Opiate Replacement Therapy at Release from Incarceration

出狱后的阿片替代疗法

• 批准号: 7217483
• 负责人: JOSIAH D RICH
• 金额: $ 34.18万
• 依托单位: MIRIAM HOSPITAL
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-06-15 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7217483
• 关键词: AIDS/HIV problem; Aftercare; Buprenorphine; Caring; Clinic; Communities; Counseling; Country; Crime; Data; Drug abuse; Drug usage; Effectiveness; Employment; Funding; Grant; HIV; Heroin; Homelessness; Housing; Imprisonment; Individual; Infection; Injection of therapeutic agent; Intervention; Interview; Jail; Letters; Link; Maintenance; Measures; Medical; Methadone; Minority; NIH Program Announcements; Naloxone; National Institute of Drug Abuse; Numbers; Occupations; Opiates; Overdose; Participant; Persons; Pharmaceutical Preparations; Population Study; Prisoner; Prisons; Provider; Purpose; Randomized Controlled Trials; Rate; Recording of previous events; Replacement Therapy; Research; Research Personnel; Resources; Rhode Island; Risk; Risk Behaviors; Risk Reduction Behavior; Seasons; Site; System; Target Populations; Time; Training Programs; United States; Upper arm; Week; Work; addiction; base; burden of illness; concept; criminal behavior; drug relapse; experience; follow-up; methadone clinic/center; payment; recidivism; reincarceration; response; social integration; transmission process; treatment program

DESCRIPTION (provided by applicant): This study will evaluate the effectiveness of initiating opiate replacement therapy prior to release from incarceration on reducing HIV risk behaviors. Individuals who inject opiates are at increased risk for HIV through both injection and sexual practices. A substantial proportion of opiate-dependent persons are incarcerated while addicted and a majority of the nearly 8 million individuals released from a correctional setting each year have a history of addiction. Minorities are both over represented in the corrections system and carry a disproportionately higher burden of disease. The period immediately after release from incarceration is a particularly high-risk time for HIV and drug relapse. Methadone is the most widely used opiate replacement therapy in the United States and has been shown to decrease HIV risk, drug use, crime, and reincarceration. Other benefits include the stabilization of employment, housing, and increased contact with medical care providers. Most prisons in the country do not offer opiate replacement therapy or refer to treatment upon release. Preliminary data from our CSAT-funded project linking opiate-dependent prisoners with methadone treatment after release from incarceration reveal that this approach is feasible and promising, but with lower-than-expected clinic attendance rates. A randomized, controlled trial will determine whether initiating methadone prior to release is a more effective strategy than referral to methadone treatment programs on release from incarceration. The primary aims will be to determine the effects of each study arm on reducing HIV risk behaviors, reducing recidivism, and increasing drug treatment attendance. The population of this study will be prisoners with multiple prior drug-related incarcerations and previous experience with methadone treatment. If this project is able to demonstrate that the use of induction of methadone treatment prior to release from incarceration is effective, this may be a "proof of concept" for other forms of opiate replacement therapy, such as buprenorphine/naloxone, to reduce HIV transmission.

描述（由申请人提供）：本研究将评估从监禁释放前开始阿片类药物替代治疗对减少HIV风险行为的有效性。注射阿片剂的个人通过注射和性行为感染艾滋病毒的风险增加。很大一部分阿片剂依赖者在吸毒期间被监禁，每年从教养机构释放的近800万人中大多数都有吸毒史。少数群体在惩教系统中的人数过多，而且疾病负担也不成比例地更高。从监禁中释放后的这段时间是艾滋病毒和毒品复发的特别高风险时期。美沙酮是美国最广泛使用的阿片替代疗法，已被证明可以降低艾滋病毒风险，吸毒，犯罪和重新监禁。其他好处包括稳定就业、住房和增加与医疗保健提供者的联系。该国的大多数监狱不提供阿片替代疗法，也不提供释放后的治疗。从我们的CSAT资助的项目连接阿片类药物依赖的囚犯与美沙酮治疗从监禁释放后的初步数据显示，这种方法是可行的，有前途的，但低于预期的诊所就诊率。一项随机对照试验将确定释放前开始美沙酮治疗是否比从监禁中释放后转介美沙酮治疗计划更有效。主要目的是确定每个研究组对减少HIV风险行为、减少累犯和增加药物治疗出勤率的影响。本研究的人群将是有多次与毒品有关的监禁和美沙酮治疗经验的囚犯。如果该项目能够证明在从监禁中释放之前使用美沙酮诱导治疗是有效的，这可能是其他形式的阿片替代疗法（如丁丙诺啡/纳洛酮）减少艾滋病毒传播的“概念证明”。