Clinical Trial: Trial of Methadone Maintenance Versus Methadone Detox in Jail

Study Status: Completed
Recruit Status: Unknown status
Study Type: Interventional

Official Title: A Randomized Trail of Continues Methadone Maintenance Versus Detoxification in Jail

Brief Summary:

Methadone maintenance treatment (MMT) has been shown to be effective in reducing drug use, criminal activity and recidivism. Given this effectiveness, maintaining individuals who are enrolled in community MMT when committed to the Department of Corrections for short term incarceration would improve post release outcomes. However, this is rarely practiced in the United States. Current practice at the Rhode Island Department of Corrections is to detox inmates on methadone within 30 days of being incarcerated. More than 75% of these individuals are incarcerated for less than six months. The period immediately after release from incarceration is a particularly high-risk time for HIV and other problems including drug relapse and overdose.

The investigators hypothesize that inmates who are incarcerated for 6 months or less will have better outcomes and cost the state less money if they are maintained on their methadone dose and relinked to their community clinic at release, than the current practice of detoxification.


Detailed Summary:

The purpose of this study is to compare the effectiveness of maintaining methadone treatment during short-term incarceration vs. methadone detoxification on continuing treatment post release, relapse, reducing HIV risk behaviors and reincarceration. Persons who inject opiates are at increased risk for HIV through both injection and sexual practices. A substantial proportion of opiate addicted persons are incarcerated and a majority of the nearly 8 million individuals released from a correctional setting each year have a history of addiction. The period immediately after release from incarceration is a particularly high-risk time for HIV and other problems including drug relapse and overdose. Methadone is the most widely used opiate replacement therapy in the United States. Despite its demonstrated benefit in decreasing drug use, criminal activity, and recidivism, some individuals on methadone treatment are reincarcerated each year. More than 75% of those individuals are incarcerated for less than six months. A program that maintains these individuals at a therapeutic dose increases the likelihood that they will successfully return to treatment upon release.

The following primary specific aims will drive this research:

  1. To determine the effect of maintaining methadone treatment during short-term incarceration vs. methadone detoxification on the time-to-post-release methadone treatment re-entry and relapse.
  2. To determine whether maintaining methadone treatment during short-term incarceration is more effective in reducing HIV risk behaviors (both injecting and sexual) than methadone detoxification upon community re-entry.
  3. To determine whether maintaining methadone treatment during short-term incarceration is more effective in r
    Sponsor: The Miriam Hospital

    Current Primary Outcome:

    • Time to post release treatment engagement [ Time Frame: 30 days post release ]
      Do individuals maintained on MMT during short term incarceration return to their community methadone clinic more rapidly than those who undergo methadone detoxification during short term incarceration? Individuals must return within 30 days of post release to be or be counted as not returning.
    • Reduction of HIV risk behaviors [ Time Frame: 12 months ]
      To determine whether individuals maintained on MMT during short term incarceration report fewer HIV risk behaviors (both drug use and sexual) as compared to standard of care arm.
    • Time to relapse [ Time Frame: 30 days post release ]
      To determine whether individuals maintained on MMT during short term incarceration report longer to relapse (or no relapse) to opiate use as compared to standard of care arm.
    • Cost effectiveness [ Time Frame: 12 months ]
      To determine the costs, cost-effectiveness and cost-benefit associated with continuing methadone maintenance versus detoxification for jailed individuals. Variables to be assessed are: reincarceration, health care utilization (i.e. emergency room use, medications), subsidized housing,


    Original Primary Outcome: Same as current

    Current Secondary Outcome:

    • Treatment retention [ Time Frame: 12 months ]
      length of time engaged in community methadone treatment
    • Fatal and nonfatal overdose [ Time Frame: 12 months ]


    Original Secondary Outcome: Same as current

    Information By: The Miriam Hospital

    Dates:
    Date Received: June 5, 2013
    Date Started: June 2010
    Date Completion: May 2014
    Last Updated: June 7, 2013
    Last Verified: December 2010