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BACKGROUND

Initiation of Methadone During Incarceration and Linkage to Treatment Upon Release N. Zaller , M. McKenzie, A. Parikh, P. Friedmann , T. Green, S. Dickman , J. Rich. BACKGROUND More than 200,000 active opiate users pass through a correctional facility in the United States each year

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BACKGROUND

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  1. Initiation of Methadone During Incarceration and Linkage to Treatment Upon ReleaseN. Zaller, M. McKenzie,A. Parikh, P. Friedmann, T. Green, S. Dickman, J. Rich BACKGROUND • More than 200,000 active opiate users pass through a correctional facility in the United States each year • Methadone maintenance therapy (MMT) is a widely available and effective pharmacological treatment for opiate addiction • A tremendous opportunity exists to engage the interconnected epidemics of addiction and incarceration. STUDY AIM • To determine whether initiating MMT prior to release from incarceration is an effective strategy for reducing drug use, increasing drug treatment retention, and reducing HIV risk behaviors. DESIGN • 3-arm, randomized trial examining methadone initiation prior to release and linkage to MMT post-release (Arm 1) as compared to linkage to MMT post-release (Arm 2) and referral only to MMT post-release (Arm 3). Arms 1 and 2 received payment for MMT in the community for up to 24 weeks. SETTING • Rhode Island Department of Corrections (RIDOC), USA STUDY POPULATION • 90 male and female prisoners with a DSM-IV diagnosis of opioid dependence OUTCOMES • Self-reported overdose, drug use, and criminal involvement ANALYSIS • Chi-square or Fisher’s exact tests, t-tests or Mann Whitney U

  2. Initiation of Methadone During Incarceration and Linkage to Treatment Upon ReleaseN. Zaller, M. McKenzie,A. Parikh, P. Friedmann, T. Green, S. Dickman, J. Rich RESULTS • Assessments at 6 months were completed on 62 participants (70% follow-up) • Arm 1 participants were more likely to enter MMT treatment post release, entered treatment more quickly, and were more likely to be in treatment at six months • Six month self-report data indicate that participation in treatment significantly decreased illicit opiate use and other illicit drugs • Of the 16 individuals who started methadone while incarcerated: • Tworeported experiencing an overdose during the follow up period • Onereported any use of opiates or drug injection at 6 months follow up • Of the 30 individuals who started methadone post-release • 5 (16.7%) reported experiencing an overdose during the follow up period • 19 (63.3%) reported heroin use and 13 (43.3%) reported drug injection

  3. Initiation of Methadone During Incarceration and Linkage to Treatment Upon ReleaseN. Zaller, M. McKenzie,A. Parikh, P. Friedmann, T. Green, S. Dickman, J. Rich LIMITATIONS • Small sample size; however, the large estimated effect sizes are notable CONCLUSIONS • Initiating methadone prior to release from incarceration and continuing treatment in the community are both feasible and can reduce drug use. • Providing methadone treatment for prisoners prior to release is a promising strategy to decrease post incarceration HIV risk behaviors, as well as reduce drug use, criminal behavior, and recidivism For more information, please contact jrich@lifespan.org www.prisonerhealth.org

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