Practice Profile: Incarceration-based Narcotics Maintenance Treatment

This practice attempts to reduce harms associated with drug dependency by prescribing synthetic opioid medication to opioid-addicted individuals who are in prison or jail. The practice is rated Ineffective for reducing recidivism. A meta-analysis found that incarcerated persons in narcotics maintenance treatment have significantly greater odds of recidivating than comparison subjects. However, the practice is rated Promising for decreasing the odds of drug relapse post-release.

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 individuals 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.

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.

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. View abstract

https://www.campbellcollaboration.org/better-evidence/effectiveness-of-incarceration-based-drug-treatment.html

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.

Office of National Drug Control Policy (ONDCP) Drug Policy Information Clearinghouse. 2000. Methadone (Fact sheet). Washington, D.C.: Office of National Drug Control Policy.

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

Prison-Initiated Methadone Maintenance Treatment

New South Wales (Australia) Prison Methadone Maintenance Program

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?