Abstract

AIMS:

This study examined the effectiveness of methadone maintenance initiated prior to or just after release from prison at 6 months post-release.

DESIGN:

A three-group randomized controlled trial was conducted between September 2003 and June 2005.

SETTING:

A Baltimore pre-release prison.

PARTICIPANTS:

Two hundred and eleven adult pre-release inmates who were heroin-dependent during the year prior to incarceration.

INTERVENTION:

Participants were assigned randomly to the following: counseling only: counseling in prison, with passive referral to treatment upon release (n = 70); counseling + transfer: counseling in prison with transfer to methadone maintenance treatment upon release (n = 70); and counseling + methadone: methadone maintenance and counseling in prison, continued in a community-based methadone maintenance program upon release (n = 71).

MEASUREMENTS:

Addiction Severity Index at study entry and follow-up. Additional assessments at 6 months post-release were treatment record review; urine drug testing for opioids, cocaine and other illicit drugs.

FINDINGS:

Counseling + methadone participants were significantly more likely than both counseling only and counseling + transfer participants to be retained in drug abuse treatment (P = 0.0001) and significantly less likely to have an opioid-positive urine specimen compared to counseling only (P = 0.002). Furthermore, counseling + methadone participants reported significantly fewer days of involvement in self-reported heroin use and criminal activity than counseling only participants.

CONCLUSIONS:

Methadone maintenance, initiated prior to or immediately after release from prison, increases treatment entry and reduces heroin use at 6 months post-release compared to counseling only. This intervention may be able to fill an urgent treatment need for prisoners with heroin addiction histories.