Opiate addiction is a chronic, relapsing medical condition that can be effectively treated through long-term opiate replacement therapy (ORT). Methadone maintenance therapy (MMT) is the most widely used form of ORT and has been used to treat opiate addiction for over thirty years. MMT has been proven to reduce injection drug use, HIV risk behaviors and recidivism, yet inmates are routinely detoxified from methadone upon incarceration, thus causing an interruption in the treatment of their opiate dependence. Even if inmates are referred to community methadone programs upon release, there is a chance that they will delay or forgo re-entry or will engage in behaviors that put them at high risk for HIV infection or reincarceration before returning to methadone maintenance treatment. Maintaining inmates on methadone therapy during short-term incarceration may facilitate their prompt re-entry into community methadone maintenance programs after release, minimizing the risk of drug relapse, HIV risk behaviors and overdose. Thus, the purpose of this study is to examine the impact of interruption of methadone maintenance treatment (MMT) during short-term incarceration (jail) as this is the standard practice in nearly all correctional facilities in the United States. We will compare methadone detoxification with continued methadone maintenance treatment using a randomized trial and examine continuing treatment post release, relapse to drug use, HIV risk behaviors, reincarceration, and the costs associated with continued MMT vs. methadone detoxification. The targeted population will be 450 individuals who, while enrolled in community methadone treatment, become incarcerated for less than 6 months. Follow-up interviews will occur 1 month post release from incarceration and 6, 12, and 18 months from baseline at an independent study site. Both groups will receive a risk behavior reduction counseling intervention and linkage to community methadone treatment upon release. If this project is able to demonstrate that maintaining inmates on methadone for short-term incarcerations is more beneficial and/or less costly than detoxification, then this can inform correctional policy to encourage collaboration with community substance use treatment providers and to minimize disruption of treatment during short term incarceration.

Public Health Relevance

With injection drug users continuing to play an important role in the transmission of HIV in the US and a substantial proportion of this traditionally hard-to-reach population passing through correctional facilities each year, a tremendous opportunity exists to engage the interconnected epidemics of addiction and HIV in the correctional setting. Methadone maintenance therapy has been proven to reduce injection drug use, HIV risk behaviors and recidivism, yet inmates are routinely detoxified from methadone upon incarceration thus causing an interruption in the treatment of their opiate dependence. Maintaining inmates on methadone therapy during short-term incarceration may facilitate their prompt re-entry into community methadone maintenance programs after release, minimizing the risk of drug relapse, HIV risk behaviors and overdose.

Agency
National Institute of Health (NIH)
Institute
National Institute on Drug Abuse (NIDA)
Type
Research Project (R01)
Project #
5R01DA027211-04
Application #
8268443
Study Section
Special Emphasis Panel (ZRG1-AARR-G (50))
Program Officer
Wiley, Tisha R A
Project Start
2009-08-01
Project End
2014-05-31
Budget Start
2012-06-01
Budget End
2013-05-31
Support Year
4
Fiscal Year
2012
Total Cost
$453,040
Indirect Cost
$111,288
Name
Miriam Hospital
Department
Type
DUNS #
063902704
City
Providence
State
RI
Country
United States
Zip Code
02906
Rich, Josiah D; Beckwith, Curt G; Macmadu, Alexandria et al. (2016) Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis. Lancet 388:1103-14
Lima, Viviane D; Graf, Isabell; Beckwith, Curt G et al. (2015) The Impact of Implementing a Test, Treat and Retain HIV Prevention Strategy in Atlanta among Black Men Who Have Sex with Men with a History of Incarceration: A Mathematical Model. PLoS One 10:e0123482
Rich, Josiah D; McKenzie, Michelle; Larney, Sarah et al. (2015) Methadone continuation versus forced withdrawal on incarceration in a combined US prison and jail: a randomised, open-label trial. Lancet 386:350-9
Beckwith, Curt G; Kurth, Ann E; Bazerman, Lauri et al. (2015) Survey of US Correctional Institutions for Routine HCV Testing. Am J Public Health 105:68-71
Beckwith, Curt; Bazerman, Lauri; Gillani, Fizza et al. (2014) The feasibility of implementing the HIV seek, test, and treat strategy in jails. AIDS Patient Care STDS 28:183-7
Zaller, Nickolas; McKenzie, Michelle; Friedmann, Peter D et al. (2013) Initiation of buprenorphine during incarceration and retention in treatment upon release. J Subst Abuse Treat 45:222-6
Rich, Josiah D; DiClemente, Ralph; Levy, Judith et al. (2013) Correctional facilities as partners in reducing HIV disparities. J Acquir Immune Defic Syndr 63 Suppl 1:S49-53
Matusow, Harlan; Dickman, Samuel L; Rich, Josiah D et al. (2013) Medication assisted treatment in US drug courts: results from a nationwide survey of availability, barriers and attitudes. J Subst Abuse Treat 44:473-80
McKenzie, Michelle; Zaller, Nickolas; Dickman, Samuel L et al. (2012) A randomized trial of methadone initiation prior to release from incarceration. Subst Abus 33:19-29
Rich, Josiah D; Wohl, David A; Beckwith, Curt G et al. (2011) HIV-related research in correctional populations: now is the time. Curr HIV/AIDS Rep 8:288-96

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