Fifteen years of heroin-assisted treatment in a Swiss prison—a retrospective cohort study

Harm Reduction Journal

Alex Gamma¹  Roman Schleifer¹  Michael Liebrenz¹  Stéphanie Baggio²  Bruce Schwartz³  Andres Schneeberger⁴  Anna Buadze⁵  Ambros Uchtenhagen⁶ 

[1] Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 18, 3012, Bern, Switzerland;Department of Forensic Psychiatry, Institute of Forensic Medicine, University of Bern, Falkenplatz 18, 3012, Bern, Switzerland;Division of Prison Health, Geneva University Hospitals and University of Geneva, Geneva, Switzerland;Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA;Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA;Psychiatrische Dienste Graubünden (PDGR), Chur, Switzerland;Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland;Swiss Research Institute for Public Health and Addiction ISGF, University of Zurich, Zurich, Switzerland;

关键词: Heroin-assisted treatment;    Prison;    Jail;    Incarceration;    Opioid crisis;    Opioid-using individuals;    Social functioning;   

DOI  :  10.1186/s12954-020-00412-0

来源: Springer

【 摘 要 】

BackgroundIn the context of the current US opioid crisis and the compelling fact that a quarter to a third of all those addicted to heroin pass through its prisons and jails each year, the care of incarcerated opioid-using individuals (OUI) needs to be improved.AimsLittle has been published on the effectiveness or outcomes of heroin-assisted treatment (HAT), a treatment option for severely dependent OUI delivered in a prison setting. The aim of this study was therefore to evaluate such treatment since its implementation. The primary objective was to investigate whether heroin-assisted treatment was associated with severe detrimental health outcomes. The secondary objective was to compare the heroin-assisted treatment group with the general prison population in terms of occupational functioning.DesignRetrospective cohort studySettingAn open prison with 120 placesSubjectsData on 1885 male prisoners with a total of 2239 imprisonment periods between 2000 and 2015 was available. Ninety-seven inmates in heroin-assisted treatment were compared with 1788 inmates from the general prison population (reference group).MeasurementsMortality, medical complications (including overdoses), and work performance (days worked, sick days, and monthly wages earned).FindingsInmates receiving HAT were on average 1 year younger (33.8 vs. 34.9 years), had longer prison stays (7.3 vs. 3.0 months), were more often of Swiss nationality (68.0% vs. 28.9%), and had committed more drug- and property-related offenses (49.5% vs. 23.2% and 63.9% vs. 38.3%, respectively) compared to the reference group. No serious heroin-related medical complication occurred during the 15-year window of observation among inmates with heroin-assisted treatment. Their work performance was comparable to that of the reference group.ConclusionsThis study shows that heroin-assisted treatment can be a valuable treatment option for severely dependent OUI during imprisonment, can be delivered safely by prison health staff over extended periods of time, and allows OUI in treatment to achieve work performance rates comparable to that of the general prison population.

【 授权许可】

CC BY