Prisoners with pre-incarceration heroin addiction histories rarely receive drug abuse treatment while incarcerated, or upon release. Re-addiction among such individuals typically occurs within one month of release, placing these individuals at disproportionately high risk for HIV and hepatitis B and C infections, overdose death, increased criminal activity, and re-incarceration. Research is clearly needed to evaluate the effectiveness of innovative drug treatment interventions spanning incarceration and the community. Based on substantial evidence of the effectiveness of opioid agonist treatment in the community, and the authors' considerable investigative experience with prison-initiated opioid agonist maintenance treatment of male inmates, a five-year study is proposed to examine the effectiveness of the administration of buprenorphine to previously-addicted inmates initiated in the institution and continued on release to the community. Moreover, the proposed study would be the first to examine the effectiveness of opioid agonist therapy for female (n=160) as well as male (n=160) pre-release inmates with pre-addiction heroin addiction histories. Finally, the proposed research will examine the extent to which the setting of post-release buprenorphine is provided [in an opioid agonist treatment program (OTP) vs. a community health center (CHC)]. Participants will be randomly assigned, within gender, to one of four treatment conditions: 1) buprenorphine and counseling in prison, with referral for continued treatment at an OTP upon release; 2) buprenorphine and counseling in prison, with referral for continued treatment at a CHC upon release; 3) counseling only in prison, with referral for buprenorphine and counseling at a OTP upon release; and 4) counseling only in prison, with referral for buprenorphine and counseling at a CHC upon release. Participants will be assessed at study entry and at 1, 3, 6, and 12 months following their release from prison. Outcome measures include: treatment entry and retention in the community, heroin use, cocaine use, HIV infection, HIV-risk behaviors, criminal activity, and employment.
While there have been substantial advances in the effectiveness of drug abuse treatment, only limited improvements have occurred in the provision of treatment services in non-research settings. Therefore, both researchers and practitioners have emphasized the need for rigorous research to examine the delivery of treatment services to heroin-dependent individuals in real-world settings, including prisons and community health centers. The presently proposed clinical trial aims to bridge this gap by examining the extent to which opioid maintenance treatment initiated in prison for inmates with a history of opioid addiction and the type of post-release treatment setting to which they are referred has an impact on public health and public safety outcomes in pre-release prison inmates.
