Recent Incarceration May be a Barrier to Methadone Treatment Among Individuals with Injection Drug Use

Individuals with opioid use disorder, particularly those who inject heroin, are at high risk for incarceration. Methadone maintenance is an effective treatment for opioid use disorder and has been shown to reduce criminal activity, but incarceration may present a barrier to initiating or continuing treatment. Researchers used data from the Vancouver Injection Drug Users Study, a prospective cohort study that began in 1996, to examine the relationship between incarceration and engagement in methadone maintenance treatment.

• Of the 2758 individuals recruited during the study who were followed for a median of 64 months, 381 (14%) reported being incarcerated in the past 6 months at 1 of the semiannual interviews.
• Those who reported recent incarceration were more likely to inject heroin daily and to inject or smoke cocaine daily; they were also more likely to have unstable housing.
• On multivariate analysis of factors associated with participation in a methadone treatment program, incarceration in the last 6 months had an adjusted odds ratio (OR) of 0.87. Other factors included age (OR, 2.04 per 10 years older), female gender (OR, 3.11), Caucasian ethnicity (OR, 2.11), and daily injection heroin use (OR, 0.36).

Comments:

It makes sense that incarceration may be a barrier to engagement in longitudinal treatment, but the association was modest and does not establish a cause-and-effect relationship. The association may be due (at least partly) to methadone maintenance treatment reducing the risk of incarceration. We need to do more to engage people with opioid use disorder in treatment; incarceration should be viewed as an opportunity to do so.

Darius A. Rastegar, MD

Reference:

Koehn JD, Bach P, Hayashi K, et al. Impact of incarceration on rates of methadone use in a community cohort of injection drug users. Addict Behav. 2015;46:1–4.