Perceived access to opioid agonist treatment in prison among people with a history of injection drug use: A qualitative study

被引:5
作者
Marshall, Alison D. [1 ,2 ,9 ]
Schroeder, Sophia E. [3 ]
Lafferty, Lise [1 ,2 ]
Drysdale, Kerryn [2 ]
Baldry, Eileen [4 ]
Stoove, Mark [3 ,5 ,6 ]
Dietze, Paul [3 ,7 ]
Higgs, Peter [3 ,8 ]
Treloar, Carla [2 ]
机构
[1] Univ New South Wales UNSW Sydney, Kirby Inst, Sydney, NSW, Australia
[2] Univ New South Wales UNSW Sydney, Ctr Social Res Hlth, Sydney, Australia
[3] Burnet Inst, Dis & Eliminat Program, Melbourne, Australia
[4] Univ New South Wales UNSW Sydney, Law & Justice, Sydney, Australia
[5] Monash Univ, Sch Publ Hlth & Prevent Med, Melbourne, Australia
[6] La Trobe Univ, Australian Res Ctr Sex Hlth & Soc, Melbourne, Australia
[7] Curtin Univ, Natl Drug Res Inst, Melbourne, Australia
[8] La Trobe Univ, Sch Psychol & Publ Hlth, Melbourne, Australia
[9] Univ New South Wales UNSW Sydney, Ctr Social Res Hlth, Viral Hepatitis Clin Res Program, Kirby Inst, Sydney, Australia
来源
JOURNAL OF SUBSTANCE USE & ADDICTION TREATMENT | 2023年 / 150卷
基金
澳大利亚国家健康与医学研究理事会; 英国医学研究理事会;
关键词
Prisons; Opioid agonist treatment; People who inject drugs; Accessibility; HEPATITIS-C; SUBSTITUTION TREATMENT; MAINTENANCE TREATMENT; HIGH-RISK; METHADONE; TRUST; INTERVENTIONS; INCARCERATION; PERSPECTIVES; WITHDRAWAL;
D O I
10.1016/j.josat.2023.209066
中图分类号
B849 [应用心理学];
学科分类号
040203 ;
摘要
Introduction: Opioid agonist treatment (OAT) is associated with a reduced likelihood of hepatitis C incidence, nonfatal overdose, and (re)incarceration among people who inject drugs (PWID), yet factors underpinning decisions to access OAT in prison and postrelease are not well understood. The aim of the qualitative study was to explore the perspectives of OAT access while in prison among PWID recently released from prison in Australia.Methods: Eligible participants enrolled in the SuperMix cohort (n = 1303) were invited to take part in a semistructured interview in Victoria, Australia. Inclusion criteria were informed consent, aged >= 18 years, history of injection drug use, incarcerated for >= 3 months, and released from custody <12 months. The study team analysed data via a candidacy framework to account for macro-structural influences.Results: Among 48 participants (33 male; ten Aboriginal), most injected drugs in the prior month (n = 41) with heroin the most frequently injected (n = 33) and nearly half (n = 23) were currently on OAT (primarily methadone). Most participants described the navigation and permeability of OAT services in prison as convoluted. If not on OAT pre-entry, prison policies often restricted access, leaving participants to withdraw in cells. In turn, some participants commenced OAT postrelease to ensure OAT continuity of care if reincarcerated. Other participants who experienced delayed access to OAT in prison stated no need to initiate while in prison or postrelease as they were now "clean". Last, implementation of OAT delivery in prison (e.g., lack of confidentiality) frequently led to changes in OAT type to avoid peer violence (pressure to divert OAT).Conclusion: Findings draw attention to simplistic notions of OAT accessibility in prisons, illuminating how structural determinants influence choice in PWID decision-making. Suboptimal access and acceptability of OAT delivery in prisons will continue to place PWID at risk of harm postrelease (e.g., overdose).
引用
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页数:9
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