A Randomized Trial of Continued Methadone Maintenance Vs. Detoxification in Jail

Transcription

1 The Warren Alpert Medical School of Brown University A Randomized Trial of Continued Methadone Maintenance Vs. Detoxification in Jail Michelle McKenzie, MPH Bradley Brockmann, JD Nickolas Zaller, PhD Josiah Rich, MD, MPH The Miriam Hospital/Brown University Center for Prisoner Health and Human Rights

2 The Team Christina Anastacio, BSW - Intervention Candy Barroso - Evaluation Chandra Cannon, MS Billing Coordinator Maria Garcia Intervention Ricky Lugo - Evaluation Skye Tirado, BSW Research Assistant Liem Tran, MS Data Manager

3 Background It is estimated that 20% of individuals under correctional jurisdiction have used opiates Methadone is the most widely used opiate replacement therapy in the US. At the Rhode Island Department of Corrections (RIDOC) over 250 inmates yearly are enrolled in community methadone treatment at the time of incarceration

4 RIDOC Methadone Dosing New inmates are maintained for 7 days, then tapered. Depending on dose, the taper lasts about 30 days Pregnant or chronically ill inmates are maintained as determined by DOC physician. Communication with the clinic of origin is maintained, and incorporated into the discharge planning.

5 The NITE Study (Non-Interrupted Treatment Experience) Specific Aims To determine the effect of maintaining methadone treatment during short-term incarceration vs. methadone detoxification on: 1) time-to-post-release methadone treatment re-entry and relapse to illicit drug use. 2) reducing HIV risk behaviors 3) reducing reincarceration 4) health services utilization costs

6 NITE Study Methods Participants are randomized to one of two arms: Maintained on stable methadone dose during short term incarceration (< 6 months) Withdrawn from methadone as is standard procedure at the RIDOC Participants in both arms receive assistance in returning to community methadone treatment post release, including payment of treatment for 10 weeks if needed.

7 NITE Study Eligibility 1) Currently incarcerated at the RIDOC 2) Enrolled in a methadone treatment program at the time of incarceration 3) Currently maintained at the pre-incarceration methadone dosage level 4) Estimated total incarceration time of < 6 months and > 1 week 5) English or Spanish-speaking 6) Willing to remain on MMT and continue MMT after release.

8 Maintaining Methadone at RIDOC Arm1 After consent/enrollment/randomization, PI writes order to maintain dose (this nullifies RIDOC physician order to taper) PI visits new participants and coordinates with physician at community methadone clinic Research nurses administer daily methadone dose and monitor progress Any concerns or requests by participants are relayed immediately to PI

9 Community Re-entry In both arms of the study: staff communicate with the community treatment providers regarding length of participant s incarceration and release date staff arrange transportation to the first clinic appointment post release staff assist securing ID and social security card the study pays for post-release methadone for 10 weeks if needed

10 Demographics Gender Male Female Race/Ethnicity African American American Indian Hispanic/Latino White # of days employed (30 day before jail) Arm 1 MMT N= Arm 2 Detox N= Education (HS or GED) Heroin use (avg yrs) 8 9 Total N=

11 Post Release Outcomes (as of 1/20/2012) Arm 1 MMT Arm 2 Detox Total Total Enrolled Still inside Released Entered methadone post release* *confirmed by community methadone clinic

12 Post Release Outcomes (as of 1/20/2012) Time to MMT post release Arm 1 (MMT N=56 Arm 2 (Detox) N= days days 2 4 No show 0 17 Mean 1.96 days 3.49 days Median 1 1 Min/max 0/26 0/28

13 1 Month Assessment (as of 1/20/2012) Drug Use last 30 days (self report) Arm 1 MMT N=55 Arm 2 Detox N=39 P-value Cocaine Methamphetamines Opiates Benzos Prescribed Methadone <0.01

14 1 Month Assessment (as of 1/20/2012) Arm 1 MMT N=55 Arm 2 Detox N=39 P-value Relapse (TLFB) Opiates Mean days Min/Max / / Other drugs Mean days Min/Max / /

15 1 Month Assessment (as of 1/20/2012) Arm 1 MMT N=55 Arm 2 Detox N=39 P-value Retention in MMT <0.01 Injection drug use (last 30 days) Incarcerated (last 30 days) Sexual Risks (last 30 days) unprotected w/hiv+ unprotected w/idu unprotected sex n/a

16 Discussion Based on preliminary data: Maintaining individuals on methadone during short term incarceration and linking them back to treatment post release is feasible Significantly more participants returned to treatment post release if maintained on methadone during incarceration rather than detoxed, and in a shorter time frame. Significantly fewer participants relapsed to illicit opiate use and injection drug use if maintained in the 30 days following release. Methadone maintenance during incarceration did not impact reincarceration, other illicit drug use, or sexual risk behaviors.

17 Discussion High numbers of opioid addicted individuals pass through correctional settings, including individuals actively enrolled in community methadone treatment. Why? Once criminally justice involved its sticky Addiction is a chronic, relapsing disease Dosing stability depends on secure source of payment

18 Discussion Individuals withdrawn from methadone during incarceration, particularly short term incarceration, are at high risk of: relapse, overdose, binging, sharing syringes, engaging in risky sexual behaviors, HIV transmission, reincarceration. Based on preliminary results, maintaining individuals on methadone reduces many of those risks. Future questions: costs and longer term outcomes.

19 Acknowledgements This research is funded by National Institute on Drug Abuse, grant number R01DA It has been facilitated in part by the infrastructure and resources provided by the Lifespan/Tufts/Brown Center for AIDS Research, an NIH funded program, grant number P30- AI-42853, from the National Institutes of Health, Center for AIDS Research (NIH/CFAR) and by 5K24DA from the National Institute On Drug Abuse. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute On Drug Abuse or the National Institutes of Health. A special thanks to our participants!!!