RESUMEN
Inmates have high rates of opioid use disorder and are at risk for morbidity and mortality both during incarceration and after release. We conducted a retrospective chart review to assess prescribers' fidelity to the New Jersey Department of Corrections practice guideline for prescribing maintenance or prerelease buprenorphine. We compared the entire group of inmates prescribed buprenorphine at the conclusion of 2019 (n = 875) with a sample of inmates diagnosed with opioid use disorder (OUD) but not prescribed buprenorphine (n = 396) and a sample of inmates not diagnosed with OUD (n = 367). Inmates on buprenorphine were more likely to be male, White, in treatment for a mental illness, have higher scores on the Texas Christian University Drug Screen, be closer to release, have multiple substance use disorder comorbidities, and have more substance-related disciplinary charges. They were most often prescribed buprenorphine-naloxone strips, with doses ranging from 2 mg to 12 mg, and a median dose of 8 mg. Racial disparities in prescribing were observed, though the reasons for this are likely multifactorial, and research from the community has shown similar findings. We propose strategies to reduce these differences, including staff education, patient education, and quality improvement initiatives.
Asunto(s)
Buprenorfina , Trastornos Relacionados con Opioides , Buprenorfina/uso terapéutico , Femenino , Humanos , Masculino , New Jersey , Tratamiento de Sustitución de Opiáceos , Trastornos Relacionados con Opioides/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
A hunger strike is a common, expensive, and potentially lethal event within a correctional institution. In this study, we describe the characteristics of inmates who initiated hunger strikes in a state prison system. Electronic medical records for a state prison system were reviewed for documentation of hunger strikes from January 2005 through September 2015. There were 292 hunger strikes during the study period. Most (71%) lasted three or fewer days. When weight data were available, only 12.9 percent of the hunger strikes resulted in a weight loss >10 percent. Mental health patients were disproportionately represented in the sample (45%), although diagnoses of personality disorders (48%) rather than mood (17%) or psychotic (10%) disorders accounted for most of these cases. Nearly 75 percent of inmates who initiated hunger strikes did so while residing in disciplinary housing. In more than 80 percent of the strikes, the reason for stopping the strike was unknown. When the reasons were known, custody intervention rather than mental health intervention was the most common reason for the ending of a strike. Improving communication with custody administration and mitigating unnecessarily aversive housing environments are likely to reduce the incidence of hunger strikes.