Program Goals/Target Population
Research has shown that prisoners with heroin addiction are most likely to relapse within 90 days of release (Office of National Drug Control Policy 1999). Thus the primary goal of providing methadone maintenance to prisoners is to engage heroin-addicted offenders in drug abuse treatment before they are released and return to the community. Prison-initiated maintenance therapy offers inmates the opportunity to participate in substance abuse treatment while incarcerated and then provides referrals to community-based treatment programs to encourage their continued treatment during reentry.
The medication-assisted treatment, called methadone maintenance treatment (MMT), is targeted at individuals with dependence on opioids, including heroin and morphine. Most facilities providing MMT are community based; there are very few treatment programs available to offenders in jail or prison, despite the higher rates of heroin use among prisoners compared to the general population (Kinlock et al. 2007).
Methadone is a long-acting synthetic opioid analgesic that works as a pharmacologic intervention for patients in drug treatment and detoxification programs. Methadone maintenance helps opioid-addicted patients alleviate withdrawal symptoms, reduce opiate cravings, and bring about a biochemical balance in the body to reduce the illicit use of drugs.
Slow induction rates of methadone may be used in the beginning to treat heroin-addicted prisoners in case they are not physiologically tolerant to opioids at the time the medication is initiated. Dosage generally starts out small (such as 5 milligrams (mg) of methadone) at the beginning of treatment and continues to increase until a target dose is reached (such as 60 mg). Dosage may be increased or decreased, depending on the clinical need of each patient.
In addition to administering medication, prisoners participating in methadone maintenance also receive counseling services. Services can include group-based education and discussion on relapse and overdose prevention, cocaine and alcohol abuse, and other reentry issues. Upon release from incarceration, prisoners are advised to report to a community-based facility as soon as possible to continue MMT.
Prison-initiated methadone maintenance initiates treatment shortly before release from incarceration, to ensure that participants receive a minimum amount of time in treatment (such as 3–6 months) and encourage them to continue the remainder of MMT in the community. The amount of time a prisoner continues to receive methadone will vary. In general, MMT takes a minimum of 12 months, but some heroin-addicted prisoners may require continuous treatment that lasts over a period of several years.
35 to 45
Urine Drug Tests for Opioids and Cocaine
Gordon and colleagues (2008) found that study participants that received counseling + methadone were significantly less likely to test positive for opioids compared to participants who received counseling only in prison. For cocaine use, only counseling + transfer participants were significantly less likely to test positive for cocaine use compared to counseling only participants.
Self-reported Heroin and Cocaine Use
The results of self-reported drug use were similar to results of the urine drug tests. Participants in the counseling + methadone group reported significantly fewer days of heroin use in the past 180 days post-release compared to counseling only participants. Participants in the counseling + transfer group reported significantly fewer days of cocaine use compared to counseling only participants.
Days in Treatment
Participants in the counseling + methadone group were significantly more likely to spend more days in treatment compared to the counseling only and counseling + transfer groups. Participants in the counseling + transfer condition were more likely than participants in the counseling only condition to remain in treatment longer. In addition, participants who completed treatment in prison were more likely to have, on average, longer durations of community-based treatment than those participants who failed to complete prison treatment. None of the counseling only participants entered methadone maintenance treatment following release from prison.
Participants in the counseling + methadone and counseling + transfer groups reported significantly fewer days of criminal activity, on average, compared to participants in the counseling only group.
There were no statistically significant differences between the groups on the number of days reincarcerated.
Urine Drug tests for Opioids and Cocaine
Kinlock and colleagues (2009) found that, at 12 months, there were significant differences between the groups in the percentage of participants who tested positive for opioids and cocaine. The counseling only and counseling + transfer groups were significantly more likely to test positive for opioids and cocaine then the counseling + methadone group.
Self-reported Heroin and Cocaine Use
Participants were asked about the number of days of heroin and cocaine use in the past 365 days postrelease. However, there were no significant differences in the number of self-reported days of heroin or cocaine use.
Days in Treatment
There were significant differences between the groups on the mean number of days that participants were enrolled in community-based treatment during the 12-month follow-up period. The counseling only group was in treatment for an average of 23.1 days. The counseling + transfer group had an average of 91.3 days in treatment, and the counseling + methadone group had an average of 166 days in treatment. Again the study found that none of the counseling only participants had entered treatment following release from prison.
There were also no statistically significant differences in the reported number of days of criminal activity in the past 365 days postrelease.
There were no significant differences between treatment conditions on the number of arrests during the postrelease follow-up period.
There were no significant differences in the reported number of days employed during the past 30 days.