Effectiveness of Opiate Replacement Therapy Administered Prior to Release From a Correctional Facility - 1

Not Applicable

Completed

Conditions: HIV Prevention
Opioid-Related Disorders

Interventions: Behavioral: Pre-release Initiation of MMT
Behavioral: Post Release Initiation of MMT.
Behavioral: Standard of Care Plus

Registration Number: NCT00142935

Lead Sponsor: The Miriam Hospital

Brief Summary: Much of the HIV/AIDS epidemic is driven by transmission from or to persons addicted to opiates. Many of these individuals pass through a correctional setting each year, creating an opportunity for linkage to substance abuse treatment. The purpose of this study was to evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors and drug relapse. In addition, this study evaluated the effectiveness of short-term payment versus non-payment of community opiate replacement therapy immediately following release from incarceration.

Detailed Description: A substantial proportion of individuals addicted to heroin are incarcerated while addicted and a majority of individuals released from a correctional setting have a history of heroin addiction. The period immediately after release from incarceration is a particularly high-risk time for HIV transmission and other problems, including drug relapse and overdose. Methadone treatment is the most widely used opiate replacement therapy in the United States and has been shown to decrease HIV risk, as well as drug use, addiction relapse, and criminal activity. The purpose of this study was to evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors and drug relapse. In addition, this study evaluated the effectiveness of short-term payment versus non-payment of community opiate replacement therapy immediately following release from incarceration.

Participants in this were randomly assigned to 1 of 3 treatment groups. Participants enrolled in Group 1 initiated methadone opiate replacement therapy about 1 month prior to release from incarceration. They proceeded with a methadone program of their choice upon release and received short-term payment to cover treatment costs. Participants enrolled in Group 2 were referred to a methadone program of their choice and received short-term payment to cover treatment costs. Participants enrolled in Group 3 were referred to a program of choice upon release from incarceration without receiving financial assistance. All participants had the opportunity to partake in existing support programs available at the Rhode Island Department of Corrections while incarcerated and in the community upon release. Follow-up assessments occurred at Months 1.5, 6, and 12. These included interviews and urine specimens for toxicology analysis to verify self-reports.

Recruitment & Eligibility

Status: COMPLETED

Sex: All

Target Recruitment: 87

Inclusion Criteria

Currently incarcerated at the Rhode Island Department of Corrections with a scheduled release date at least 28 days after enrollment
Incarceration length not to have exceeded two years at the time of enrollment
Heroin dependent with self-reported heroin injection in the month prior to incarceration OR enrollment in a methadone treatment program prior to incarceration for heroin addiction with a history of injection drug use
Desire to enter methadone treatment upon release and plans to secure funding for methadone treatment after study completion
History of prior tolerance to methadone
History of at least one drug-related incarceration
Speaks English or Spanish
Plans to remain in Rhode Island for the duration of the study (24 months)
Ability to provide at least two names of individuals who can verify participant information

Exclusion Criteria

Currently receiving methadone at the Rhode Island Department of Corrections
Currently undergoing a non-narcotic detoxification from illicit opiates at the Rhode Island Department of Corrections
Plans to leave Rhode Island within the two years following enrollment

Study & Design

Study Type: INTERVENTIONAL

Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Pre-Release Initiation MMT	Pre-release Initiation of MMT	Participants assigned to this arm will undergo extensive assessment (physical, medical history, drug use and treatment history) prior to initiating treatment. MMT will begin 1-30 days prior to release from incarceration. MMT first dose will begin at 5 mg with 2 mg increase per day until release or therapeutic dose of 60-120 mg is achieved. Daily observation by dosing nurses and twice weekly symptom review by Research Assistant will occur. Additionally, participants assigned to Arm 1 will have all logistical arrangements made for entry into a community methadone clinic program within 24 hours of release from incarceration. The study will fully pay for MMT for 12 weeks and half the costs of treatment for the next 12 weeks.
Post Release Initiation of MMT	Post Release Initiation of MMT.	Participants assigned to this arm will have all logistical arrangements made for entry into a community methadone clinic program within 24-48 hours of release from incarceration. The study will fully pay for MMT for 12 weeks and half the costs of treatment for the next 12 weeks.
Standard of Care Plus	Standard of Care Plus	Participants assigned to this arem will not begin treatment prior to release from incarceration or have treatment paid for by the study. However, study staff will work with participants to identify ways to pay for treatment, including assisting with medicaid applications, etc. Further, the study will make the logistical arrangements for entering treatment if participant has a means to finance MMT.

Primary Outcome Measures

Name	Time	Method
Treatment Engagement	within 30 days post release of incarceration	Participants are considered to have successfully initiated community methadone maintenance treatment only if they make their first clinic appointment within 30 days after being released from incarceration. This outcome is measured by frequency - yes, participant attended initial clinic appointment within 30 days post release or no, participant did not attend clinic appointment within 30 days post release. Data source was methadone clinic chart review.
Time to MMT Initiation Post Release Based on Clinic Chart Review	within 30 days post release from incarceration	Participants are considered to have successfully initiated community methadone maintenance treatment only if they make their first clinic appointment within 30 days after being released from incarceration. This outcome measures number of days from release to the first day of clinic attendance, only for those participants who successfully entered methadone treatment post release. Data source was methadone clinic chart review.
HIV Risk Behaviors - Self Report	6 month follow-up interviews	Participants who self-reported injecting illicit drugs in the past 30 days, based on responses to face-to-face administration of the 6 month interview.

Secondary Outcome Measures

Name	Time	Method
Drug Use	6 month follow-up interviews	Participants who self-reported heroin use in the past 30 days, based on responses to face-to-face administration of the 6 month interview.
Fatal Overdose	Within six months from release of incarceration	Number of participants who died as the result of drug poisoning within six months of release of incarceration. This outcome was based on review of death records.
Non-fatal Overdose	6 month follow-up interviews	Participants who self-reported experiencing an overdose within the past six months, based on responses to face-to-face administration of the 6 month interview.