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Practice Profile

Incarceration-based Narcotics Maintenance Treatment

Evidence Ratings for Outcomes:

Promising - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types

Practice Description

Practice Theory/Practice Goals
Narcotics maintenance treatment programs help opioid-addicted individuals alleviate withdrawal symptoms, reduce opiate cravings, and bring about a biochemical balance in the body in order to reduce the illicit use of opioids, including narcotics such as heroin, morphine, and oxycodone.
 
Target Population
A report by the Bureau of Justice Statistics (1995) indicated that frequent drug users were 53 percent more likely to be rearrested than non-drug users. Additional 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). Incarceration-based narcotic maintenance treatment programs target offenders with opioid dependence problems while they are in prison or jail, before they are released into the community.
 
Program Components
Narcotic maintenance programs attempt to reduce harms associated with opioid dependency, such as disease transmission and criminal activity, by prescribing synthetic opioid medication. The medication is designed to block the euphoric high produced by opioid use and suppress withdrawal symptoms. Opioids cause a release of excess dopamine in the body. Users become dependent on the drug because they need opiates to continuously occupy the opioid receptor in the brain.
 
In addition to administering medication, incarceration-based narcotic maintenance programs may also provide counseling services, group-based education, and discussions on relapse and overdose prevention, drug and alcohol abuse, and other reentry issues. Inmates may be offered services in partnership with community-based substance abuse programs, to continue treatment following release.
 
Two common types of narcotic maintenance programs are methadone maintenance treatment and buprenorphine maintenance treatment. Methadone and buprenorphine work by occupying the opioid receptor and blocking the high that usually comes from illicit opioid drug use. This reduces the need and desire for users to seek and abuse opioids and diminishes the disruptive and uncontrolled behavior often associated with addiction.
 
Methadone Maintenance Treatment (MMT). Methadone can suppress narcotic withdrawal symptoms for 24 to 36 hours for patients. Single oral doses are administered daily under observation at a licensed clinic. Dosage is determined by several factors related to the patient, such as opioid tolerance level, history of opioid use, age, and current medical status. The amount of time in MMT will also vary by patient. In general, MMT takes a minimum of 12 months, but some patients may require continuous treatment that lasts over a period of several years.
 
Buprenorphine Maintenance Treatment (BMT). Buprenorphine exerts a weaker agonist effect at opioid receptor sites because it is a partial agonist. The effects of buprenorphine increase as the dosage of the drug is increased, until, at moderate doses, the effects reach a plateau and no longer continue to grow (known as the ceiling effect). Methadone causes a stronger agonist effect because it is a full agonist. However, buprenorphine can be used as a viable pharmacological alternative to methadone because it carries a lower risk of abuse, overdose, and side effects than do full opioid agonists. Another benefit is the dosing schedule. While methadone requires daily dosing, buprenorphine can be taken once every 2 days.
 
Additional Information: Negative Effects on Participants
The meta-analysis by Mitchell, Wilson, and MacKenzie (2012) (described in the Meta-Analysis Outcomes and Methodology section below) found that participation in incarceration-based narcotic maintenance programs increased the odds of recidivism after release.

Meta-Analysis Outcomes

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Promising - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
Mitchell, Wilson, and MacKenzie (2012) synthesized five effect sizes from studies that examined the effectiveness of incarceration-based narcotics maintenance programs on offenders avoiding a drug relapse, post-release. The effect size (odds ratio=2.10) was significant and moderate, in favor of the treatment group. This means that treatment group offenders who participated in narcotic maintenance programs were significantly less likely to experience relapse after release, compared with comparison group offenders. Overall, the mixed findings from the 2012 meta-analysis by Mitchell, Wilson, and MacKenzie suggest that incarceration-based narcotics maintenance programs may increase the odds of recidivism for program participants, but decrease the odds of a drug relapse.
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Mitchell, Wilson, and MacKenzie (2012) synthesized six effect sizes from studies that examined the effectiveness of incarceration-based narcotics maintenance programs on recidivism of adult offenders, post-release. The effect size (odds ratio=0.57) was significant and favored the comparison group. This means that treatment group offenders who participated in narcotics maintenance programs while incarcerated were significantly more likely to recidivate, compared with comparison group offenders after release (odds ratio=0.57). It should be noted that this finding is influenced by the presence of a negative outlier (i.e., a strong, negative result from one study). When the outlier is removed from the sample, the mean effect size is no longer significant (odds ratio=1.09). Overall, the results suggest that incarceration-based narcotic maintenance programs do not usually reduce recidivism.
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Meta-Analysis Methodology

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Meta-Analysis Snapshot
 Literature Coverage DatesNumber of StudiesNumber of Study Participants
Meta-Analysis 11980 - 201160

Meta-Analysis 1
Mitchell, Wilson, and MacKenzie (2012) analyzed the results from studies that examined the effectiveness of incarceration-based drug treatment programs on recidivism and drug use post-release. For inclusion in the analysis, studies needed to be conducted between 1980 and 2011, assess the effectiveness of prison- or jail-based drug treatment programs, specifically target substance users, use a random or quasi-experimental design with a no-treatment or minimal-treatment comparison group, and measure recidivism or drug use post-release.
 
A comprehensive search was conducted to identify eligible studies. The search resulted in the inclusion of 74 independent effect sizes from 61 studies. The majority of the studies included in the overall analysis were published after 1999 (60 percent) and were conducted in the United States (88 percent). Of the 61 studies, six studies reported on the effects of incarceration-based narcotics maintenance programs on recidivism post-release and five studies reported on the effects of incarceration-based narcotics maintenance programs on drug use post-release. Offenders in the treatment groups received narcotics maintenance treatment while incarcerated and offenders in the comparison groups received no treatment or treatment-as-usual while incarcerated.
 
The primary outcomes of interest were recidivism and drug relapse. Recidivism could be measured as rearrest, reconviction, and reincarceration. Drug relapse included measures such as self-reports of drug use or results from urinalysis. Odds-ratio effect sizes were calculated and analyzed using the random-effects, inverse-variance weight method.
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Cost

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According to the White House Office of National Drug Control Policy (2000), methadone maintenance therapy (MMT) has a cost–benefit ratio of 4:1. This means that for every $1 spent on MMT, $4 is accrued in economic benefit.
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Evidence-Base (Meta-Analyses Reviewed)

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These sources were used in the development of the practice profile:

Meta-Analysis 1

Mitchell, Ojmarrh, David B. Wilson, and Doris L. MacKenzie. 2012. "The Effectiveness of Incarceration-Based Drug Treatment on Criminal Behavior: A Systematic Review." Campbell Systematic Reviews 18.


http://www.campbellcollaboration.org/lib/project/20/
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Additional References

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These sources were used in the development of the practice profile:

Bureau of Justice Statistics. 1995. Drugs and Crime Facts, 1994: A Summary of Drug Data Published in 1994. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Office of National Drug Control Policy. 1999. The National Drug Control Strategy Annual Report. Washington, D.C.: The White House Office of National Drug Control Policy.
http://www.ncjrs.gov/ondcppubs/publications/policy/99ndcs/99ndcs.pdf

Office of National Drug Control Policy (ONDCP) Drug Policy Information Clearinghouse. 2000. Methadone (Fact sheet). Washington, D.C.: Office of National Drug Control Policy.
https://www.ncjrs.gov/ondcppubs/publications/pdf/ncj175678.pdf
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Related Programs

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Following are CrimeSolutions.gov-rated programs that are related to this practice:

Prison-Initiated Methadone Maintenance Treatment Promising - One study
This program offers methadone maintenance to heroin-addicted prisoners and provides referrals to community-based treatment programs to encourage continued treatment during reentry. The program is rated Promising. The counseling + methadone group were significantly more likely to spend more days in treatment compared to the other groups. There were fewer positive urine drug tests for opioids and cocaine for the counseling + methadone group compared to those who received counseling only in prison.

New South Wales (Australia) Prison Methadone Maintenance Program No Effects - One study
This program aims to reduce recidivism, prevent the spread of blood-borne viral infections (HIV and hepatitis) in prison, and encourage continuation of treatment in the community following release. The program is rated No Effects. Overall, the evidence did not find a significant difference between the prison methadone maintenance treatment group and the control group on measures of mortality, reincarceration, hepatitis C virus seroconversion and treatment retention.
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Practice Snapshot

Age: 18+

Gender: Both

Targeted Population: Alcohol and Other Drug (AOD) Offenders, Prisoners

Settings: Correctional

Practice Type: Alcohol and Drug Therapy/Treatment

Unit of Analysis: Persons