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Research Summary

Prison-Initiated Methadone Maintenance Improves Postrelease Treatment Outcomes

The risk of postrelease relapse is high among inmates who were opioid dependent prior to incarceration. Although research has shown that initiating methadone maintenance treatment (MMT) in prison reduces this risk, the practice has not received widespread acceptance. In this randomized clinical trial, male inmates (N=204) with preincarceration heroin dependence who were about to be released were assigned to either counseling (advice to seek MMT upon release), counseling plus transfer (directive to report to an MMT facility within 10 days of release), or counseling plus methadone (gradual initiation of MMT in prison and directive to report to an MMT facility within 10 days for continued care). Mean age of participants was 40 years; 70% were African American, and 71% had received prior substance abuse treatment. The mean duration of incarceration was 605 days. Primary outcomes at 12 months are shown in Table 1.

Table 1. Treatment and urine toxicology results
Outcome measure Treatment condition p

 

Counseling only Counseling + transfer Counseling + methadone  
 Mean days of methadone  treatment 23 91 166 <0.01
 In methadone treatment for  12 months 0% 17% 37% --
 Opioid-positive urine test 66% 49% 25% <0.01
 Cocaine-positive urine test 72% 67% 43% <0.05

Comments:

In this trial, counseling plus prerelease MMT was superior to counseling alone or counseling plus transfer to MMT at engaging patients in treatment and decreasing illicit drug use among inmates with a history of heroin dependence. The primary limitation of the study is that urine toxicology data were not available in 44% of the sample due to reincarceration, hospitalization, or relocation. Nevertheless, this study provides further support for public-health initiatives that improve the transition of substance-use care from the institutional to the community setting. Jeanette M Tetrault, MD

Reference:

Kinlock TW, Gordon MS, Schwartz RP, et al. A randomized clinical trial of methadone maintenance for prisoners: results at 12 months post-release. J Subst Abuse Treat. 2009;37(3):277–285.

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