Pharmacotherapy for opioid dependence in jails and prisons: research review update and future directions.

IF 5.1 Q1 SUBSTANCE ABUSE Substance Abuse and Rehabilitation Pub Date : 2016-04-27 eCollection Date: 2016-01-01 DOI:10.2147/SAR.S81602
Anjalee Sharma, Kevin E O'Grady, Sharon M Kelly, Jan Gryczynski, Shannon Gwin Mitchell, Robert P Schwartz
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引用次数: 42

Abstract

Purpose: The World Health Organization recommends the initiation of opioid agonists prior to release from incarceration to prevent relapse or overdose. Many countries in the world employ these strategies. This paper considers the evidence to support these recommendations and the factors that have slowed their adoption in the US.

Methods: We reviewed randomized controlled trials (RCTs) and longitudinal/observational studies that examine participant outcomes associated with the initiation or continuation of opioid agonists (methadone, buprenorphine) or antagonists (naltrexone) during incarceration. Papers were identified through a literature search of PubMed with an examination of their references and were included if they reported outcomes for methadone, buprenorphine, or naltrexone continued during incarceration or initiated prior to release in a correctional institution.

Results: Fourteen studies were identified, including eight RCTs and six observational studies. One RCT found that patients treated with methadone who were continued on versus tapered off methadone during brief incarceration were more likely to return to treatment upon release. A second RCT found that the group starting methadone treatment in prison versus a waiting list was less likely to report using heroin and sharing syringes during incarceration. A third RCT found no differences in postrelease heroin use or reincarceration between individuals initiating treatment with methadone versus those initiating treatment with buprenorphine during relatively brief incarcerations. Findings from four additional RCTs indicate that starting opioid agonist treatment during incarceration versus after release was associated with higher rates of entry into community treatment and reduced heroin use. Finally, one pilot RCT showed that providing extended-release naltrexone prior to discharge resulted in significantly lower rates of opioid relapse compared to no medication.

Conclusion: Reasons why uptake of these pharmacotherapies is limited in the US and relatively widespread in Europe are discussed. Recommendations for future research are outlined.

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监狱中阿片类药物依赖的药物治疗:研究综述、最新进展和未来发展方向。
目的:世界卫生组织建议在出狱前开始使用阿片类激动剂,以防止复发或过量使用。世界上许多国家都采用这些策略。本文考虑了支持这些建议的证据,以及阻碍这些建议在美国被采纳的因素。方法:我们回顾了随机对照试验(rct)和纵向/观察性研究,这些研究检查了参与者在监禁期间开始或继续使用阿片类激动剂(美沙酮、丁丙诺啡)或拮抗剂(纳曲酮)的结果。通过PubMed的文献检索和参考文献的检查来确定论文,如果它们报告了美沙酮、丁丙诺啡或纳曲酮在监禁期间继续使用或在教养机构释放前开始使用的结果,则将其纳入。结果:共纳入14项研究,包括8项rct和6项观察性研究。一项随机对照试验发现,接受美沙酮治疗的患者在短暂监禁期间继续接受美沙酮治疗,而不是逐渐停止美沙酮治疗,更有可能在释放后重新接受治疗。另一项随机对照试验发现,在监狱中开始美沙酮治疗的小组与等候名单中的小组相比,报告在监禁期间使用海洛因和共用注射器的可能性较小。第三项随机对照试验发现,在相对短暂的监禁期间,开始接受美沙酮治疗的人与开始接受丁丙诺啡治疗的人在释放后海洛因使用或再监禁方面没有差异。另外四项随机对照试验的结果表明,在监禁期间与释放后开始阿片类激动剂治疗与更高的社区治疗率和减少海洛因使用有关。最后,一项试点随机对照试验显示,在出院前提供缓释纳曲酮,与不使用药物相比,阿片类药物复发率显著降低。结论:讨论了这些药物治疗在美国有限而在欧洲相对广泛的原因。对今后的研究提出了建议。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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发文量
9
审稿时长
16 weeks
期刊最新文献
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