Opiate Replacement Therapy at Release from Incarceration

Miriam Hospital, Providence RI

Investigators

Linked publications & trials

Abstract

DESCRIPTION (provided by applicant): This study will evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors. Individuals who inject opiates are at increased risk for HIV through both injection and sexual practices. A substantial proportion of opiate-dependent persons are incarcerated while addicted and a majority of the nearly 8 million individuals released from a correctional setting each year have a history of addiction. Minorities are both over represented in the corrections system and carry a disproportionately higher burden of disease. The period immediately after release from incarceration is a particularly high-risk time for HIV and drug relapse. Methadone is the most widely used opiate replacement therapy in the United States and has been shown to decrease HIV risk, drug use, crime, and reincarceration. Other benefits include the stabilization of employment, housing, and increased contact with medical care providers. Most prisons in the country do not offer opiate replacement therapy or refer to treatment upon release. Preliminary data from our CSAT-funded project linking opiate-dependent prisoners with methadone treatment after release from incarceration reveal that this approach is feasible and promising, but with lower-than-expected clinic attendance rates. A randomized, controlled trial will determine whether initiating methadone prior to release is a more effective strategy than referral to methadone treatment programs on release from incarceration. The primary aims will be to determine the effects of each study arm on reducing HIV risk behaviors, reducing recidivism, and increasing drug treatment attendance. The population of this study will be prisoners with multiple prior drug-related incarcerations and previous experience with methadone treatment. If this project is able to demonstrate that the use of induction of methadone treatment prior to release from incarceration is effective, this may be a "proof of concept" for other forms of opiate replacement therapy, such as buprenorphine/naloxone, to reduce HIV transmission.