International Journal of Drug Policy最新文献

National impact of a constraining regulatory framework on pregabalin dispensations in France, 2020–2022 2020-2022 年限制性监管框架对法国普瑞巴林配药的全国性影响

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-23 DOI: 10.1016/j.drugpo.2024.104660

Julia de Ternay , Claire Meley , Patrick Guerin , Sébastien Meige , Nicolas Grelaud , Benjamin Rolland , Mathieu Chappuy

Background

Pregabalin is a drug approved for neuropathic pain, epilepsy and general anxiety disorder. However, pregabalin is also an increasing cause of diversion and misuse, and, for this reason, the French health authorities have decided in 2021 to classify it as a narcotic drug, requiring secured prescription pads. Our study aimed to evaluate the impact of this measure on pregabalin dispensation patterns.

Methods

Using data from a national representative sample of 12,690 French community pharmacies, we assessed the impact of the new regulatory framework, implemented in June 2021, on the total monthly quantity of pregabalin dispensed by conducting an interrupted time-series (ITS) analysis. We built a counterfactual model to predict what would have happened without the intervention. We conducted the same analyses in the subsample of pregabalin dispensations exceeding the maximum recommended dosage of 600 mg per day. Additionally, we compared (1) the number of pregabalin dispensations (2) the co-dispensing of opioids and/or benzodiazepines one year before and one year after the regulation.

Results

Following the regulatory change, there was an immediate and significant drop of 38,475,375 mg (95 %CI [-66,931,799 mg; -10,018,951 mg] in pregabalin dispensations. This decline continued in the following months, with a decrease of 4,788,107 mg (95 %CI: [-8,888,326 mg; -687,888 mg] per month. The counterfactual model predicted that, without the intervention, there would have been no notable change in pregabalin dispensations. The ITS analyses showed no significant change in pregabalin dispensations following the new regulation for the subsample with doses exceeding 600 mg per day. Concurrently, there was a significant decrease in co-dispensing of opioids (18.4 % pre-regulation versus 11.6 % post-regulation, p < 0.001) and benzodiazepines (21.4 % pre-regulation versus 11.7 % post-regulation, p < 0.001).

Conclusion

The constraining regulation adopted in 2021 by the French health authorities significantly curtailed total pregabalin dispensing in community pharmacies. Our findings underscore the importance of regulatory measures to limit the misuse of a prescribed medication.

背景普瑞巴林是一种获准用于治疗神经性疼痛、癫痫和一般焦虑症的药物。然而，普瑞巴林也日益成为被转移和滥用的原因，因此，法国卫生当局决定在 2021 年将其列为麻醉药品，要求使用安全的处方笺。我们的研究旨在评估这一措施对普瑞巴林配药模式的影响。方法我们利用具有全国代表性的 12,690 家法国社区药房的样本数据，通过中断时间序列 (ITS) 分析，评估了 2021 年 6 月实施的新监管框架对普瑞巴林每月配药总量的影响。我们建立了一个反事实模型，以预测在没有干预措施的情况下会发生什么。我们对普瑞巴林配药量超过每天 600 毫克最高推荐剂量的子样本进行了同样的分析。此外，我们还比较了（1）普瑞巴林的配药次数（2）法规实施前一年和法规实施后一年阿片类药物和/或苯二氮卓类药物的联合配药情况。结果法规实施后，普瑞巴林的配药次数立即大幅下降了 38,475,375 毫克（95 %CI [-66,931,799 毫克；-10,018,951 毫克]）。这种下降趋势在接下来的几个月中仍在继续，每月减少 4,788,107 毫克（95 %CI：[-8,888,326 毫克；-687,888 毫克]）。根据反事实模型预测，如果不采取干预措施，普瑞巴林的用量将不会发生显著变化。ITS 分析表明，在新法规实施后，每日剂量超过 600 毫克的亚样本的普瑞巴林配药量没有发生显著变化。同时，阿片类药物（监管前为 18.4%，监管后为 11.6%，p <0.001）和苯二氮卓类药物（监管前为 21.4%，监管后为 11.7%，p <0.001）的联合配药量大幅减少。我们的研究结果强调了限制滥用处方药的监管措施的重要性。

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引用次数: 0

Suboptimal uptake and placement of a mandatory alcohol pregnancy warning label in Australia 澳大利亚对强制性酒精怀孕警告标签的接受程度和贴标情况不佳

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-23 DOI: 10.1016/j.drugpo.2024.104661

Tazman Davies , Paula O'Brien , Jacqueline Bowden , Bella Sträuli , Asad Yusoff , Michelle Jongenelis , Alexandra Jones , Aimee Brownbill , Tanya Chikritzhs , Julia Stafford , Simone Pettigrew

Background

Mandatory pregnancy warning labels are an important public health measure to signal the harms of drinking alcohol during pregnancy. Ensuring these labels are salient is critical to enhancing their effectiveness. On 31 July 2020, Australia mandated that alcoholic beverages labelled from 1 August 2023 display a pregnancy warning label. This study assessed uptake and placement of this warning on alcohol containers after the policy start date.

Methods

Between August and November 2023, data collectors obtained images of 4026 unique alcoholic beverages available for sale across four major Australian alcohol retailers in Sydney (three physical stores and one online store). Product images were investigated to assess overall uptake of the mandatory pregnancy warning label and its placement on products (i.e., front, side, back, top, or bottom). Analyses were conducted overall and stratified across six alcohol product categories.

Results

Two-thirds (63 %) of products displayed the mandatory pregnancy warning label. Uptake was lowest for spirits (50 %), followed by wine (65 %), cider (79 %), premix drinks (79 %), beer (83 %), and other alcoholic beverages (e.g., sake and soju) (91 %). The mandatory pregnancy warning label was most commonly located on the back (88 %) and less commonly on the side (8 %), bottom (3 %), top (1 %), or front (0.3 %).

Conclusion

To increase uptake of the mandatory pregnancy warning label, policymakers should consider mandating that all alcoholic beverages available for sale, not just products labelled from 1 August 2023, display the warning. Existing requirements could be revised to ensure that the label is more prominently displayed.

背景强制性妊娠警告标签是一项重要的公共卫生措施，旨在提醒人们注意孕期饮酒的危害。确保这些标签醒目是提高其有效性的关键。2020 年 7 月 31 日，澳大利亚规定自 2023 年 8 月 1 日起，贴有怀孕警示标签的酒精饮料必须显示怀孕警示标签。在 2023 年 8 月至 11 月期间，数据收集人员获取了悉尼四家澳大利亚主要酒类零售商（三家实体店和一家网店）出售的 4026 种不同酒类的图片。对产品图片进行了调查，以评估强制性怀孕警告标签的总体使用情况及其在产品上的位置（即正面、侧面、背面、顶部或底部）。结果三分之二（63%）的产品展示了强制性怀孕警告标签。烈性酒的使用率最低（50%），其次是葡萄酒（65%）、苹果酒（79%）、预混合饮料（79%）、啤酒（83%）和其他酒精饮料（如清酒和烧酒）（91%）。为提高强制怀孕警告标签的使用率，政策制定者应考虑强制要求所有上市销售的酒精饮料（而不仅仅是 2023 年 8 月 1 日以后上市的产品）标示怀孕警告。可对现有要求进行修订，以确保标签更加醒目。

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引用次数: 0

How does climate change impact people who use alcohol and other drugs? A scoping review of peer reviewed literature 气候变化对酒精和其他药物使用者有何影响？同行评议文献范围综述。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-21 DOI: 10.1016/j.drugpo.2024.104649

Sarah MacLean , Julia de Nicola , Kimberlea Cooper , Heather Downey , Jacqui Theobald , Lisa de Kleyn , Todd Denham , Eleanor Costello , Lauren Rickards

Background

The world has experienced devastating extreme weather events, alongside slow-onset processes including increasing temperature means, that scientists agree are manifestations of human-induced climate change. Even with radical action to reduce greenhouse gas emissions, effects of climate change will become increasingly severe.

Objectives

The aim of this review was to classify impacts of climate change for people who use alcohol and other drugs (AoD), as reflected in peer reviewed literature.

Method

A scoping review was conducted to achieve this. Included studies involved a human population, a climate change related exposure, and an AoD outcome. Studies were published in English between 1998 and November 2023. Exposure events of interest included extreme heat, fires, storms, floods, droughts, and longer-term environmental changes. 8,204 studies were screened, with 82 included for data extraction and narrative analysis.

Results

Most papers describe increased AoD use, with smaller numbers showing decreased or unchanged substance use. Some studies identify unplanned withdrawal, changed drug markets, disrupted service access, specific physiological vulnerabilities of AoD users to extreme heat, and compounding effects on mental health. We note the relative absence of peer reviewed studies investigating impacts of climate change on AoD use in low-and middle-income countries. Further, few studies consider impacts that occur because of long-term or gradual climatic shifts such as environmental changes that are detrimental to livelihoods.

Conclusion

It is crucial to document effects of a changing climate on people who use AoD so that policy and services can meet future needs. We call for research to remedy gaps identified in this review.

背景：世界经历了毁灭性的极端天气事件，同时还经历了缓慢发生的过程，包括气温上升，科学家们一致认为这是人类引起的气候变化的表现。即使采取激进行动减少温室气体排放，气候变化的影响也会变得越来越严重：本综述旨在对同行评议文献中反映的气候变化对酒精和其他药物（AoD）使用者的影响进行分类：为此，我们进行了一次范围界定审查。纳入的研究涉及人口、与气候变化相关的暴露和酗酒及其他药物使用者的结果。这些研究是在 1998 年至 2023 年 11 月期间用英文发表的。相关暴露事件包括极端高温、火灾、风暴、洪水、干旱和长期环境变化。共筛选出 8204 项研究，其中 82 项用于数据提取和叙事分析：结果：大多数论文描述了嗜酸性物质使用量的增加，少量论文显示药物使用量的减少或不变。一些研究指出了计划外戒毒、毒品市场变化、服务中断、鸦片和摇头丸使用者在极端高温下的特殊生理脆弱性以及对心理健康的复合影响。我们注意到，在中低收入国家，调查气候变化对鸦片和摇头丸使用影响的同行评审研究相对缺乏。此外，很少有研究考虑因长期或渐进的气候变化而产生的影响，如不利于生计的环境变化：结论：记录不断变化的气候对使用户外活动的人们的影响至关重要，这样才能使政策和服务满足未来的需求。我们呼吁开展研究，弥补本综述中发现的不足。

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引用次数: 0

Increases in employment over six months following Khanya: A secondary analysis of a pilot randomized controlled trial of a peer-delivered behavioral intervention for substance use and HIV medication adherence in Cape Town, South Africa Khanya之后六个月内就业率的提高：对南非开普敦由同伴提供的药物使用和艾滋病药物依从性行为干预试点随机对照试验的二次分析。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-21 DOI: 10.1016/j.drugpo.2024.104632

Jennifer M. Belus , Kristen S. Regenauer , Thanh Lu , Sean M. Murphy , Alexandra L. Rose , Yvonne Akinyi Ochieng , John Joska , Sybil Majokweni , Lena S. Andersen , Bronwyn Myers , Steven A. Safren , Jessica F. Magidson

Introduction

Evidence suggests that brief, skills-based behavioral interventions are effective at improving clinical outcomes related to substance use and HIV, but little data exists on whether such interventions can incidentally improve employment. We examined preliminary changes in employment over six months following Khanya, a brief peer-delivered behavioral intervention to reduce substance use and improve antiretroviral therapy (ART) adherence compared to enhanced treatment as usual (ETAU).

Methods

Adults living with HIV (N = 61) with at least moderate substance use and ART non-adherence were recruited from a primary care clinic in Khayelitsha, South Africa, a community with high rates of unemployment. Participants were randomized 1:1 to Khanya versus ETAU and assessed at baseline, 3- and 6-months. Employment was categorized as unemployed, casually, or full-time employed. Multilevel modeling was used to predict log odds and probability of categorical employment status over time, by arm.

Results

At baseline, 78.7% of the sample were unemployed, 16.4% were casually employed, and 4.9% were employed full-time. There was a significant increase in employment in both treatment arms at 3-months (p = 0.03) but only the Khanya arm demonstrated significant increases at 6-months (p = 0.02). At 6-months, 59% of participants in Khanya had any employment (from 13% at baseline), compared to 38% in ETAU (from 29% at baseline).

Conclusions

Study data suggest a brief behavioral intervention for substance use and ART adherence may support employment among people with HIV living in a resource-constrained community. However, future research with larger sample sizes and longer-term follow ups is needed to replicate these findings.

Trial registration

ClinicalTrials.gov identifier: NCT03529409. Trial registered on May 18, 2018

导言：有证据表明，以技能为基础的简短行为干预能有效改善与药物使用和艾滋病相关的临床结果，但关于此类干预是否能附带改善就业的数据却很少。Khanya 是一种由同伴提供的简短行为干预措施，旨在减少药物使用并改善抗逆转录病毒疗法（ART）的依从性：从南非失业率较高的社区 Khayelitsha 的一家初级保健诊所招募了至少有中度药物使用和抗逆转录病毒疗法未坚持治疗的成年 HIV 感染者（N = 61）。参与者按 1:1 随机分配到 Khanya 和 ETAU，并在基线、3 个月和 6 个月时进行评估。就业分为失业、临时就业和全职就业。我们采用多层次模型来预测随着时间的推移，各部门分类就业状况的对数几率和概率：基线时，78.7% 的样本处于失业状态，16.4% 的样本处于临时就业状态，4.9% 的样本处于全职就业状态。两个治疗组的就业率在 3 个月后都有明显提高（p = 0.03），但只有康亚治疗组的就业率在 6 个月后有明显提高（p = 0.02）。在 6 个月时，59% 的 Khanya 参与者有工作（基线时为 13%），而 ETAU 为 38%（基线时为 29%）：研究数据表明，针对药物使用和坚持抗逆转录病毒疗法的简短行为干预可以帮助生活在资源有限社区的艾滋病病毒感染者实现就业。然而，未来的研究需要更大的样本量和更长期的随访，以复制这些发现：试验注册：ClinicalTrials.gov identifier：NCT03529409。试验注册时间：2018年5月18日。

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引用次数: 0

The criminal careers of Australian drug traffickers 澳大利亚贩毒者的犯罪生涯。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-21 DOI: 10.1016/j.drugpo.2024.104650

Don Weatherburn , Michael Farrell , Wai-Yin Wan , Sara Rahman

Background

Very few studies have examined the criminal careers of drug traffickers. Our aim in this study was to determine (a) the percentage of drug traffickers who cease involvement in crime following their first conviction for drug trafficking, (b) the factors that affect the likelihood and speed of re-offending among drug traffickers, (c) the factors that affect the rate of reoffending among drug traffickers and (d) the scale of drug trafficker involvement in crimes other than drug trafficking.

Methods

We characterize the criminal careers of a sample of 30,020 cases of offenders convicted of drug trafficking in New South Wales (NSW), Australia over the 29-year period between 2000 and 2023, focussing on how drug charge, trafficker type, and drug and alcohol use affect the risk and frequency of offending. We use a combination of descriptive statistics, cure fraction regression and negative binomial regression. Our controls in the regression analyses consist of age, age of first conviction and number of prior convictions.

Results

The ‘cure’ rate among males aged 30–39 who were first convicted between 19 and 35 years of age, whose principal offence is trafficking in a non-commercial quantity of heroin, who have three prior convictions and who score ‘moderate’ in terms of the LSI-R drug/alcohol scale is 31 per cent. The instantaneous risk of re-offending among ATS, heroin, cannabis and ecstasy traffickers ranges between 62 and 82 per cent higher than among cocaine traffickers. Convicted drug traffickers commit a wide variety of offences but only a small proportion are convicted of drug offences before or after their first conviction for drug trafficking.

Conclusions

The present study raises two important questions for future research. The first concerns whether those involved in drug trafficking in Australia rely on it as a primary source of income or whether it is just one of several income-generating criminal activities they switch between in the course of a criminal career. The second question is why there are such marked differences in the risk, speed and frequency of offending among traffickers of different drugs.

背景：很少有研究调查过贩毒者的犯罪生涯。本研究旨在确定：(a) 首次因贩毒被定罪后不再参与犯罪的贩毒者比例；(b) 影响贩毒者再次犯罪的可能性和速度的因素；(c) 影响贩毒者再次犯罪率的因素；(d) 除贩毒外，贩毒者参与其他犯罪的规模：我们对澳大利亚新南威尔士州（NSW）2000 年至 2023 年 29 年间 30,020 例因贩毒而被定罪的罪犯的犯罪生涯进行了抽样调查，重点关注毒品指控、毒贩类型以及毒品和酒精的使用如何影响犯罪风险和频率。我们结合使用了描述性统计、固化分数回归和负二项回归。回归分析中的控制因素包括年龄、首次定罪年龄和前科数量：年龄在 30-39 岁之间、首次定罪年龄在 19-35 岁之间、主要罪行是贩运非商业数量的海洛因、有三次前科且在 LSI-R 毒品/酒精量表中得分 "中等 "的男性的 "治愈 "率为 31%。苯丙胺类兴奋剂、海洛因、大麻和摇头丸贩运者的瞬时再犯罪风险比可卡因贩运者高 62%至 82%。被定罪的贩毒者所犯的罪行种类繁多，但只有一小部分人在首次因贩毒被定罪之前或之后因毒品犯罪而被定罪：本研究为今后的研究提出了两个重要问题。第一个问题涉及在澳大利亚参与贩毒的人是否将贩毒作为主要收入来源，还是贩毒只是他们在犯罪生涯中转换的几种创收犯罪活动之一。第二个问题是，为什么不同毒品的贩运者在犯罪风险、速度和频率上存在如此明显的差异。

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引用次数: 0

Impact of the COVID-19 pandemic on cannabis cultivation and use in 18 countries. COVID-19 大流行对 18 个国家大麻种植和使用的影响。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-21 DOI: 10.1016/j.drugpo.2024.104652

Bernd Werse, Gerrit Kamphausen, Thomas Friis Søgaard, Daniel Bear, Martin Audran, Chris Wilkins, Gary Potter, Davide Fortin, Pekka Hakkarainen, Rita Faria, Jorge Quintas, Jodie Grigg, Marie Jauffret-Roustide, Monica J Barratt

Background: The COVID-19 pandemic and the accompanying measures to mitigate infection affected many areas of society, including the supply and use of cannabis. This paper explored how patterns of behaviour among people who cultivate cannabis were affected by the COVID-19 pandemic and restrictions.

Methods: An anonymous web survey of people who cultivated cannabis was conducted from Aug 2020 to Sep 2021, spanning 18 countries and 11 languages (N = 11,479). Descriptive statistics and mean comparison tests were conducted.

Results: Most cannabis growers reported that their practices were relatively unaffected by the COVID-related restrictions. While 35.2 % reported difficulties buying cannabis from their usual dealer, <10 % stated that access to materials needed for growing was impaired during the pandemic. Over one-quarter (28.2 %) of respondents increased their cannabis use and 21.4 % also increased cannabis cultivation (more than twice as many as those who said they were growing less or not anymore) while COVID restrictions were in place. People who lost their job or were casually employed were more likely to increase use and cultivation. Overall, the pandemic had little impact on reasons for growing, however, difficulties obtaining cannabis were mentioned as the most prevalent COVID-19-related growing motive. A small number (16 %) reported starting their growing activity during the pandemic. Italian and Portuguese growers were more likely to report shortages in supply and increases in their growing activity.

Conclusions: This study is the first to document an increase in cannabis cultivation activity following COVID restrictions. Increased home cultivation was not only driven by higher use as a result of home isolation, but also by disruptions of wider illegal cannabis supply. Limitations of this study include the non-representativeness of the sample as well as differences in approaches and duration of restrictions in different countries.

背景：COVID-19 大流行和随之而来的减轻感染措施影响了社会的许多领域，包括大麻的供应和使用。本文探讨了种植大麻者的行为模式如何受到 COVID-19 大流行和限制措施的影响：从 2020 年 8 月到 2021 年 9 月，对种植大麻的人进行了匿名网络调查，涉及 18 个国家和 11 种语言（N = 11,479 人）。调查进行了描述性统计和均值比较测试：大多数大麻种植者表示，他们的种植行为相对不受 COVID 相关限制措施的影响。35.2%的种植者称难以从其惯常的经销商处购买大麻：这项研究首次记录了 COVID 限制令实施后大麻种植活动的增加。家庭种植活动的增加不仅是由于家庭隔离导致使用量增加，也是由于更广泛的非法大麻供应受到干扰。这项研究的局限性包括样本不具代表性，以及不同国家的限制方法和期限存在差异。

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引用次数: 0

“No penalties. No arrests. No jails”: Perspectives on drug decriminalization among people who inject drugs in Sydney "没有处罚。没有逮捕。没有监狱"：悉尼注射毒品者对毒品非刑罪化的看法。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-20 DOI: 10.1016/j.drugpo.2024.104657

George Christopher Dertadian, Vicki Sentas

The decriminalization of drug possession in varied forms is gaining some traction around the world. Yet prospects for people with lived and living experience of drug use to influence the direction of drug law and policy reform remains bound by stigma and exclusion. This study considers the aspirations for decriminalization of people who inject drugs through 20 semi-structured qualitative interviews with the clients of the Sydney injecting centre. What does decriminalization mean for those most criminalised by drug law and policy? The study found that participants' views of what is possible for decriminalization are mediated by the same structures and experiences of criminalization, incarceration and exclusion that has disrupted their lives. Participants anticipate the need to mobilise incremental and partial changes associated with de facto models, including fines, increased police discretion (and therefore power) and treatment orders. At the same time, participants collective imaginary also exceeds the limits of a police-controlled depenalization. We document people's claims on a future drug policy that speaks to a world without criminal drug offences, punitive controls and the exclusion of people who use drugs from the policy table.

在世界范围内，各种形式的持有毒品非刑罪化正在获得一些关注。然而，有吸毒经历和生活经验的人影响毒品法律和政策改革方向的前景仍然受到耻辱和排斥的束缚。本研究通过对悉尼注射中心的客户进行 20 次半结构化定性访谈，探讨注射毒品者对非刑罪化的期望。对于那些最容易被毒品法律和政策定罪的人来说，非刑罪化意味着什么？研究发现，参与者对非刑罪化可能带来的影响的看法受到了同样的结构和定罪、监禁和排斥经历的影响，这些经历扰乱了他们的生活。参与者预计需要动员与事实模式相关的渐进和局部变革，包括罚款、增加警察的自由裁量权（因此也是权力）和治疗令。与此同时，参与者的集体想象也超越了警方控制下的去 "禁化性 "限制。我们记录了人们对未来缉毒政策的诉求，这些诉求表达了一个没有毒品刑事犯罪、惩罚性管制以及将吸毒者排除在政策之外的世界。

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引用次数: 0

Tackling the overdose crisis through unionization a response to Rivera & Friedman (2024) 通过工会化应对用药过量危机，回应 Rivera & Friedman (2024)。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-20 DOI: 10.1016/j.drugpo.2024.104659

Abdullah Shihipar, Brandon D.L. Marshall

引用次数: 0

“Tethered to this ball and chain”: Women's perspectives on bodily agency within opioid treatment programs "拴在这个球和链子上"：妇女对阿片类药物治疗项目中身体机构的看法。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-19 DOI: 10.1016/j.drugpo.2024.104645

Aden McCracken , Kristina Brant , Carl Latkin , Abenaa Jones

Background

Methadone Maintenance Treatment (MMT) reduces the risks associated with opioid use disorder (OUD), including overdose mortality and HIV/HCV transmission, and promotes patient well-being. Nonetheless, MMT is highly underutilized in the United States, with less than 10 % of those with OUD receiving MMT. This study examines how women's feelings of bodily agency while receiving MMT through Opioid Treatment Programs (OTPs) can impact treatment retention.

Methods

In-depth interviews were conducted with 20 women in Pennsylvania with a lifetime history of criminal legal involvement and use of medications for opioid use disorder (MOUD), and 12 substance use disorder (SUD) treatment professionals who work with criminal-legal involved women using MOUD. A thematic analysis was conducted using iterative rounds of inductive coding.

Results

While women attested to the profound benefits which methadone treatment can provide, they also described how both formal and informal policies in the OTP system can taper these benefits by diminishing their feelings of bodily agency. Women reported a lost sense of bodily agency due to being unable to provide input in the dosing process, navigating strict requirements that tied medication receipt to compliance, and facing mistreatment or threats of punishment when committing perceived transgressions. Women responded through actions that reclaimed bodily agency, by either leaving treatment or using illicit drugs while in treatment; both of these actions can end women's engagement with treatment. Finally, evidence suggests that these feelings of lost agency may be particularly prevalent among female patients due to gendered judgments about women's histories and capabilities.

Conclusion

Findings suggest the need for MMT programs to shift toward patient-centered, trauma-informed care informed by harm-reductionist principles. Concrete policy recommendations include reducing measures of surveillance, prohibiting administrative discharge due to the use of other substances, and expanding access to methadone beyond OTPs.

背景：美沙酮维持治疗（MMT）可降低与阿片类药物使用障碍（OUD）相关的风险，包括用药过量死亡和艾滋病毒/丙肝病毒传播，并促进患者的健康。然而，在美国，阿片类药物维持治疗的利用率非常低，只有不到 10% 的阿片类药物使用障碍患者接受了阿片类药物维持治疗。本研究探讨了女性在通过阿片类药物治疗项目（OTPs）接受 MMT 治疗时的身体代入感如何影响治疗的持续性：本研究对宾夕法尼亚州 20 名终生涉及刑事法律并使用药物治疗阿片类药物使用障碍（MOUD）的女性，以及 12 名为涉及刑事法律并使用 MOUD 的女性提供服务的药物使用障碍（SUD）治疗专业人员进行了深入访谈。我们采用反复的归纳编码方法进行了专题分析：结果：尽管妇女们证实了美沙酮治疗所能带来的巨大益处，但她们也描述了 OTP 系统中的正式和非正式政策是如何通过削弱她们的身体能动性来减少这些益处的。妇女们报告说，由于无法在服药过程中提供意见，无法应对将药物领取与依从性挂钩的严格要求，以及在犯下自认为的过失时面临虐待或惩罚威胁，她们失去了身体的能动性。妇女们的应对措施是重新获得身体代理权，要么离开治疗，要么在治疗期间使用违禁药物；这两种行为都可能会终止妇女对治疗的参与。最后，有证据表明，由于对女性历史和能力的性别判断，这些丧失代理权的感觉在女性患者中可能尤为普遍：研究结果表明，MMT 项目需要转向以患者为中心、以减少伤害为原则的创伤知情护理。具体的政策建议包括减少监控措施、禁止因使用其他药物而行政遣散病人，以及将美沙酮的使用范围扩大到 OTP 以外。

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引用次数: 0

Opioid agonist treatment programs and hepatitis C virus elimination in Taiwan: Ways of expanding the care cascade in screening and treatment 台湾的阿片类受体激动剂治疗计划与丙型肝炎病毒的消除：扩大筛查和治疗护理级联的方法。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy

Pub Date : 2024-11-14 DOI: 10.1016/j.drugpo.2024.104658

Yu-Chu Ella Chung , Ching-Ing Tseng , Sheng-Chang Wang , Chieh-Liang Huang , Lian-Yu Chen , Raoh-Fang Pwu , Ching-Ching Claire Lin , An-Nie Chung , Jing-Shu Lin , Wei J. Chen

Background

One key population related to achieving the global goal of hepatitis C virus (HCV) elimination is people who inject drugs (PWID). By surveying opioid agonist treatment (OAT) programs nationwide in Taiwan, this study aimed to examine (1) the current status of HCV care cascade provision by OAT programs and (2) the opinions of the programs’ directors on integrating the HCV care cascade into OAT programs.

Methods

From September to November 2022, questionnaires were sent via administrative networks to case managers for information on daily operation and routine booking and to directors for information on the HCV care cascade of 185 OAT programs. The responses of the 125 OAT programs that provided information from both case managers and directors were included for subsequent analyses.

Results

Among the 125 OAT programs, 91 (73 %) offered HCV antibody testing, and 69 (55 %) offered HCV treatment services. The provision of HCV antibody testing was associated with being general hospital- or psychiatric hospital-based and having more care team personnel, whereas the provision of HCV treatment was associated with being general hospital-based. However, on-site HCV treatment was found to be rarely offered, and the future willingness to do so remained low.

Conclusion

Our survey revealed that the provision of HCV screening and treatment in OAT programs in Taiwan has substantial room for improvement. Increasing the number of care personnel for satellite-dispensing OAT programs is key to expanding the service for HCV screening, as more issues related to multidisciplinary medical resources are involved in the provision of HCV treatment. Our results point to some options that might help accomplish these goals.

背景：注射吸毒者（PWID）是实现消除丙型肝炎病毒（HCV）这一全球目标的关键人群之一。本研究通过调查台湾全国的阿片类受体激动剂治疗（OAT）项目，旨在了解（1）OAT项目提供HCV级联护理的现状；（2）项目负责人对将HCV级联护理纳入OAT项目的看法：方法：2022年9月至11月，通过行政网络向185个OAT项目的个案经理发送了调查问卷，以了解其日常运作和例行预约的情况，并向项目主任发送了调查问卷，以了解其HCV级联护理的情况。在随后的分析中，纳入了同时向个案经理和主任提供信息的 125 个 OAT 项目的答复：在 125 个 OAT 项目中，91 个（73%）提供了 HCV 抗体检测，69 个（55%）提供了 HCV 治疗服务。提供 HCV 抗体检测与综合医院或精神病院以及拥有更多护理团队人员有关，而提供 HCV 治疗则与综合医院有关。然而，现场 HCV 治疗很少提供，而且未来提供治疗的意愿仍然很低：我们的调查显示，在台湾，OAT 项目中提供的 HCV 筛查和治疗还有很大的改进空间。增加卫星配药 OAT 项目的护理人员数量是扩大 HCV 筛查服务的关键，因为在提供 HCV 治疗时会涉及更多与多学科医疗资源相关的问题。我们的研究结果指出了一些有助于实现这些目标的方案。

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引用次数: 0