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  1. New South Wales (Australia) Prison Methadone Maintenance Program

New South Wales (Australia) Prison Methadone Maintenance Program

Program Goals

The New South Wales Prison Methadone Program provides prison-based methadone maintenance treatment (MMT) for incarcerated injecting drug users (IDUs) dependent on opioids. The goals of the prison-based MMT program are to reduce recidivism, prevent the spread of HIV and hepatitis in prison, and encourage the continuation of treatment in the community following an inmate’s release from prison.


 

Methadone is a synthetic opioid agonist used in maintenance therapy or as a withdrawal agent for drug users dependent on opioids, such as heroin and oxycodone. It is taken orally on a daily basis and reduces the use of opioids through cross tolerance, which can result in a reduction of withdrawal symptoms, less desire to use opioids, and reduced euphoric effect when opioids are ingested. MMT programs are generally community based, but Australia is one of a few countries that operate and offer a prison-based program.


 

Program Theory

The prison methadone program began as a prerelease program that targeted IDUs with extensive drug careers and histories of incarceration (although inmates with less extensive drug careers and fewer prior incarcerations are now admitted). The program has been modified over the years to reflect a maintenance treatment philosophy. This includes shifting the concentration of MMT to not only reduce heroin injection and use but also to minimize the spread of blood-borne viral infections, such as HIV and hepatitis C.


 

Australia’s National Methadone Guidelines provide four basic categories where MMT might be appropriate for prisoners: 1) withdrawal; 2) continuation of treatment for those on methadone before imprisonment; 3) commencement of treatment for those who are heroin dependent on prison entry or who have used heroin in prison in a harmful way, including those who are HIV positive; and 4) the reduction of intravenous opioid use upon release (Dolan et al. 2002, 14).


 

Target Population/Eligibility

The program is targeted toward incarcerated IDUs who are addicted to opioids. To determine eligibility for MMT, inmates are assessed by trained nurses who have experience conducting a standardized Corrections Health Methadone Assessment. The assessment is followed by a medical review by a corrections health career medical officer. The medical officer makes appropriate medical observations and confirms drug use history and any treatment history. Inmates found suitable for the methadone program are placed on a waitlist, which can last 6 months. If inmates are assessed as requiring priority placement (they are HIV positive), then they immediately begin the methadone program.


 

Services Provided

When inmates begin the prison methadone program, they start on a 30-milligram (mg) dose. This dosage increases by 5 mg every 3 days until a 60-mg dose is achieved. Inmates in MMT are subject to the usual security arrangements, which means they are subject to ‘lockdowns’ and not allowed unscheduled movements that may interrupt treatment or stabilization periods.


 

Drug and alcohol counseling is also available to all inmates in prison. Inmates treated through the prison methadone program are offered the opportunity to transfer to community-based methadone programs, to continue treatment following release.


 

Target Sites

The prison methadone program is available at five prison facilities in the Sydney, Australia, metropolitan area (John Morony, Long Bay Complex, Metropolitan Remand Centre, Parramatta, and Silverwater) and seven prisons outside the metropolitan area (Bathurst, Cessnock, Goulburn, Grafton, Junee, Lithgow, and Tamworth). If inmates are located in a prison that does not offer the methadone program, they may be moved to one that does.


 

Key Personnel

The Department of Corrective Services (DCS) is in charge of running the prison system in New South Wales. However, the health needs and services of prisoners are the responsibility of the Corrections Health Service (CHS), which is part of the Department of Health and is separate from the DCS. The National Methadone Guidelines stipulate that the medical staff prescribing methadone to prisoners should be independent of the DCS, to minimize conflicts of interest. Therefore, trained medical staff from the CHS administers the methadone doses.

Intervention ID
197
Ages

18 to 100

Rating
No Effects
Outcomes

Study 1

Overall, Dolan and colleagues (2005) did not find significant differences between the prison methadone maintenance treatment (MMT) group and the control group on measures of mortality, reincarceration, hepatitis C virus (HCV) seroconversion, and treatment retention.


 

All-Cause Mortality

At the time of the 4-year follow-up, 17 of the original 382 study participants in the original randomized controlled trial died from the date of the first interview to May 2002 (when the death record check was performed). However, there was no statistically significant difference in morality risk between the prison methadone maintenance treatment (MMT) group compared with the control group.


 

Reincarceration

Of the study participants who had been released from prison, 280 have been reincarcerated. There was no significant difference between the number of treatment group members who were reincarcerated (n=143) and the number of control group member reincarcerated (n=137) since first release from prison.


 

HCV and HIV Seroconversion

The HIV incidence rate was quite low (only two cases were found, so comparison between treatment and control groups was not possible). In contrast, there were 16 cases of HCV seroconversion found in the treatment group and 23 cases in the control group. However, the difference in HCV incidence rate between the groups was not statistically significant.


 

Retention in First MMT Episode

There was an overall attrition rate of 63 percent. The treatment group had 152 participants drop out of its first methadone treatment episode, while the control group had 123 participants drop out. However, this difference was not significant.

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