Buprenorphine Maintenance for Opioid Addicted Persons in Jail and Post-Release

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DESCRIPTION (provided by applicant): Heroin and other opioid abuse continue as a significant problem among the criminal justice population. In 2002, the criminal justice system was the source of referral for 36% of all substance abuse treatment admissions, the largest source of referrals. Heroin use among offenders has serious health and social consequences. Injection, still the primary route of administration among heroin users, is strongly associated with the transmission of HIV, Hepatitis C, and other blood-borne diseases. During 1997, 20% to 26% of all people living with HIV in the United States, and 29% to 43% of all those infected with Hepatitis C, passed through a correctional facility. The relationship between heroin use and criminal activity has been extensively documented. Although methadone maintenance has been the primary treatment for chronic opioid dependence since the 1970's, correctional systems in the U.S., with very few exceptions, have not provided institutional access to methadone maintenance. Regrettably, negative attitudes to methadone are prevalent among criminal just professionals, the public, treatment providers and opioid-dependent offenders themselves; there is little prospect of that changing soon. Buprenorphine maintenance is a recently approved therapy that may be more acceptable for several reasons than methadone to the criminal justice system and opioid-dependent offenders. With one minor exception, buprenorphine has never been systematically administered as an opioid replacement therapy in a correctional setting in the U.S. The specific aims of this exploratory/developmental study are as follows: 1. to determine the feasibility of providing buprenorphine maintenance to out-of-treatment opioid-dependent offenders in a jail setting and of transitioning those patients to buprenorphine maintenance in the community after release. 2. To conduct a randomized clinical trial of buprenorphine maintenance (N = 50) vs. methadone maintenance (N =50) initiated in the jail setting and continuing in community programs. 3. To determine the reasons that offenders fail to report for community-based buprenorphine or methadone treatment after release or drop out of community treatment. Consenting eligible inmates will be randomly assigned to buprenorphine or methadone maintenance in jail and will be referred to a corresponding community treatment at release. Outcomes will be assessed at 6 months after release from jail by chart review, personal interviews and toxicologies for drugs of abuse.