雷的接受率下降.
- 虽然不具有统计学意义,但所有原因的死亡率在男性中呈现下降趋势 (1.9%对2.8%),在女性中保持稳定 (1.6%). 阿片类药物过量剂量率没有显著变化.
结论:
- 监禁期间布普伦诺芬的可用性导致释放后增加了这种药物的接收,并减少了纳尔特雷的使用.
- 该研究表明,在癌症环境中提供布普伦诺芬可以改善阿片类药物使用障碍的护理连续性.
- 需要进一步的研究来证实对过量服用和死亡率的影响,特别是在女性中.
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