Program Profile: Prison-Initiated Methadone Maintenance Treatment

This is a methadone maintenance treatment designed for currently incarcerated individuals with a heroin addiction. The program is rated Promising. Treatment group participants spent a greater number of days in community-based drug treatment following release and improved opioid drug test results, compared with control group participants. These differences were statistically significant. However, there were mixed results regarding cocaine use, criminal activity, and frequency of heroin use.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

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 addicts 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 those 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 encourages 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.

Study

Gordon and colleagues (2008) conducted a randomized, controlled trial to examine the effectiveness of methadone maintenance that was initiated while participants were incarcerated. Participants were recruited in Baltimore, Md., between September 2003 and June 2005 and were determined eligible if they were male, had been incarcerated for at least 1 year, were in their final 3 to 6 months previous to anticipated release, met the diagnostic criteria of heroin dependence according to the Diagnostic and Statistical Manual of Mental Disorders (DSM–IV) at the time of incarceration, were determined suitable for methadone maintenance following a medical evaluation, and would reside in Baltimore following release.

A total of 211 inmates were recruited and randomized into either the 1) control group, 2) the counseling and transfer treatment group, or 3) the counseling and methadone maintenance treatment group. The control group participants (n = 70) received only counseling while incarcerated, with passive referral to treatment upon release. The counseling and transfer treatment group (n = 70) received counseling while incarcerated and were transferred to methadone maintenance treatment upon release. The counseling and methadone maintenance treatment group (n = 71) received both counseling and methadone maintenance while incarcerated and continued in a community-based methadone maintenance program upon release. The CrimeSolutions review of this study concentrated on the differences between the counseling-only control group and the counseling and methadone maintenance treatment group. Study participants were predominately Black, were 35 to 45 years old, had not completed high school, and had at least six previous incarcerations. In the 30-days before incarceration, the average participant reported using heroin and committing crime every day. There were no statistically significant differences between the control and treatment groups on baseline characteristics.

Outcomes of interest included drug test results regarding use of opioids and cocaine, the number of days of heroin and cocaine use, the number of days spent in community-based drug treatment, and the number of days of criminal activity and reincarceration. Data were collected at baseline and at a 6-month postrelease follow-up. Urine drug tests were conducted using the enzyme-multiplied immunoassay technique (EMIT) for opioids and cocaine. The remaining outcomes were measured through self-reporting regarding the past 180 days at the follow-up. Follow-up assessments were conducted on 201 of the original 211 participants (63 of 70 in the control group, 68 of 70 in the counseling and transfer treatment group, and 70 of 71 in the counseling and methadone maintenance treatment group). The study used logistic regression for the analyses of dichotomous outcome variables and Poisson regression for the continuous variables. No subgroup analyses were conducted.

Study

Kinlock and colleagues (2009) conducted a follow-up of Study 1 (Gordon et al. 2008) to examine the effectiveness of methadone maintenance that was initiated while participants were incarcerated, looking at results at 12-months postrelease. The study used the same final sample of participants in Study 1 (n = 204) who were randomized into 1) the control group (n = 64), 2) the counseling and transfer treatment group (n = 69), or 3) the counseling and methadone maintenance treatment group (n = 71). Of the control group participants, 64.1 percent were Black, 32.8 percent were White, and 3.1 percent were categorized as Other. The average age was 40.7 years, and 44 percent had prior drug treatment. Of the counseling and transfer treatment group, 73.9 percent were Black, 18.8 percent were White, and 7.2 percent were categorized as Other. The average age was 40.3 years, and 48 percent had prior drug treatment. Of the counseling and methadone maintenance treatment group participants, 70.4 percent were Black, 21.1 percent were White, and 8.5 percent were categorized as Other. The average age was 39.9 years, and 52 percent had prior drug treatment. The treatment and control groups were statistically significantly different on one baseline characteristic: counseling and methadone maintenance treatment group participants were incarcerated for a longer average length of time, compared with the control group. The CrimeSolutions review of this study concentrated on the differences between the control group and the counseling and methadone maintenance treatment group.

Outcomes of interest included the number of days spent in community-based drug treatment, drug test results regarding opioids and cocaine use, the number of days of heroin and cocaine use, rearrest rates, the number of days of criminal activity, and employment in the past 30 days. Data on drug treatment status were obtained from program records, and urine drug tests were conducted using EMIT for opioids and cocaine. Data on rearrests were obtained from the Maryland Department of Public Safety and Correctional Services. Employment data, the number of days of heroin and cocaine use, and criminal activity were obtained through self-reports. 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 2 months after their due date for the scheduled interview. The study used logistic regression for the analyses of dichotomous outcome variables and Poisson regression for the continuous variables. No subgroup analyses were conducted.

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

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.

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

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.

Evidence Ratings for Outcomes

	Drugs & Substance Abuse - Multiple substances
	Crime & Delinquency - Multiple crime/offense types

Methadone Maintenance Therapy

This practice involves a medication-assisted treatment for individuals with opioid dependence. Methadone is a long-acting synthetic opioid analgesic that works as a pharmacologic intervention to prevent or reverse withdrawal symptoms, reduce opiate cravings, and bring about a biochemical balance in the body in order to reduce the illicit use of opioids. The practice is rated Effective for reducing use of heroin/opioids but rated Ineffective for reducing criminal activity and mortality.

Evidence Ratings for Outcomes

	Drugs & Substance Abuse - Heroin/opioids
	Drugs & Substance Abuse - Mortality
	Drugs & Substance Abuse - Mortality

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