Effectiveness of Opiate Replacement Therapy Administered Prior to Release From a Correctional Facility - 1

Lifespan

Status: Completed

Conditions: Opioid-Related Disorders; HIV Prevention

Treatments: Behavioral: Post Release Initiation of MMT.; Behavioral: Standard of Care Plus; Behavioral: Pre-release Initiation of MMT

Study type: Interventional

Funder types: Other

Identifiers

NCT00142935

R01-DA018641-1

NIDA-18641-1

DPMC

Details and patient eligibility

About

Much of the HIV/AIDS epidemic is driven by transmission from or to persons addicted to opiates. Many of these individuals pass through a correctional setting each year, creating an opportunity for linkage to substance abuse treatment. The purpose of this study was to evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors and drug relapse. In addition, this study evaluated the effectiveness of short-term payment versus non-payment of community opiate replacement therapy immediately following release from incarceration.

Full description

A substantial proportion of individuals addicted to heroin are incarcerated while addicted and a majority of individuals released from a correctional setting have a history of heroin addiction. The period immediately after release from incarceration is a particularly high-risk time for HIV transmission and other problems, including drug relapse and overdose. Methadone treatment is the most widely used opiate replacement therapy in the United States and has been shown to decrease HIV risk, as well as drug use, addiction relapse, and criminal activity. The purpose of this study was to evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors and drug relapse. In addition, this study evaluated the effectiveness of short-term payment versus non-payment of community opiate replacement therapy immediately following release from incarceration.

Participants in this were randomly assigned to 1 of 3 treatment groups. Participants enrolled in Group 1 initiated methadone opiate replacement therapy about 1 month prior to release from incarceration. They proceeded with a methadone program of their choice upon release and received short-term payment to cover treatment costs. Participants enrolled in Group 2 were referred to a methadone program of their choice and received short-term payment to cover treatment costs. Participants enrolled in Group 3 were referred to a program of choice upon release from incarceration without receiving financial assistance. All participants had the opportunity to partake in existing support programs available at the Rhode Island Department of Corrections while incarcerated and in the community upon release. Follow-up assessments occurred at Months 1.5, 6, and 12. These included interviews and urine specimens for toxicology analysis to verify self-reports.

Enrollment: 87 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Currently incarcerated at the Rhode Island Department of Corrections with a scheduled release date at least 28 days after enrollment
• Incarceration length not to have exceeded two years at the time of enrollment
• Heroin dependent with self-reported heroin injection in the month prior to incarceration OR enrollment in a methadone treatment program prior to incarceration for heroin addiction with a history of injection drug use
• Desire to enter methadone treatment upon release and plans to secure funding for methadone treatment after study completion
• History of prior tolerance to methadone
• History of at least one drug-related incarceration
• Speaks English or Spanish
• Plans to remain in Rhode Island for the duration of the study (24 months)
• Ability to provide at least two names of individuals who can verify participant information

Exclusion criteria

• Currently receiving methadone at the Rhode Island Department of Corrections
• Currently undergoing a non-narcotic detoxification from illicit opiates at the Rhode Island Department of Corrections
• Plans to leave Rhode Island within the two years following enrollment

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

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87 participants in 3 patient groups

Pre-Release Initiation MMT

Experimental group

Description:

Participants assigned to this arm will undergo extensive assessment (physical, medical history, drug use and treatment history) prior to initiating treatment. MMT will begin 1-30 days prior to release from incarceration. MMT first dose will begin at 5 mg with 2 mg increase per day until release or therapeutic dose of 60-120 mg is achieved. Daily observation by dosing nurses and twice weekly symptom review by Research Assistant will occur. Additionally, participants assigned to Arm 1 will have all logistical arrangements made for entry into a community methadone clinic program within 24 hours of release from incarceration. The study will fully pay for MMT for 12 weeks and half the costs of treatment for the next 12 weeks.

Treatment:

Behavioral: Pre-release Initiation of MMT

Post Release Initiation of MMT

Experimental group

Description:

Participants assigned to this arm will have all logistical arrangements made for entry into a community methadone clinic program within 24-48 hours of release from incarceration. The study will fully pay for MMT for 12 weeks and half the costs of treatment for the next 12 weeks.

Treatment:

Behavioral: Post Release Initiation of MMT.

Standard of Care Plus

Active Comparator group

Description:

Participants assigned to this arem will not begin treatment prior to release from incarceration or have treatment paid for by the study. However, study staff will work with participants to identify ways to pay for treatment, including assisting with medicaid applications, etc. Further, the study will make the logistical arrangements for entering treatment if participant has a means to finance MMT.

Treatment:

Behavioral: Standard of Care Plus