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Impact of a jail-based treatment decision-making intervention on post-release initiation of medications for opioid use disorder.
Drug and Alcohol Dependence ( IF 4.2 ) Pub Date : 2019-12-11 , DOI: 10.1016/j.drugalcdep.2019.107799
C J Banta-Green 1 , J R Williams 2 , J M Sears 3 , A S Floyd 4 , J I Tsui 5 , T J Hoeft 6
Affiliation  

INTRODUCTION Opioid use disorder (OUD) is common among people in jail and is effectively treated with medications for OUD (MOUD). People with OUD may have an incomplete or inaccurate understanding of OUD and MOUD, and of how to access care. We evaluated an OUD treatment decision making (TDM) intervention to determine whether the intervention increased MOUD initiation post-release. METHODS We conducted an observational retrospective cohort study of the TDM intervention on initiation of MOUD, individuals with records data indicating confirmed or suspected OUD incarcerated in four eligible jails were eligible to receive the intervention. Time-to-event analyses of the TDM intervention were conducted using Cox proportional hazard modeling with MOUD as the outcome. RESULTS Cox proportional hazard modeling, with the intervention modeled as having a time-varying effect due to violation of the proportionality assumption, indicated that those receiving the TDM intervention (n = 568) were significantly more likely to initiate MOUD during the first month after release from jail (adjusted hazard ratio 6.27, 95 % C.I. 4.20-9.37), but not in subsequent months (AHR 1.33 95 % C.I. 0.94-1.89), adjusting for demographics, prior MOUD, or felony or gross misdemeanor arrest in the prior year compared to those not receiving the intervention (n = 3174). CONCLUSION The TDM intervention was associated with a significantly higher relative hazard of starting MOUD, specifically during the first month after incarceration. However, a minority of all eligible people received any MOUD. Future research should examine ways to increase initiation on MOUD immediately after (or ideally during) incarceration.

中文翻译:

基于监狱的治疗决策干预措施对阿片类药物使用障碍的药物释放后启动的影响。

简介阿片类药物使用障碍(OUD)在监狱中很常见,可以用OUD(MOUD)药物有效治疗。患有OUD的人可能对OUD和MOUD以及如何获得医疗服务的理解不完整或不准确。我们评估了OUD治疗决策制定(TDM)干预措施,以确定该干预措施是否增加了MOUD释放后的启动。方法我们对开始进行MOUD的TDM干预进行了一项观察性回顾性队列研究,记录数据表明在四个合格监狱中确诊或怀疑OUD入狱的人有资格接受干预。使用Cox比例风险模型,以MOUD作为结果,对TDM干预进行了事件分析。结果Cox比例风险建模,干预被建模为由于违反比例假设而具有随时间变化的影响,表明接受TDM干预的人(n = 568)在从监狱释放后的第一个月内更有可能发起MOUD(调整后的危险比) 6.27,95%CI 4.20-9.37),但以后没有(AHR 1.33 95%CI 0.94-1.89),与未接受干预的人群相比,根据上一年的人口统计学,先前的MOUD或重罪或轻罪轻罪逮捕进行了调整(n = 3174)。结论TDM干预与开始MOUD的相对较高的危险性相关,特别是在入狱后的第一个月。但是,所有符合条件的人中只有少数人收到了MOUD。
更新日期:2019-12-11
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