Drug use and opioid substitution treatment for prisoners

Drug use is prevalent throughout prison populations, and, despite advances in drug treatment programmes for inmates, access to and the quality of these programmes remain substantially poorer than those available for non-incarcerated drug users. Because prisoners may be at greater risk for some of the harms associated with drug use, they deserve therapeutic modalities and attitudes that are at least equal to those available for drug users outside prison. This article discusses drug use by inmates and its associated harms. In addition, this article provides a survey of studies conducted in prisons of opioid substitution therapy (OST), a clinically effective and cost-effective drug treatment strategy. The findings from this overview indicate why treatment efforts for drug users in prison are often poorer than those available for drug users in the non-prison community and demonstrate how the implementation of OST programmes benefits not only prisoners but also prison staff and the community at large. Finally, the article outlines strategies that have been found effective for implementing OST in prisons and offers suggestions for applying these strategies more broadly

Substitution treatment for opioid addicts in Germany

BACKGROUND: After a long and controversial debate methadone maintenance treatment (MMT) was first introduced in Germany in 1987. The number of patients in MMT – first low because of strict admission criteria – increased considerably since the 1990s up to some 65,000 at the end of 2006. In Germany each general practitioner (GP), who has completed an additional training in addiction medicine, is allowed to prescribe substitution drugs to opioid dependent patients. Currently 2,700 GPs prescribe substitution drugs. Psychosocial care should be made available to all MMT patients. RESULTS: The results of research studies and practical experiences clearly indicate that patients benefit substantially from MMT with improvements in physical and psychological health. MMT proves successful in attaining high retention rates (65 % to 85 % in the first years, up to 50 % after more than seven years) and plays a major role in accessing and maintaining ongoing medical treatment for HIV and hepatitis. MMT is also seen as a vital factor in the process of social re-integration and it contributes to the reduction of drug related harms such as mortality and morbidity and to the prevention of infectious diseases. Some 10 % of MMT patients become drug-free in the long run. Methadone is the most commonly prescribed substitution medication in Germany, although buprenorphine is attaining rising importance. Access to MMT in rural areas is very patchy and still constitutes a problem. There are only few employment opportunities for patients participating in MMT, although regular employment is considered unanimously as a positive factor of treatment success. Substitution treatment in German prisons is heterogeneous in access and treatment modalities. Access is very patchy and the number of inmates in treatment is limited. Nevertheless, substitution treatment plays a substantial part in the health care system provided to drug users in Germany. CONCLUSION: In Germany, a history of substitution treatment spanning 20 years has meanwhile accumulated a wealth of experience, e.g. in the development of research on health care services, guidelines and the implementation of quality assurance measures. Implementing substitution treatment with concomitant effects and treatment elements such as drug history-taking, dosage setting, co-use of other psychoactive substances (alcohol, benzodiazepines, cocaine), management of 'difficult patient populations', and integration into the social environment has been arranged successfully. Also psychosocial counseling programmes adjuvant to substitution treatment have been established and, in the framework of a pilot project on heroin-based treatment, standardised manuals were developed. Research on allocating opioid users to the 'right' form of therapy at the 'right' point in time is still a challenge, though the pilot project 'heroin-based treatment' brought experience with patients who do not benefit from methadone treatment. There is also expertise in the treatment of specific co-morbidity such as HIV/AIDS, hepatitis and psychiatric disorders. The promotion and involvement of self-help groups plays an important part in the process of successful substitution treatment

A qualitative assessment of an abstinence-oriented therapeutic community for prisoners with substance use disorders in Kyrgyzstan.

BACKGROUND: Kyrgyzstan, where HIV is concentrated in prisons and driven by injection drug use, provides a prison-based methadone maintenance therapy program as well as abstinence-oriented therapeutic community based on the 12-step model called the "Clean Zone." We aimed to qualitatively assess how prisoners navigate between these treatment options to understand the persistence of the Clean Zone despite a lack of evidence to support its effectiveness in treating opioid use disorders. METHODS: We conducted an analysis of policy documents and over 60 h of participant observation in February 2016, which included focus groups with a convenience sample of 20 therapeutic community staff members, 110 prisoners across three male and one female prisons, and qualitative interviews with two former Clean Zone participants. Field notes containing verbatim quotes from participants were analyzed through iterative reading and discussion to understand how participants generally perceive the program, barriers to entry and retention, and implications for future treatment within prisons. RESULTS: Our analyses discerned three themes: pride in the mission of the Clean Zone, idealism regarding addiction treatment outcomes against all odds, and the demonization of methadone. CONCLUSION: Despite low enrollment and lack of an evidence base, the therapeutic community is buttressed by the strong support of the prison administration and its clients as an "ordered" alternative to what is seen as chaotic life outside of the Clean Zone. The lack of services for Clean Zone patients after release likely contributes to high rates of relapse to drug use. The Clean Zone would benefit from integration of stabilized methadone patients combined with a post-release program

Is pricing a way to affect share of fruits and vegetables in a diet?

Sahlgrenska Akademin vid Göteborgs universitet Avdelningen för invärtesmedicin och klinisk nutrition Sammanfattning Titel: Är priset ett sätt att påverka mängd frukt och grönsaker i kosten? Författare: Maria Popov Handledare: Heléne Bertéus Forslund Examinator: Ingrid Larsson Linje: Dietistprogrammet, 180/240 hp Typ av arbete: Examensarbete, 15 hp Datum: 2013-05-23 Bakgrund: Intag av frukt och grönsaker (FG) är viktigt för hälsan, bland annat för förekomst av fetma, diabetes och hjärt-kärlsjukdomar. I höginkomstländer är en ökning av FG-intaget önskvärd, då endast en liten del av befolkningen äter rekommenderade mängder, samtidigt som nämnda sjukdomar står för flest fall av ohälsa och död. Förutom generella informationskampanjer eller kostråd till individer finns ekonomiska metoder att påverka vad människor väljer att köpa. Syfte: Att undersöka om olika prissättning har samband till FG-intag eller -inköp. Sökväg: Sökningen gjordes i databaser PubMed, Scopus och Summon med sökord "vegetable consumption", "price/pricing policy" och "food choice" i olika kombinationer. Urvalskriterier: Studierna skulle vara gjorda under tiden efter 2000-talet på minst 18 år gamla personer i Nordamerika, Australien eller Europa, och undersöka prisändringar och FG-inköp. Vissa interventionsplatser och undersökta parametrar exkluderades. Datainsamling och analys: Elva artiklar valdes ut, varav fyra uppfyllde alla kriterier. De fyra granskades enligt SBU:s granskningsmallar och evidensstyrkan bedömdes enligt GU:s formulär. Resultat: En tvärsnittsstudie visade att högre FG-priser var associerade med lägre FG-intag, men förklarade inte ett möjligt orsakssamband. De tre resterande studierna var väldesignade RCT med verklighetstrogna köpsituationer och blandade grupper, men grupperna var små. Interventionen var olika stora rabatter på FG och resultaten i alla studier visade med signifikans att interventionsgrupperna köpte mer än kontroller. Underlaget bedömdes ha måttlig evidensstyrka. Slutsats: Resultaten är samstämmiga och signifikanta: prissänkning leder till större inköp av FG. Men det krävs fler studier på större grupper. Det finns dessutom andra faktorer som komplicerar bilden, till exempel köpt total kalorimängd och socioekonomisk tillhörighet.Sahlgrenska Academy at University of Gothenburg Department of Internal Medicine and Clinical Nutrition Abstract Title: Is pricing a way to affect share of fruits and vegetables in a diet? Author: Maria Popov Supervisor: Heléne Bertéus Forslund Examiner: Ingrid Larsson Programme: Dietician study programme, 180/240 ECTS Type of paper: Examination paper, 15 hp Date: May 23, 2013 Background: Fruits and vegetables (FV) are important for health, including occurrence of diabetes, obesity and cardiovascular diseases. Said diseases cause most cases of illness and death in high-income countries. Only a small part of the population achieves the FV-intake goal, so a higher FV-intake is desirable. Besides general information campaigns there is another method of influencing what people might buy. Objective: To examine whether different pricing is connected to FV-intake or –purchase. Search strategy: Databases PubMed, Scopus and Summon were searched with “vegetable consumption", "price/pricing policy" and "food choice” in different combinations. Selection criteria: Studies performed after year 2000 on at least 18 years old persons from North America, Europe or Australia, examining changes in FV-price and -purchase. Some additional parameters were excluded. Data collection and analysis: Eleven articles were selected, whereof four met all the criteria. They were reviewed and the evidence was compiled according to the certain templates. Main results: One cross-sectional study showed an association between higher FV-prices and lower FV-intake, but it didn’t explain any causation. Three RCTs with good design had small assorted groups who participated in realistic shopping situations. The intervention was different price discounts on FV. The studies showed consistent significant results of lower prices leading to higher FV-purchase. Evidence strength was deemed to be moderate. Conclusions: The lowering of prices on FV might increase FV-purchase. Yet the evidence is not strong enough and more research with a larger number of participants is needed. There are further additional factors which may complicate the picture, such as total amount of purchased calories or socioeconomic belonging