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Program Profile: Prison-Initiated Methadone Maintenance Treatment

Evidence Rating: Promising - One study Promising - One study

Date: This profile was posted on June 14, 2011

Program Summary

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.

Program Description

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).

 

Program Components

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.

Evaluation Outcomes

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Study 1
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.

Criminal Activity
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.

Reincarceration
There were no statistically significant differences between the groups on the number of days reincarcerated.

Study 2
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.

Criminal Activity
There were also no statistically significant differences in the reported number of days of criminal activity in the past 365 days postrelease.

Arrests
There were no significant differences between treatment conditions on the number of arrests during the postrelease follow-up period.

Employment
There were no significant differences in the reported number of days employed during the past 30 days.
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Evaluation Methodology

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Study 1

Gordon, Kinlock, Schwartz, and O’Grady (2008) employed a three-group randomized controlled trial to study the effectiveness of methadone maintenance initiated prior to, or just after, release from a prison. Study participants were male prisoners in a Baltimore (Md.) pre-release facility who been incarcerated at least 1 year and had been recruited between September 2003 and June 2005. Eligibility criteria for participation in the study included:

 

  • Inmates were in their final 3–6 months before anticipated release from prison
  • Inmates met the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) of heroin dependence at the time of incarceration and were physiologically dependent during the year prior to incarceration
  • Participants’ suitability for methadone maintenance was determined by a medical evaluation
  • Inmates were willing to enroll in prison-based methadone maintenance
  • Participants would reside in Baltimore following release

A total of 211 inmates met the criteria and were randomized into one of three treatment conditions:

 

·        Counseling only, which received counseling in prison, with passive referral to treatment upon release (n= 70)

·         Counseling + transfer, which received counseling in prison with a transfer to methadone maintenance treatment upon release (n= 70)

·         Counseling + methadone, which received methadone maintenance and counseling in prison, and continued in a community-based methadone maintenance program upon release (n= 71)


There were no statistically significant differences between the three treatment conditions. Study participants were predominately African American, between 35 and 45 years of age, had not completed high school, and had at least 6 previous incarcerations.

 

Data on the outcome measures was collected at baseline (study entry) and at a 6-month follow-up on 201 study participants. The outcomes of interest were drug abuse, drug abuse treatment, criminal activity, and criminal justice system involvement. Urine drug tests were conducted using the enzyme-multiplied immunoassay technique (EMIT) for opioids and cocaine. Study participants were administered the Addiction Severity Index (ASI) which assessed the severity of problems in seven areas: alcohol use, drug use, medical, psychiatric, family/social, employment, and legal functioning. Participants were asked about the number of days in the past 180 days that they were in drug abuse treatment, using heroin, using cocaine, involved in other illegal activity, and reincarcerated. In addition to the urine drug tests and the ASI, treatment records of each participant were reviewed.

 

The study utilized logistic regression for the analyses of dichotomous outcome variables and Poisson regression for the continuous variables. For the analysis of each outcome variable, the predictor variable of primary interest, treatment condition, and the control variables (age, age at first crime, previous cocaine use, and complete prison treatment) were entered simultaneously in the relevant regression analysis for each dependent variable.

 

Study 2

Kinlock and colleagues (2009) followed the Gordon and colleagues (2008) study by examining outcome measures at a 12-month follow-up on 204 study participants.

 

Study participants were 69.6 percent African American, 24 percent Caucasian, and 6.4 percent other ethnicity, with an average age of 40.3 years. There were no statistically significant differences between the three treatment groups, except for one difference: the counseling + methadone group was incarcerated for a longer period then the counseling only group.

 

In addition to the data collected above, arrest data was obtained from the Maryland Department of Public Safety and Correctional Services. Employment data was also analyzed based on data collected from the ASI. Urine drug tests were not obtained for 89 of the 204 participants because of incarceration, hospitalization, being located out of the Baltimore area and interviewed by telephone, or being interviewed more than two months after their due date for the scheduled interview.

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Cost

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There is no cost information available for this program.
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Evidence-Base (Studies Reviewed)

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

Study 1
Gordon, Michael S., Timothy W. Kinlock, Robert P. Schwartz, and Kevin E. O’Grady. 2008. “A Randomized Clinical Trial of Methadone Maintenance for Prisoners: Findings at 6 Months Post Release.” Addiction 103:1333–42.

Study 2
Kinlock, Timothy W., Michael S. Gordon, Robert P. Schwartz, Terrence T. Fitzgerald, and Kevin E. O’Grady. 2009. “A Randomized Clinical Trial of Methadone Maintenance for Prisoners: Results at 12 Months Post Release.” Journal of Substance Abuse Treatment 37:277–85.
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Additional References

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

Gordon, Michael S., Timothy W. Kinlock, Kathryn A. Couvillion, Robert P. Schwartz, and Kevin E. O’Grady. 2012. “A Randomized Clinical Trial of Methadone Maintenance for Prisoners: Prediction of Treatment Entry and Completion in Prison.” Journal of Offender Rehabilitation 51:222–38.

Gordon, Michael S., Timothy W. Kinlock, Kathryn A. Couvillion, Monique E. Wilson, Robert P. Schwartz, and Kevin E. O’Grady. 2013. “Gender Differences Among Prisoners With Preincarceration Heroin Dependence Participating in a Randomized Clinical Trial of Buprenorphine Treatment.” Journal of Offender Rehabilitation 52:376–91.

Kinlock, Timothy W., Michael S. Gordon, Robert P. Schwartz, Kevin E. O’Grady, Terrence T. Fitzgerald, and Monique Wilson. 2007. “A Randomized Clinical Trial of Methadone Maintenance for Prisoners: Results at 1-Month Post-Release.” Drug and Alcohol Dependence 91:220–7.

Kinlock, Timothy W., Michael S. Gordon, Robert P. Schwartz, and Kevin E. O’Grady. 2008. “A Study of Methadone Maintenance for Male Prisoners: 3-Month Postrelease Outcomes.” Criminal Justice and Behavior 35(1):34–47.

Kinlock, Timothy W., Michael S. Gordon, Robert P. Schwartz, and Kevin E. O’Grady. 2013. “Individual Patient and Program Factors Related to Prison and Community Treatment Completion in Prison-Initiated Methadone Maintenance Treatment.” Journal of Offender Rehabilitation 52:509–28.

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

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Following are CrimeSolutions.gov-rated practices that are related to this program:

Opiate Maintenance Therapy for Dual Heroin–Cocaine Abusers
A medication-assisted treatment for opioid dependence, including methadone, buprenorphine, and Levo-Alpha-Acetymethadol (LAAM). The overall goals are to help opioid-addicted patients alleviate withdrawal symptoms, reduce or suppress opiate cravings, and reduce the illicit use of opioids (such as heroin). The practice is rated Effective for achieving higher sustained heroin abstinence for dual heroin–cocaine abusers, but No Effects for cocaine abstinence for dual abusers.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Drugs & Substance Abuse - Heroin/opioids
No Effects - One Meta-Analysis Drugs & Substance Abuse - Cocaine/crack cocaine



Incarceration-based Narcotics Maintenance Treatment
This practice attempts to reduce harms associated with drug dependency by prescribing synthetic opioid medication to opioid-addicted offenders who are in prison or jail. The practice is rated No Effects for reducing recidivism of offenders. A meta-analysis found that incarcerated offenders in narcotics maintenance treatment have significantly greater odds of recidivating than comparison offenders However, the practice is rated Promising for decreasing the odds of drug relapse post-release.

Evidence Ratings for Outcomes:
Promising - One Meta-Analysis Drugs & Substance Abuse - Multiple substances
No Effects - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
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Program Snapshot

Age: 35 - 45

Gender: Male

Race/Ethnicity: Black, White, Other

Geography: Urban

Setting (Delivery): Correctional, Other Community Setting

Program Type: Alcohol and Drug Therapy/Treatment, Aftercare/Reentry, Group Therapy, Individual Therapy, Wraparound/Case Management

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

Current Program Status: Active

Researcher:
Timothy W. Kinlock
Friends Research Institute, Inc.
1040 Park Avenue, Suite 103
Baltimore MD 21201
Phone: 410.837.3977
Fax: 410.752.4218
Website
Email

Researcher:
Michael S. Gordon
Friends Research Institute, Inc.
1040 Park Avenue, Suite 103
Baltimore MD 21201
Phone: 410.837.3977
Fax: 410.752.4218
Website
Email